If you’re reading this on the toilet, take a breath! Holding it won’t help.
About 20% of adults deal with constipation, but you mostly just hear about “eat more fiber” as the solution, right? When that doesn’t work, it’s frustrating.
As two GI docs who spend our days troubleshooting sluggish colons, we can tell you the story is far more complex and interesting.
WHY YOU SHOULD READ THIS NOW
Know what to say to your doctor to get the tests and treatments you need
Get our take on a recent study pointing to a specific probiotic strain that can help with BOTH constipation and, believe it or not, depression
TikTok trend we dissect: Thinking about doing a Castor Oil Cleanse? Read this first (and reconsider)
TODAY’S OPPONENT:
Constipation
Constipation is a dysfunctional transit system.
Sometimes the entire system slows to a crawl (slow-transit constipation). Other times traffic stalls right at the exit because the pelvic floor muscles fail to open the gate. Medications can act like roadblocks (opioids, iron, calcium, certain antidepressants, even your “gentle” antacid can slow gut motility).
Layer on sitting at a desk, insufficient hydration, and stress (your brain and gut share a hotline called the “vagus nerve”), and your colon can essentially freeze.
The bottom line: You need to pinpoint what’s stalling your system, or no amount of fiber will set you free.
If you’re not sure where to start, consider asking for the following tests with your general practitioner:
→ Standard blood panel to check for high calcium levels, low magnesium & potassium levels, or an under-active thyroid
→ Celiac blood panel to eliminate possibility of Celiac (Yes, Celiac can sometimes actually present as constipation!)
Then, once you have a referral to a gastroenterologist, have them consider the following tests:
→ Endoscopy and colonoscopy with biopsy: This can evaluate for various potential causes of constipation, which can include a twisty colon, blockages or areas of narrowing, caused by inflammation, a polyp or mass.
→ Breath test to evaluate for SIBO (especially methane-predominant SIBO) or even SIFO (more on this later).
Pro tip: Follow the pre-op prep closely, no matter how hungry you may get.
→ Cross-sectional imaging of the abdomen (CT scan or MRI)
→ Anorectal manometry and Defecography: If you have difficulty fully evacuating, you may need one or both of these tests. This is sometimes described as a "motility workup" and is usually only performed at highly specialized GI clinics.
You may need to be persistent with you doctor to help you find one. Tell them to contact your insurance company and declare these tests medically necessary.
If your tests come back positive, pelvic floor therapy & biofeedback therapy can be very useful!
You will likely have a diagnosis (and subsequently, a plan for treatment) after these tests.
“Don’t ignore it—treat the cause, not just the symptom.”
Chronic constipation is a quality-of-life issue if nothing else. If you’re not going regularly, I would want to know why. Is it pelvic floor dysfunction? Neuropathy? Thyroid? A stricture or narrowing in your digestive tract somewhere? There are tests for these. And treatments exist in various forms, each with a distinct mechanism of action: osmotic agents, stimulants, prokinetics, biofeedback therapy… Don’t settle for “just take a laxative” or “just get more fiber”. Investigate.
“The probiotic Bifidobacterium animalis may help alleviate constipation and depression.”
I’ve been waiting for a study like this! In an 8-week double-blind trial of 107 patients, daily doses of Bifidobacterium animalis subsp. Lactis A6 demonstrated measurable benefits for people with both constipation and depression. While we still need bigger, more diverse cohorts, the data strengthen my clinical mantra: nurture the right microbes, and they’ll rewrite both your bathroom schedule and your outlook (link to study).
WHAT TO TELL YOUR DOCTOR
“I’ve noticed some changes in how often I go, and I’m not sure it’s normal. I’ve tried more fiber and water, but it hasn’t helped much. Could this be related to my medications or diet? Should I get any tests, or try something different?”
TIKTOK TREND WE’D BAN
Hmm…
The Castor Oil Cleanse… Yes, we’ve seen this on TikTok. But we’ve had patients describe (in graphic detail) 12-hour bathroom marathons, cramps that rival giving birth, and dehydration headaches worthy of Coachella Day 4. The FDA does label it safe, but only for short-term emergencies. So if you like life outside the bathroom, stick with polyethylene glycol (PEG) or magnesium.
WHAT’S ON YOUR MIND?
Respond to this email and let us know!
As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
