by Victoria Tyler Registered Nutritional Therapist

updated 13th May 2024

Contents

• Can stress cause constipation?
• What is constipation?
• Why does stress cause constipation?
• Alternatives to Laxatives
• Magnesium Glycinate and Citrate as an alternative to laxatives
• Foods high in Magnesium that may help constipation
• Do proboitics help constipation?
• Best diet for Chronic constipation
• Mineral water and constipation
• Hydration and Fibre- a winning combination
• Foods high in fibre
• Conclusion

Is there a link with Stress and Constipation?

Have you ever noticed that when you are stressed, you have a tendency towards constipation?

This is a common complaint we hear of frequently in our clinic.

Stress, doesn’t just play havoc with our minds; it can also leave its mark on our digestive system. Changes in bowel movements such as constipation are very common.

But that’s not all—stress can further intensify gastrointestinal distress, unleashing symptoms like nausea and stomach pain.

What is constipation?

Chronic constipation is a prevalent issue affecting people worldwide, with around 12% of adults experiencing it. It’s one of the most common gastrointestinal concerns and often leads to visits to doctors and specialists. This condition isn’t just about infrequent bowel movements; it includes symptoms like straining, feeling like you can’t completely empty your bowels, and a sense of blockage in the rectal area.

Constipation means that you may have (Source Pubmed):

• dry stools
• less than 3 bowel movements in a week
• Difficulty passing stools
• and feeling of incomplete evacuation

Chronic constipation comes in two main types:

Primary Constipation: This means constipation is the main problem and can take different forms, such as normal transit, slow transit, or defecatory disorders.

Secondary Constipation: This type results from other factors like certain medications or, rarely, structural issues.

Chronic constipation doesn’t discriminate—it can affect people of all ages, backgrounds, and nationalities. While it’s more common in non-Caucasians, women, and older people, it can trouble anyone. It’s a widespread concern that can significantly impact daily life.

So how exactly does stress cause constipation?

Even though stress helps us stay alert, it can also mess with our digestion making it important to find ways to relax and take care of ourselves during stressful times.

Picture this, you wake up every morning feeling overwhelmed, there is always so much to do, in such a short space of time. You need to start work by nine am and there is simply not enough time to complete all your morning routine.

When we feel stressed, our bodies kick into ‘fight-or-flight’ mode. This means our adrenal glands release Epinephrine, also called adrenaline. This hormone makes our body, ready for action, diverting blood to our heart and muscles, and taking it away from our intestines.

This can slow how food moves through your system, ultimately make it harder to go to the toilet leading to constipation. Because of this, waste can stay in our bodies longer, making it harder and sometimes painful to pass.

Stress also causes an increase of a hormone called corticotrophin-releasing factor, this hormone directly affects the intestines, slowing down their function and causing inflammation.

Stress can cause a change in Gut bacteria leading to Constipation

While not conclusively proven, there is a also a belief that stress might impact the balance of your healthy gut bacteria. Specifically stress could reduce the number of your beneficial gut bacteria, consequently slowing down the digestion process. (Source PubMed) Some patients have found that conducting a gut microbiome test and gut bateria test has been very helpful to analyse their specific strains of gut bacteria.

Stress may cause Small Intestinal Bacterial Overgrowth and Intestinal Methanogen Overgrowth

We now know that Rifaximin, an antibiotic used for a condition known as small intestinal bacterial overgrowth can also improve symptoms of Irritable Bowel Syndrome (Source PubMed) .

Again, stress can be a trigger for small intestinal bacterial overgrowth leading to low stomach acid. This can have a knock on effect of bacteria overgrowing in the small intestine. Typically an overgrowth of methane may be linked to a slow transit time and constipation. In addition to constipation, symptoms include bloating, gas and wind and pain. If you suspect you have SIBO, we offer SIBO tests and consultations and treatment for this condition.

Stress can cause Leaky Gut and Inflammation

Stress can also increase intestinal permeability or ‘leaky gut’ leading to change in bowel habits and difficulty tolerating many foods.(Source PubMed)

In people with irritable bowel syndrome (IBS), there’s evidence of ongoing low-level inflammation. Stress can increase the production of certain immune system messengers called cytokines. In IBS patients, levels of cytokines like IL-1β, IL-6, IL-8, and TNF-α are often very high.

And it’s not just IBS—people with post-traumatic stress disorder (PTSD) and even healthy folks under stress, like army medics during combat training, can have higher levels of these inflammatory cytokines in their blood. When these cytokines are released, they can mess with the tight junctions between cells in the intestine, making it more leaky. (Source PubMed)

Leaky gut can also be linked to another common issue in IBS: feeling pain in the gut, known as visceral hypersensitivity. There are a couple of ideas why this might happen. One is that inflammation directly triggers pain signals in the gut. Another possibility is that stuff leaking through the gut lining somehow makes the gut more sensitive to pain signals. Either way, inflammation seems to play a role in both gut leakiness and feeling pain in the gut for people with IBS.(Source PubMed)

In summary, stress triggers the release of hormones like adrenaline, slowing down digestion and leading to constipation, while also potentially disrupting the balance of healthy gut bacteria. Additionally, stress can contribute to conditions like Small Intestinal Bacterial Overgrowth (SIBO) and increase intestinal permeability, commonly known as leaky gut and inflammation, exacerbating symptoms of constipation and gut discomfort.

Alternatives to Laxatives

While there are several treatments available for chronic constipation, a significant portion of individuals (28%) are dissatisfied with laxatives. In fact, a large-scale survey revealed that as many as 83% of respondents expressed interest in exploring other treatment options, including complementary and alternative therapies. Source- Pubmed

The reasons for dissatisfaction with laxatives include concerns like “ineffective results ” and side effects as well as safety-related issues. People want solutions that work consistently and with minimal side effects. Source- Pubmed

Magnesium Gycinate and Magnesium Citrate for constipation

Have you ever tried Magnesium for constipation? These laxatives work by retaining water in your intestines, which makes your stool softer and bulkier. There are different types of magnesium supplements available. Some, like magnesium citrate, are stronger and work mainly by drawing water into the intestines – these are called osmotic laxatives,

Others, such as magnesium hydroxide, magnesium gluconate, and magnesium oxide, are saline laxatives. These supplements are very easy to get hold of and can be purchased in most health food stores.

However none of these should be taken long-term as they made reduce calcium levels or cause electrolyte imbalances,

It is important to seek advice from a nutritionist as side-effects can occur. For example, Magnesium is primarily excreted through the kidneys, and in individuals with compromised kidney function, there can be challenges in regulating magnesium levels.

What foods is Magnesium found in?

Magnesium is found in green leafy vegetables, nuts, legumes, and whole grains. For some people eating foods rich in magnesium can indeed help with constipation.

Magnesium helps to draw water into the intestines, which can soften stools and make them easier to pass. Some magnesium-rich foods include:

1. Leafy greens like spinach, kale, and Swiss chard.
2. Nuts and seeds such as almonds, cashews, and pumpkin seeds.
3. Whole grains like brown rice, quinoa, and oats.
4. Legumes like black beans, chickpeas, and lentils.
5. Avocados.
6. Bananas.

Incorporating these foods into your diet may help alleviate constipation, but remember to also drink plenty of water to aid digestion. If constipation persists or is severe, it’s always a good idea to consult with a healthcare professional for personalized advice.

Probiotics for Constipation Relief

Probiotics have been making waves in the world of digestive health. Several studies have explored the role of probiotics in alleviating constipation, and the results are promising.

Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus reuteri, Lactobacillus plantarum, and Bifidobacterium have all been shown to help with constipation offering hope to those seeking relief.

Sometimes combining multiple probiotic strains, rather than relying on a single strain, may be a more effective approach. It’s like creating a dream team of probiotics to tackle constipation from different angles.

If you require help selecting the most appropriate diet and supplements, our registered nutritional therapists can help you. Book an IBS appointment today.

Best diet for Chronic Constipation

There are a number of dietary approaches that may help with constipation.

Source Pubmed

1. Maintain a Balanced Diet: It’s crucial to follow a balanced diet that includes a variety of foods from different food groups. Ensure you’re getting a mix of fruits, vegetables, whole grains, lean proteins, and healthy fats in your daily meals.
2. Don’t Skip Meals: Skipping meals, especially breakfast, should be avoided. Regular food intake plays a role in stimulating the gastrocolic reflex. This reflex increases colonic motility in response to stomach distension. This effect is enhanced by the orthocolic reflex, which is triggered when you shift from a lying position to an upright one. In simple terms, eating regular meals can help your digestive system work more efficiently.
3. Listen to Your Body: One essential piece of advice is not to ignore the urge to have a bowel movement. In our fast-paced lives, it’s common for people to delay going to the toilet. However, this can lead to a gradual reduction in your body’s ability to perceive the need to evacuate.
4. Fibre Intake: Adequate fibre intake is essential for healthy digestion. The recommended daily fibre intake for adults is approximately 25 grams for women, 38 grams for men, and 19–25 grams for children. However If you find that eating fibre aggravates your symptoms of constipation, you may have a condition known as small intestinal bacterial overgrowth.

The Role of Mineral Water in Managing Chronic Constipation

Hydration as the First Line of Defence: The primary treatment for chronic constipation often begins with ensuring an adequate intake of water, typically around 1.5 to 2 litres per day.

While this recommendation isn’t always based on robust scientific evidence, it holds practical significance- Source PubMed.

The colon has a remarkable ability to absorb ingested water, and certain types of mineral waters, especially those rich in magnesium and sulfates, have known laxative properties.

Waters abundant in magnesium sulfate owe their laxative properties to the magnesium compounds they contain.

Hépar (Nestlé Waters, France) is a magnesium sulfate-rich natural mineral widely available in France and people frequently consume Hépar to alleviate their symptoms of constipation. Source PubMed

Hydration and High-Fiber Diet: A Winning Combo for Chronic Constipation

While it’s essential to include fibre in your diet, making sure you’re well-hydrated can further support healthy and regular bowel movements.

A study by Anti and colleagues (Source PubMed) found that among patients who were already consuming 25 grams of fibre daily, increasing fluid intake to 2.0 liters per day had a remarkable impact. It significantly enhanced the frequency of bowel movement and has clear benefits in reducing chronic constipation.

So, along with fibre-rich foods, remember to drink plenty of water to keep your bowel movements regular and healthy.

This study underscores the importance of not only a high-fibre diet but also proper hydration in managing chronic constipation.

What foods are high in Fibre?

Try to incorporate more of these foods into your diet aiming for 25 grams Source PubMed

• Almonds (28g): 3.3g
• Apple (1 medium): 3.3g
• Artichoke (1 piece): 6.5g
• Banana (1 medium): 3.1g
• Black beans (125ml): 7.5g
• Bran ready-to-eat cereal (125ml): 8.8g
• Broccoli (125ml): 2.8g
• Chickpeas (125ml): 6.2g
• Figs, dried (60ml): 3.7g
• Green peas (125ml): 4.4g
• Lentils (125ml): 7.8g
• Navy beans (125ml): 9.5g
• Oat bran (60ml): 3.6g
• Orange (1 medium): 3.1g
• Peas (125ml): 2.5g
• Prunes (125ml): 3.8g
• White beans (125ml): 6.3g

Avoid Excessive Fibre: While fibre is beneficial, it’s essential to note that an extremely high fibre intake, exceeding 50 grams per day, may lead to abdominal distension and flatulence. Balance is key.

Key Takeaways:

1. Chronic constipation is a widespread issue characterized by infrequent bowel movements, difficulty passing stool, and a feeling of incomplete evacuation.
2. Stress, alongside factors like gut bacteria imbalance and dietary choices, can worsen constipation by disrupting intestinal function and causing inflammation.
3. Alternative approaches such as magnesium supplementation and probiotics offer promising relief for constipation, providing options beyond traditional laxatives.
4. A balanced diet rich in fiber, along with adequate hydration, is essential for managing constipation effectively, with studies showing significant improvement in bowel movement frequency when fluid intake is increased alongside fiber consumption.
5. Seeking personalized advice from healthcare professionals is crucial for tailored management strategies, empowering individuals to alleviate symptoms and improve overall well-being.

Booking an appointment

If you need help with digestive symptoms please contact us and we would be pleased to book you in for a consultation at our IBS clinic