Getting familiar
With the multiple
Causes of constipation

In this article, we go through the main causes of constipation, at a high level.

This will feel overwhelming at first. But you need to understand the foundations for this condition in order to progress toward building your own natural program.

And don’t forget, there will be separate articles developing further each one of those causes.

Before we start…

Our goal is not to worry you unnecessarily. As frustrating as it can be, most of the time constipation is linked to non-life-threatening causes. But once in a while, it can hide a more serious condition.

On this website, even though we empower you to understand your situation and take action, we also assume that you are being followed by your health care practitioner. This is necessary in order to rule out any serious condition.

Review time

In the definition of constipation article, we went through the role of the colon, and the basic mechanisms behind bowel movements. If you haven’t read that article, we invite you to do so now.

Let’s review one of the key roles of the colon: it dehydrates food residues coming from the small intestine, and reclaims precious fluids and minerals so that we don’t get dehydrated.

Intuitively, we can see that if stools stay too long in the colon, if the colon “conveyor’s belt” is not moving fast enough, or if its progress is impeded, the stools will end up too dry and too hard.

But why would that conveyor’s belt move too slowly?

Lifestyle Factors

Over the last centuries, with the arrival of the industrial society, our lifestyle has changed drastically. Our bodies were never meant to have such a static and sedentary lifestyle. We became industrial beings, fed by industrial products.

That being said, we cannot blame it all on lifestyle. On this website, we will cut through the clutter and see what can really make a difference on chronic constipation. We will focus on two main subjects :

Nutrition
See article Foods that cause constipation.

We will see that nutritional supplements can be of help. But on the other hand, too much of a good thing can, you guessed it, turn against you. Taking too much of certain supplements like Calcium or Iron can cause constipation.

Physical activity
Certain movements promote gut motility, in other words can get food residues to move more efficiently through your colon, limiting constipation. On the other hand, lack of physical activity can be problematic.

At the extreme, being bedridden and not being to move at all due, for instance, to a surgical procedure can create significant constipation problems.

Stress
Thinking that stress does not cause constipation, that it is all in your head? Think again and read that article...

Psychological Factors

Stress
As an alternative medicine practitioner, I can assure you that we underestimate the negative effect of stress on our physiological functions. It is very important to understand the direct impact of stress on blood circulation, muscles functions, sugar management, and more. We will cover stress as a cause of constipation in a separate article.

Depression and Chronic Anxiety
Depression encompasses many constipation triggers. We don’t eat as we used too. We don’t sleep well. Our stress hormones are elevated. We might be medicated. These are many causes of constipation indeed.

We will discuss depression in a separate article.

Medication

Since we are becoming an over-medicated population, consuming drugs on a regular basis, I could have included medication in the “lifestyle” section. But it is so important that it deserves its own section.

Medications seem to be causes of constipation in up to 40% of constipated patients(1). This number should be an eye-opener.

Multiple classes of drugs can create constipation issues by slowing down the progression of residues through the colon. These drugs are: calcium channel blockers, beta-blockers, opioids, diuretics, antidepressants, anticonvulsants, anti-acids, anticholinergics, antispasmodics(2), and more.

Of course, laxatives can also impact your colon’s ability to function on its own the day you decide to stop.

Here is a list of drugs that can cause constipation:

  • Clomid (clomifene), a drug used for infertility issues;
  • (more drugs will soon be added to this list)

Functional or Chronic Idiopathic Constipation

After studying your case and running a full battery of tests, your doctor may conclude that your constipation is functional or idiopathic. Idiopathic means that its causes are unknown, nothing seems to be wrong with your gut from an organ or physiology perspective.

There are some anomalies with the way your colon functions however, through its network of nerves and muscles. Some problematic tendencies may have been inherited, or may have developed due to lifestyle or other factors.

On this website, we will present the following causes of constipation :

Those causes of constipation will be addressed in separate pages.

Colon Anatomical Blockage

The causes of constipation can be physical: an abnormal growth or anatomical deformation in the colon. This is not common, so do not get yourself too worked up. We are listing it here for the sake of completeness, and to make sure you have the big picture in mind.

If an anatomical blockage is suspected, your health-care practitioner will be able to diagnose this situation, possibly through X-ray, colonoscopy or other examination of the colon and rectum.

The blockage could be a rectocele. A rectocele is a tear in the tissue separating the rectum and the vagina, with a piece of rectum bulging through the tear. It could also be an abnormal perineal descent (perineum has descended below its normal position).

On the colon blockage page, we discuss the following causes of constipation:

  • Volvulus of the colon
  • Sigmoid diverticulitis
  • Sigmoid Endometriosis
  • Strictures caused by Irritable Bowel Disease
  • Fecal impaction
  • Colon cancer

Of course, a blockage does not have to be anatomical, it could be psychological too. Think of a painful hemorrhoid due to too much pushing, or an anal fissure due to the passage of large hard feces. The expectation of pain during defecation can create a significant psychological blockage.

Endocrine and Metabolic Imbalances

Hormones are key chemicals used by the brain to orchestrate the functioning of our vital processes. “Endocrine” means related to the production, management and excretion of hormones. Hormonal imbalances can be the cause of constipation.

Hypothyroidism for instance (when the thyroid gland does not make enough hormone) or hypopituitarism (when the pituitary gland does not make enough hormones) can be a trigger. Those two causes of constipation will be subjects of separate articles.

In women, the change in hormone levels during pregnancy or menopause can also have an impact on transit. More on this later.

When the management of sugar becomes a problem, we talk about a "metabolic disorder". The metabolism is the process by which we turn sugar into energy. When sugar metabolism gets out of balance, we have diabetes. Diabetes and constipation will be covered in details in a separate section.

Mineral Imbalances

How our body manages (or mismanages) key minerals can be a cause of constipation. We will see how hypokalemia (a lower than normal amount of potassium in the blood) or hypercalcemia (a higher than normal amount of calcium in the blood) can be a cause of constipation.

Neurological Diseases

Neurological diseases can be a cause of constipation. You remember the key role of the autonomic nervous system in managing the progression of food residues in the colon, with in-place churning and forward propulsion. This was described in the definition of constipation article.

If that autonomic nervous system is thrown off balance by a neurological disorder, the colon will not function properly.

On this website, we will cover the following two causes of constipation:

  • Parkinson’s disease
  • Multiple sclerosis

Conclusion

This article was a high-level overview of all the possible causes of constipation, starting with lifestyle factors and ending with more serious pathologies.

As explained in the introduction, this large amount of information might feel overwhelming. Do not worry, the important key factors will be covered again in different terms in other articles. We are slowly building a foundational understanding of constipation and this will bear fruit later on.

So please stay with us as we get deeper and deeper into common but frustrating condition.


References for "Causes of Constipation"

(1) Michael Snyder, MD, Houston TX, "Functional Bowel Disorders", core subject on the American Society of Colon & Rectal Surgeon web-site.

(2) Foxx-Orenstein et al. "Update on constipation: One treatment does not fit all". Cleveland Clinic. J Med 2008; 11:813-824.


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