Causes and Complications of Chronic Constipation

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH

Young woman holding her stomach from chronic constipationHaving one or two episodes of constipation a year, although annoying, is something most of us experience. Sometimes your regular routine is disrupted due to travel, or maybe you’ve slacked off with your diet for a week and now you’re feeling the effects. It’s not usually something to worry about but if you have chronic constipation, you may be heading towards dangerous territory.

Although doctors and health institutions sometimes disagree, the most common definition of constipation is less than three bowel movements a week. According to the Mayo Clinic, having one or more of the following symptoms for three months or longer means you have chronic constipation:

  • Passing fewer than three stools a week;
  • Strained bowel movements;
  • A feeling that something in your rectum is obstructing the passage of stools;
  • Needing to press on your abdomen to facilitate bowel movements or remove stools with your fingers;
  • Feeling as though you can’t empty your bowels completely;
  • Lumpy or hard pellet-like stools.

If you have occasional constipation, you may experience bloating, abdominal discomfort, pain while passing stools, and maybe even tiny tears that cause a small amount of bleeding. These symptoms generally go away once your bowel movements return to normal. This is not the case with chronic constipation, which can cause more challenging health complications. Plus, it likely points to deeper causal factors that could become serious health problems if left unaddressed.

If you have adrenal fatigue and your NeuroEndoMetabolic (NEM) stress response system is dysregulated, your condition may be aggravated by chronic constipation and at the same time, your adrenal fatigue could aggravate your constipation.

Several factors can indicate your constipation is becoming chronic, including anatomical wear and tear, digestive issues, inflammation, and toxicity levels—each of which has its own set of risk factors—and can place a lot of additional stress on your body.

Let’s start with wear and tear.

Wear and Tear Complications of Chronic Constipation

Prolonged constipation can lead to hemorrhoids, anal fissures, and even rectal prolapse. Hemorrhoids occur when veins inside your rectum and anus or under the skin around your anus begin to swell. This can happen if you frequently strain to pass stools.

Swollen hemorrhoids can be painful and itchy and can bleed during bowel movements. Although more of an annoyance than a serious issue for most people, if hemorrhoids become infected, they can be harmful.

Passing hard stools can cause tears, or fissures, around the anus. Fissures are usually small and heal on their own, but if they become infected or enlarged, prescription medications or surgery may be necessary. Rectal prolapse occurs when part or all of your rectum slips out of the anus. Again, this is usually due to the frequent pushing and straining when passing stools.

Finally, when several stools accumulate inside the intestines, called fecal impaction, the combined stools can become hard, creating a dangerous intestinal blockage. This can cause nausea and vomiting and may necessitate a trip to the emergency room.

Digestive Issues and Toxicity Levels

Body with organs showing chronic constipationDigestive issues can be the cause or the result of unresolved chronic constipation. For example, constipation is a symptom of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), ulcerative colitis, diverticulitis, and slowed motility.

Slowed motility is quite important when it comes to adrenal fatigue. If the symptoms of Adrenal Fatigue Syndrome (AFS) are not addressed, the condition can progress further. During the initial stages, your energy levels drop quickly and then, as the thyroid gland and adrenal glands slow down, your basal metabolic rate is lowered to conserve energy. This slows digestion and intestinal motility, which can cause stools to accumulate in your digestive tract.

The accumulation of waste and lack of timely elimination from your body inevitably increases toxicity levels. Occasionally, toxins cross the blood-brain barrier, resulting in brain fog and anxiety, and the buildup of toxins can also increase your risk of IBS, food and drug sensitivities, and yeast infections.

In response, your liver and kidneys have to work harder to eliminate toxins that would normally leave your body naturally with regular bowel movements. Inflammation also increases as your body continues to attack the accumulated toxins.

Constipation and the Inflammation Circuit

The NEM stress response system is composed of six circuits working together to fight stress. Your adrenal glands are part of the hormonal circuit and are considered the NEM system’s first responders. However, because the NEM system acts globally in response to stress, all of its circuits are engaged, to some degree.

The inflammation circuit—composed of the gut, the immune system, and the microbiome—is most affected by issues related to the digestive system and bowel movements. This is because inflammation almost always begins in the gut, and for good reason. Two thirds of your immune system’s cells are located in the gut.

A highlight about chronic constipation and the effect to the bodyIf you’re suffering from chronic constipation, your body’s digestive and elimination functions will not be working properly. This can lead to imbalances in your gut microbiome—a state called dysbiosis—which is a big contributor to inflammation and many other problems.

In addition, your body will view accumulating toxins as threats, therefore, your immune system will launch an attack. However, if constipation is chronic, the stress it causes will be persistent and repetitive, and your immune system will have to mount attack after attack.

Inflammation is a normal and healthy part of your immune response but when your body becomes stuck in this loop, inflammation can become chronic, which is one of the main underlying causes of chronic disease.

Another issue sometimes seen in advanced AFS is a low concentration of stomach acid, which makes it more difficult to break down food, and absorb and assimilate nutrients. If your cells are deprived of essential nutrients and minerals, your body will have an even bigger need to conserve energy and motility will slow even more.

The Bioenergetics Circuit and Constipation

The bioenergetics circuit—composed of the thyroid, pancreas, and liver—of the NEM system is responsible for transferring energy to your cells and tissues. The thyroid gland regulates your basal metabolic rate, the pancreas secretes insulin to regulate glucose levels, and the liver is your body’s main detoxifier. Your metabolism creates chemical reactions in your cells that convert food into energy but also plays a role in managing stress.

In fact, your metabolism is activated alongside the hypothalamic-pituitary-adrenal (HPA) axis—a hormone cascade that stimulates your adrenal glands to secrete cortisol and other important anti-stress hormones. The bioenergetics circuit increases your basal metabolic rate to prepare your body to flee or fight and keep your brain alert when it senses danger—real or perceived.

Optimal functioning of the bioenergetics circuit will help your body defend itself from the symptoms of stress and oxidative damage by helping your body to properly detoxify and control inflammation. The bioenergetics circuit also ensures your brain has enough glucose and your body has enough energy to function normally.

With chronic constipation, your bioenergetics circuit may suffer. First of all, constipation disrupts digestion and absorption, thereby depleting your cells of necessary nutrients and energy they need.

The resulting increase in toxicity, extracellular matrix congestion, imbalance of your gut microbiome, and spread of inflammation all contribute to weakening your bioenergetics circuit. Moreover, a weakened circuit will worsen these issues and allow oxidative stress to build up.

So, now that we know how constipation, stress, inflammation, and bioenergetics can all feed into each other, how do we interrupt this negative cycle and start the recovery process? The first and arguably most important step is to determine what’s causing your constipation.

Causes of Chronic Constipation

  • Unhealthy diet – the Standard American Diet is high in fat and low in fiber. Fiber keep things moving through the intestines. Too much dairy can also cause constipation.
  • Dehydration – water helps keep things moving smoothly. Most people are chronically dehydrated without realizing it. Are you drinking enough water for your body weight and needs?
  • Sedentary lifestyle – laziness and not moving your body on a daily basis will lead to lazy digestion and elimination.
  • Certain types of medication and supplements – iron supplements, NSAIDs, calcium supplements, antacids, antipsychotics, and diuretics, to name a few, can cause constipation. If you suspect your medication may be the cause, speak to your doctor about it.
  • Pregnancy – an increase in progesterone during pregnancy can cause your muscles to relax, including the intestinal muscles.

We’ve already mentioned a few digestive issues than can cause constipation but there are a few other conditions worth noting, such as Parkinson’s disease, colon cancer, hypothyroidism, and damaged nerves or muscles in the colon.

Of course, stress is another huge culprit and now you know why—stress affects your body globally—and constipation is a symptom of adrenal fatigue.

Armed with this information, you should make your priority getting to the bottom of your chronic constipation. Once you know which of the above issues is causing it, you’ll need to directly address the cause, rather than trying to superficially treat the symptoms of constipation.

How to Address Chronic Constipation

What about chronic constipation and the use of enemas to stimulate the gutIf your constipation stems from an unhealthy diet, dehydration, and a sedentary lifestyle, the changes you need to make are obvious. Most people would agree that eating more fruit is beneficial since fruit has a high water content, contain lots of vitamins and minerals, and plenty of fiber. Fruit is great for constipation as well but some fruits contain a lot of sugar and if you suffer from adrenal fatigue, you’ll be more sensitive to sugar spikes and crashes than the average person. Spikes and crashes will place more stress on your adrenals.

The same goes for increasing your water intake. With AFS, your sodium-potassium ratio is usually unbalanced, and your body lacks sodium relative to potassium. Drinking more water will dilute your sodium levels even more and exacerbate this imbalance. Therefore, increasing your water intake gradually is recommended, and you may even want to add a sprinkle of salt into your water.

If you suffer from adrenal fatigue, exercise could place more pressure on your adrenals instead of relieving them. It’s best to start with gentle exercises like adrenal breathing, adrenal yoga, and a small amount of walking and when you’re feeling strong enough, you can add some light cardio and strength training.

The great thing is that if you address your AFS, your chronic constipation is likely to resolve on its own. The adrenal fatigue diet is anti-inflammatory and can improve your hormone balance, which can help support your bioenergetics circuit.

Man squatting in the restroom suffering from chronic constipationIf you want to speed up the process, add some probiotics to improve your gut flora and relieve your digestive issues as well. You could also consider taking digestive enzymes or other supplements that can increase the acid levels in your stomach to help you absorb nutrients and replenish your cellular energy stores.

But if you suffer from advanced AFS, take extra care when making any big changes to your diet or using supplements, which could end up having the opposite effect to what you intended. With adrenal fatigue, you are also at risk of paradoxical reactions, which is why it’s best to seek guidance from an experienced medical professional before making any drastic changes to your diet and lifestyle.

© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Chronic constipation is having less than three bowel movements a week for longer than three months. Just reading that might sound miserable and if it is not addressed asap, it can lead to further complications you really want to avoid.

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