Hidden Causes of Constipation Beyond Diet: Lifestyle, Hormones & Medical Factors
Constipation is a common digestive issue, often defined as passing fewer bowel movements and having hard stools. While diet plays a significant role, lifestyle, medical, and psychological factors are important contributors. This article explores non-food related causes of constipation, drawing on approaches from both Ayurveda and modern medicine.
What is constipation?
According to the NICE guidelines, constipation is defined as passing less than three bowel movements per week alongside having hard stool. In Ayurveda, regular digestion is key to our overall health and well-being. You will never leave an Ayurvedic Practitioner without being asked about your bowel movement. But why does Ayurveda place such an emphasis on this?
From an Ayurvedic perspective, constipation can be a sign of internal dryness but can also be an indicator of our mindset, emotional state and outlook. It is often mistaken as just an issue of excess Vata where being out of routine, rushing around, feeling anxious or even excited can disturb our inner environment. This is similar to the modern medical perspective – during stress, the sympathetic nervous system prioritises those parts of our body that will help us in an emergency (muscles, lungs, vision etc.). Our digestion is less helpful in these moments so is shelved for later.
However, constipation can also occur where there is excess Kapha in the body. This time, rather than it being due to dryness, it has to do with being sluggish. A rich and heavy diet void of fresh vegetables and fibre alongside inactivity can reduce peristalsis (the movement of the smooth muscle lining of our gut).
Constipation signals a sense of stuckness in our mind and body and this doesn’t allow for the flow of Prana or our vital energy. This can look and feel like dullness, discomfort and stress. Having worked in nursing for the last 14 years, I have seen constipation in vulnerable groups such as the elderly, show up as agitation and confusion. This shows just how important it is to pay attention to our bowel habits.
Non-food causes of constipation
1. Physical inactivity
Working in a hospital, I would often see people on bed rest. This would have a cascade of effects on different systems of the body including muscle loss, shallow breathing, and skin damage. But, it can also lead to constipation.
Movement massages our internal organs to reduce stagnation. Just a simple walk can support peristalsis in a gentle yet effective way. Try this: soon after waking up, go for a short 10-20 minute walk and notice the changes it brings.
Abdominal massages also help the gut motility. Just ensure the massage strokes are in a clockwise direction.
2. Medications and supplements
Some medications and supplements have side effects which include a slowing down of the peristaltic movement and a reduction in gut secretions (necessary for lubrication) which help food to move along.
Opioids (strong pain relief like codeine), antacids and some antidepressants are well-known to cause constipation. Vitamin and mineral supplements such as iron and calcium can also cause hard stool.
These side effects can often be managed by ensuring we stay active (as possible) and include a fibre-rich diet. However, if you are taking prescription medication and experiencing constipation as a side effect, speak with your doctor in the first instance.
3. Menstruation and hormonal changes
When we are on our period, many women will experience a fluctuation in their bowel habit. Either looser stool or constipation.
The rise in progesterone in the week or two leading up to our period start date, decreases muscle contraction in our gut. This could explain symptoms such as a slower digestion and feeling bloated as a result.
Ayurveda links these phases to a shift in our Doshas. A busy lifestyle, feeling stressed or eating certain foods around the luteal phase, can increase Pitta dosha and we might experience loose stool. However, if we are out of routine, feel anxious or undernourished, this could exaggerate Vata dosha imbalances leading to constipation, bloating and pain.
We can support our digestion around this time of the month by focusing on simple, warm meals that are easy to digest.
4. Dehydration
Even if we’re eating enough fibre, soluble fibre needs fluid to dissolve it and move things along in our gut. Water provides vital moisture for our body. When we’re dehydrated, the colon pulls fluid from the stool, making it harder and more difficult to pass.
Again, working with elderly and vulnerable patients, I’ve seen first-hand the downstream effects of even slight dehydration on their condition (nausea and confusion among other effects). Every cell in our body is dependent on hydration to function optimally.
There is no one-size-fits-all answer for how much water we should drink each day because this will change depending on our activity level, the temperature of our environment and other factors. But, it’s important to note that research tells us that thirst is not considered a reliable indicator for dehydration. In other words, don’t wait until your thirsty to drink water.
5. Stress and emotional health
While stress is an inevitable part of life, unmanaged stress can cause disruption to our digestive system. As well as changing the composition of our gut bacteria and contributing to a leaky gut, operating in a heightened stress state can take our resources (blood supply) away from the gut, leading to constipation.
Everyone is unique and will find different stress management techniques that work for them. Whether it’s going for a walk, trying yoga or exercise, or even a catch-up with a friend, the running theme here is creating some space and time for ourselves to digest incoming information and make sense of it with clarity so that we can respond in the best way possible.
6. Changes in routine
Think to a time when you travelled abroad. Did you notice any change to your bowel habit? Many people often experience constipation when they travel to different time zones because our circadian rhythm becomes disrupted.
Well, it’s the same in our everyday lives too, because the body likes routine. Maintaining a regular sleep schedule (similar bedtime and waking-up time) is beneficial for our overall health from our energy levels, immunity and to our gut health. This is because the body takes cues from natural sunlight for it’s physiological functions. Equally, taking meals at regular times strengthens these prompts to the body. By skipping meals or eating at irregular intervals, our body doesn’t get the necessary cues to maintain a regular rhythm of peristalsis.
7. Specific medical conditions
Certain health conditions can impact our bowel movements because of the way they interfere with our normal smooth muscle contractions and nervous system signalling.
With conditions that impair our cognition such as a stroke or Parkinson’s, it could be a number of factors including:
The brain isn’t able to properly cue and coordinate our muscle contractions.
Changes in sensation make it harder to tell when you are thirsty, putting you at greater risk of dehydration.
Changes in sensation might also make it harder to recognise when the bladder or bowel are full.
Reduced mobility and activity.
Difficulty communicating may mean the person is unable to express their needs (thirst, abdominal discomfort, feeling full etc.)
Medication side-effects.
A complication of diabetes is neuropathy which is damage to our nerve cells outside of the brain and spinal cord. This can cause changes to our sensation including tingling, numbness and weakness. Within the body, damaged nerves means that our smooth muscle contractions can be less effective, leading to slower gastric emptying and other digestive symptoms.
Our thyroid hormones play a huge role in how our body uses energy (metabolism). When we have too little of this hormone (hypothyroidism), this can impact the contractions within our gut lining, also leading to constipation.
8. Recreational drugs
As mentioned above, opioids slow down gastric movement so similar effects are seen when people use heroin.
Stimulants like cocaine can also lead to constipation. By altering neurotransmitter activity, they cause blood vessels to constrict, reducing blood flow to the digestive system and limiting the amount of oxygen and nutrients reaching the stomach and intestines.
Maintaining digestive flow
Most ancient systems of health and modern medicine emphasise the fundamental need for flow – through breath, through mind, through other movements and routine. Constipation is often an overlooked health concern but can cause serious discomfort and complications. If chronic constipation is something you are struggling with, seek assessment and advice from a healthcare professional.