The Dreaded Constipation!

by | Jan 15, 2019 | Nutrition | 0 comments

There are only a handful of professions that pooping is discussed and nothing is thought of it. Being a dietitian that sees clients with gastrointestinal issues, I am one of those people. If I don’t talk about this subject with my client, I can’t understand what I can do to help them. Majority of my clients suffer from constipation. Some of them are dependent on laxatives to have a bowel movement every day. It’s frustrating and painful for many of them.

For up to 20% of Americans, constipation isn’t something that just goes away. Often times chronic constipation is experienced by people with other functional GI and motility disorders.

So, what actually is constipation?
There is not single definition of constipation, but according to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of constipation may include:
-Fewer than three bowel movements per week
-Stools that are hard, dry or lumpy
-Stools that are difficult or painful to pass
-A feeling that not all stool has passed

Last week I followed a Twitter talk with Dr. Jeanetta Frye, a gastroenterologist from University of Virginia Health System. According to Dr. Frye, chronic constipation is defined by significant symptoms, such as hard stools, incomplete evacuation, etc., that occur for at least 6 months. She talked about the different types of constipation.

1. Primary constipation which has 3 group types:
Normal Transit Constipation-muscles in your colon squeeze and relax the way they should. Waste moves at the correct speed, but still the stool is hard and difficult to pass. This can cause pain and bloating (IBS-C).
Slow Transit Constipation-the colon is not moving waste fast enough, so bowel movements are infrequent.
Pelvic Floor Dysfunction/Dyssynergic Defecation-condition where there is a problem with the function of the pelvic floor muscles.

2. Secondary constipation is related to medications and other medical conditions.

I want to touch on pelvic floor dysfunction/dyssynergic defecation before I move on. Dyssynergic defecation happens when there is an issue with the way certain nerves and muscles work in the pelvic floor. The way the muscles and nerves work together make it possible to hold a bowel movement, and also relax in a way to have a normal bowel movement. When this does not work together, it can lead to issues of constipation.

Based on those with pelvic floor dysfunction can have a variety of symptoms.
– Feeling that there is a need for several bowel movements in a short period of time
– A feeling of incomplete emptying
– Constipation and straining with a bowel movement
– Leakage of stool or urine
– Frequent need to urinate
– Painful urination
– Lower back pain with no explanation
– Continued discomfort in pelvic, genital and rectum area even without a bowel movement
– Pain during intercourse (women)

Often times those with dyssynergic defecation have failed using laxatives and stool softeners.

It is important to see a physician regarding symptoms. Some physicians may go off symptoms alone, but tests are available to help with a diagnosis:

– Balloon Expulsion Test (BET)
– Anorectal manometry (ARM)
– Defecography

The most common treatment is seeing a physical therapist trained to help those with pelvic floor dysfunction. They use a variety of techniques including biofeedback to retrain the muscles.

If you have chronic constipation it is important to get evaluated by a physician to figure out the cause. Long-term constipation needs to be addressed.

Why do individuals have chronic constipation?
To get a full list of major causes for constipation please refer to ( They have an extensive list.

-Not enough fiber/liquids/activity
By the time I see my clients, majority of them with chronic constipation have already tried this route. For many of my clients increasing these have not helped, but for those that haven’t tried increasing fiber, liquids and activity, it is a good place to start.

Fiber Needs:

19-50 years
Men: 38 grams per day
Women: 25 grams per day

50+ years
Men: 30 grams per day
Women: 21 grams per day

Certain medications can cause constipation, such as pain killers. Please check with your physician or pharmacist regarding this information.
Some supplements can contribute to constipation as well, such as calcium carbonate and iron.

When I see a new client with GI issues and constipation, they most often have a diagnosis of IBS-C. We tackle this with the FODMAP diet and see where it brings them. At the same time I offer suggestions on what to do about their chronic constipation. These suggestions come directly from the University of Michigan GI conferences I attend.

Suggestion to help with chronic constipation above and beyond increasing fiber/liquids.
1. Did you know that 2 kiwi per day in studies have been shown to help with constipation? There is an enzyme present in the kiwi. Try it!

2. Fiber supplements
Psyllium Fiber(soluble fiber)
– Start slow, go slow
– 1 tsp daily to start
Bloating usually resolves over time

3. Over the counter supplements
Stool softeners

4. Pharmaceuticals (Physician ordered)

I do have a few other tricks I share with clients that I meet with one on one. Recommendations are very individualized based on symptoms.

Are Laxatives Safe?
There are two types of laxatives:
Osmotic-pull water into the colon to soften the stool.
Stimulant-helps muscles around the intestines to squeeze and move stool through the colon.

The recommendation is to start with an osmotic laxative first. Stimulant laxatives are only to be used occasionally.
According to Dr. Jeanneta Frye, osmotic laxatives are safe long term, but she cautions to always see a doctor to get evaluated for chronic constipation. Please get evaluated!!

If a client comes to me with chronic constipation and have never had a work-up I start asking questions. If the answers point to something such as pelvic floor dysfunction, I recommend they reconnect with their physician to ask questions and get evaluated.

The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek medical advice from your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.

Meet Valerie

Registered Dietitian Nutritionist - CDN, RDN

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

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