Hello, my friend!

Well, it's still August (even if it's just the last few hours and it'll likely be September by the time you see this)!

August was a tough month in the Okanagan for wildfires and poor air quality. But it seems we may be approaching the end of it (fingers crossed)!

I hope wherever you are, you are safe and sound in your home.

Earlier this month, I started creating a resource on how to protect yourself from wildfire smoke. If you'd like to learn more about this, please reply to this email and I'll finish up this resource for next month's newsletter.

This month, though, I want to discuss a completely different topic––chronic constipation––a common problem that is usually easy to treat.

Truthfully, it's one of my favourite things to treat. Getting people pooping brings me so much joy!

How do you know if you're constipated?

Constipation is diagnosed based on any of the following criteria:

Fewer than 3 bowel movements per week
Passing hard or dry stool
Difficulty pushing stool out (pain, sluggish bowel, sensation of incomplete bowel movement, or needing to strain)

Chronic constipation is very common and frequently dismissed as "normal" (ex. "my mom has constipation too so it's obviously normal for me").

Chronic constipation is not normal but it is extremely common, and it's usually easy to improve or even resolve without permanent use of laxatives.

Why does it matter if you're chronically constipated?

Constipation typically worsens quality of life and––even worse––can lead to further health problems if left untreated.

When constipated, stool and toxins stay in the body longer than normal. This "back-up" can lead to many other health problems including:

high cholesterol
hormone imbalances
acne and skin rashes
fatigue
joint pain
headaches
chronic GI discomfort, nausea, abdominal pain, and bloating
anxiety, depression, irritability
hemorrhoids & rectal bleeding
anemia
allergies

and more.

In my naturopathic world, if someone is chronically constipated and has several other health problems, treating the constipation is considered a high-priority task that will likely resolve many of the other health issues.

What causes chronic constipation?

These are just some of the common causes of chronic constipation:

1) Diet

Insufficient dietary fibre, too much junk food, and eating foods that you are intolerant to can all contribute to chronic constipation.

When I meeting someone with chronic constipation, I usually recommend starting by adding dietary fibre in the form of psyllium, ground flax seed, or a low FODMAP type fibre supplement in addition to more plant fibres in the diet (plus enough water to hydrate that extra fibre!).

If you have tried fibre and know it makes your constipation worse, this can be an indication that small intestinal bacterial overgrowth (SIBO) may be behind your symptoms.

2) Dehydration

Water is required to hydrate the stool and keep it soft to help bulk it up and allow it to move smoothly through the intestines.

If you already drink 6-8 glasses of water daily, adding more is probably not the solution you need.

If there's room for improvement though, you can start here.

3) Hypothyroidism

Thyroid hormone is required to stimulate the muscles in the bowel and move waste along.

Low thyroid function is a common cause of constipation and easily treated.

Testing thyroid stimulating hormone (TSH) is a simple screening blood test that can catch hypothyroidism and "borderline" cases of hypothyroidism. Ideal range here is a TSH of 0.5 - 2.5.

If necessary, treating the thyroid will usually resolve chronic constipation.

4) SIBO / IMO / intestinal yeast overgrowth

Small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO), and intestinal yeast overgrowth are three similar-but-different conditions that frequently cause chronic constipation.

These conditions are often misdiagnosed as irritable bowel syndrome.

The good news is that we can test & treat these conditions quite easily.

5) Scar tissue & adhesions

A history of abdominal surgery or trauma can lead to scar tissue and adhesions in the abdomen that can mechanically disrupt the movement of waste through the bowel.

In these cases, I'll often refer patients to osteopathic practitioners, chiropractors, and/or massage therapists who can soften and mobilize structural limitations.

6) Medications & supplements

Several medications and supplements can cause chronic constipation.

Iron supplementation is a common culprit.

If your medications are causing this annoying problem, I recommend exploring treatment alternatives as there is usually a better-tolerated solution.

7) Parasites

Many people (doctors included) associate parasites with diarrhea only.

But parasites are actually also a common cause of chronic constipation.

Parasites are notoriously difficult to diagnose as they often reside in tissues outside of the gut and often escape the conventional testing available. For this reason, they often go undiagnosed and untreated.

How do you know if parasites are an issue? They are truthfully difficult to diagnose through any typical lab test. Bioresonance testing will frequently detect if parasites are an issue, and sometimes a parasite cleanse is appropriate even without testing.

How is chronic constipation treated?

Like with everything in naturopathic medicine, we treat the cause. Every case is different.

Treatment can look like:

identify & remove food triggers
eat more fibre (plus water)
hydrate
treat hypothyroidism
identify & treat SIBO, IMO, yeast, and/or parasites
optimize & support nervous system (vagal tone)
liver detox support
laxatives**
prokinetic medications (stimulate the muscles in the bowel)
manual therapy (osteo, massage, etc)
increase movement in general (exercise)

**I rarely recommend laxatives for treatment of constipation except to resolve chronic bowel impaction.

If laxatives are needed long-term, something else is usually going on and should be addressed.

Fun fact: If you struggle with chronic constipation, fibre and probiotics may be recommended by doctors and "the internet." If fibre and/or probiotics make symptoms worse, this may be a clue that underlying small intestinal bacterial overgrowth (SIBO) may be a contributing factor.

Chronic constipation feels terrible. If you have this issue, I recommend talking to a health care provider to get to the root of the issue and hopefully resolve it for once and for all!

FREE EBOOK:

Have you ever wondered if your health problems might be connected to your gut?

Chronic symptoms like low energy, rashes, acne, and hormone imbalances can all be caused by digestive issues.

You might be surprised to learn how even poor immune function and mental health issues like anxiety and depression can be related to gut health!

Read the eBook to learn more!

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Is it time to address your chronic constipation ?

If you've accepted chronic constipation as a fact of life, it may be time to discuss your symptoms with your doctor.

If your doctor just recommends ongoing use of laxatives, it may be time to work with a naturopathic doctor!

When you talk to your doctor about your constipation, some key points to mention are:

How long you've had your symptoms (weeks? months? years?)
How frequently your symptoms occur (daily? weekly? monthly?)
The severity of your symptoms (mild / moderate / severe)
How your symptoms are affecting your life (affecting work/social life? causing pain? embarrassment? fatigue?)
What you've already tried (and how it helped / didn't help)

When symptoms are chronic and persistent, it's time to test. Your medical doctor or naturopathic doctor can help find out the cause of your symptoms through several lab tests and imaging studies. Once you know why you have your symptoms, you can treat them!

If you would like support getting to the root of your chronic constipation, feel free to book an appointment. Ensuring your gut is happy is my passion and area of expertise!

That's all for this month! See you in a few hours, September :)

Comments? Questions? Just reply to this email! I'd love to hear what you think!