I'm A Gastroenterologist: These Are The 2 Main Reasons You're Constipated

Virtually 100% of patients with constipation have gas and bloating. It's the most common manifestation of inadequate evacuation. But there are a number of other symptoms that are quite common with constipation: abdominal pain virtually anywhere in the abdomen, nausea or queasiness, getting full quickly after a meal, loss of appetite or food aversion, even acid reflux. There's often fatigue and sometimes brain fog. Many of my patients will show me a photo of themselves at 7 a.m. with a flat stomach and then a second photo at 10 a.m. showing a protuberant, pregnancy-like belly. That's almost always constipation behind that.

Nearly everyone with constipation will also experience food sensitivities. These sensitivities are typically pretty nonspecific, meaning that they are sensitive to many different foods and also there doesn't seem to be a reproducible pattern to the symptoms. The problem in this case is the constipation and generally not the food itself. These food sensitivities will improve, and many times completely disappear, when the constipation is adequately treated.

The solution is to establish rhythm. Your body thrives on rhythm. When we are constipated, we are out of rhythm, out of balance. We need to get things moving once more and get into that flow state where bowel movements are effortless, complete, and, frankly, enjoyable. I am being totally serious—having a good, healthy bowel movement absolutely should be one of the highlights of your day! You should look forward to it and feel satisfied afterward. If you don't, we have work to do.

I don't recommend making dietary changes while you're constipated because constipation amplifies and fuels food sensitivities. If you start adding more plants to your diet, you'll often feel gassy and bloated and have worsening abdominal pain. Instead, focus first on restoring rhythm. Once you are in a rhythm, having good regular and complete evacuations, you will feel so much better and also be in the best position to start adding back foods without food sensitivity standing in the way.

In order to restore rhythm, you must first understand that there are two main contributors to constipation:

First is motility. People with slow motility struggle to adequately empty their bowels. This often manifests with a hard, lumpy, bumpy stool that has cracks and crevices in it or comes out like a golf ball. The solution here is to help move things along, which we can often accomplish through natural means.

There's a condition called pelvic dyssynergia, where the muscles fail to relax when they're supposed to, and in some cases, they actually contract. This results in a scenario where the only way to poop is to strain and push, often to have a small little nugget slip out. Or, people experience weird poop shapes or feel like they can never completely empty. Another symptom is going once, then returning to the bathroom 45 minutes later to go again. All of these point to pelvic dyssynergia.

For many, treatment requires working with a pelvic therapist, which is effectively a physical therapist who specializes in pelvic floor issues—both bowel and urinary. However, one thing you can try first is to simply orient your pelvic muscles in a proper position on the toilet. Here's how you do it:

From THE FIBER-FUELED COOKBOOK: Inspiring Plant-Based Recipes To Turbocharge Your Health by Will Bulsiewicz, M.D., MSCI, recipes by Alexandra Caspero, R.D., to be published on May 17, 2022, by Avery, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2022 by Will Bulsiewicz, M.D.