The case of chronic lifelong constipation
A 45-year-old well-dressed woman came to our clinic. On questioning, she described a lifelong problem with persistent constipation (as long as she could remember), was totally fed up with having to deal with it and wanted it fixed. Despite a long history of treatments from her GP and dietitians (some of which had helped briefly), she still had severe constipation. She also had a family history of the same problem on her mother’s side.
She did have problems sticking with diets long term as she was busy running her own business with high workloads and long hours, and she found that, overall, the diets really didn’t make much difference. Her food intake tended to be erratic as she often didn’t have time to eat or to go to the toilet when she had the urge.
She went to the toilet about two times per week, usually after she had taken a laxative of some type. As such, she had a long history of laxative abuse (and associated nutrient deficiencies). Her stool was very difficult to pass, and she had itchy, sore and bleeding haemorrhoids. She also had frequent abdominal pain and bloating.
General conditions associated with constipation are a consequence of inadequate fluid consumption, low fibre in the diet, physical inactivity, putting off going to the toilet even with the urge, various medications and even supplements such as calcium or magnesium can contribute to the problem. A candida overgrowth, IBS and hypothyroidism are also considered potential issues.
She was advised to eat whole (unprocessed) foods and to increase her (organic) vegetable intake significantly. She needed to drink at least eight glasses of filtered water a day (double her current intake) or equivalent in soups or other fluids (avoiding alcohol, juices because of the sugar content and tea, which can be constipating). She was advised to eat a range of prebiotic foods such as oat bran, asparagus, onions, mushrooms, Jerusalem artichokes, chickpeas and legumes, sweet potatoes, blueberries and slightly green bananas (hard, green bananas are excellent but need to be boiled before eating as a vegetable). She needed to avoid wheat, dairy and sugars and reduce the amount of meat, replacing this with wild fish three to four times per week. A regular exercise program was instigated, starting with a long walk at least three times per week.
She also needed to organise her time so she could eat regularly and go to the toilet when she felt the urge (instead of putting it off). Going to the toilet within an hour or so after eating (to trigger the gastro-colic reflex) gave her a structure she could organise. While initially this meant more time than she thought she had, it is an important practice for bowel health.
Increasing her probiotic intake with organic coconut kefir was recommended along with adding one teaspoon of slippery elm bark powder to this twice daily (drinking a large glass of filtered water at the same time). Herbal laxatives were only recommended when things were extreme as it was necessary to break the laxative habit. A witch hazel cream was recommended for her haemorrhoids, as were activated B vitamins and zinc.
She was very compliant with this regime and, while it helped a little, it was still not as successful as she had hoped. So, an abdominal X-ray was requested and (as suspected with her symptoms), her large bowel was shown to be longer than is considered normal.
One of the main functions of the large intestine is to remove water from the stool as it passes through, so when longer than normal, greater amounts of water will be removed — making the stools hard and very difficult to pass — resulting in constipation that nothing relieves. This is a mechanical (anatomical) problem not a functional condition and, while not a very common problem, it fitted her symptoms perfectly — a lifelong problem with constipation resistant to treatments and a family history of the same.
While diet and lifestyle are still critical for bowel health, the most successful treatment for this abnormality is a surgical procedure to remove a small section of the large bowel and shortening it to a normal length. On discussion of this option, she continued the regime recommended but after several months with mixed success, she conferred with a surgeon who performed the procedure for her.
When I saw her several months later, her life had changed dramatically. The surgery had been very successful, and she no longer had constipation. While she still followed the diet and lifestyle recommendations, she was a much happier, healthier(and more productive) woman.
