Laxatives, Constipation, and SIBO: Get the Facts
Chronic constipation affects 16% of all Americans and one-third of those over the age of 60.1 About 40% of Americans who report constipation use laxatives regularly.2 Of course, constipation happens to everyone occasionally. Yet it is especially frequent among those with small intestinal bacterial overgrowth, or SIBO. In my clinic, when a patient experienced constipation that stuck around for a while, I immediately thought of SIBO.
To provide temporary relief from constipation, many people turn to over-the-counter laxatives and stool softeners or prescription medications called prokinetics. However, these can have side effects ranging from cramping to becoming reliant on them.
As a functional medicine physician, I advocate getting to the root cause of constipation to truly resolve the issue rather than relying on laxatives. In the meantime, Magnesium Citrate is an effective tool for supporting healthy bowel movements and avoiding constipation.
The Problem with Constipation
Not only is constipation uncomfortable, if left untreated, it can contribute to other issues. That’s because stool is waste matter that is full of toxins. If it remains in your intestines due to constipation, those toxins can escape back into your bloodstream if you have a leaky gut. Additionally, the straining from constipation can also lead to hemorrhoids, anal fissures (torn skin in the anus), fecal impaction, and rectal prolapse.
Fortunately, our digestive systems are designed to handle the job of elimination quite efficiently. If this isn’t the case for you, there is an underlying cause. SIBO is often the culprit.
I’m often asked about what to do for constipation relief, especially by those dealing with SIBO. First, let’s talk about what constipation or lack of motility is, and how SIBO may be the root cause. Later, I’ll also explain what laxatives are and what I recommend if you need a little help.
What are Constipation and Motility?
Optimally, you’ll have at least one bowel movement each day. It’s even better if it’s two or three because that means your body is moving waste out consistently and efficiently. Generally, conventional medicine describes constipation as less than three bowel movements per week.
Constipation is chronic if the condition persists for more than several weeks. “Motility” simply refers to the digestive system moving what you eat from the beginning (esophagus) to the end of the GI, or gastrointestinal, tract (colon and rectum).
The final stage of digestion is elimination. This process has four steps 3:
- Your body absorbs water.
The large intestine contains about five gallons of water from liquids and foods you ingest. Your body reabsorbs a lot of this fluid to avoid dehydration.
- Your colon contracts to combine the water and waste.
These contents remain in your system for up to 30 hours. During this time, bacteria break down the good you’ve eaten.
- High amplitude propagating contractions (HAPC) take place in your large intestine.
This occurs six to eight times per day and moves fecal matter to the rectum for elimination.4
- Your bowels empty.
When the rectum is full, nerves send signals to the brain, which notifies the sphincter muscles to relax and empty your bowels. As I mentioned, conventional medicine considers, bowel movements “regular” if they occur between three times a week and three times a day. I consider a minimum of once per day to be “regular.”
What is SIBO?
SIBO occurs when the bacteria in your colon and large intestine proliferate and move into the small intestines. This upsets the healthy balance of gut flora. This bacteria is a part of your gut microbiome which supports your immune system, inflammatory response, mental health, thyroid function, and even your bone health. The bacteria that normally populate the large intestine and the colon aid in the digestion of food, vitamin synthesis, and waste removal.
In SIBO, overgrown bacteria in the small intestine feeds on undigested food, mainly carbohydrates. Consequently, this leads to fermentation and the release of methane or hydrogen, depending on which type of bacteria overgrows.
If you suspect you have SIBO, there is a breath test you can take. However, after working with thousands of patients in my clinic, I developed this simple quiz to help you determine if SIBO might be the root cause of your constipation.
How Do Laxatives Affect Constipation?
Laxatives are substances used on a short-term basis to treat constipation. Additionally, your doctor may ask you to use them to clear your bowel prior to a bowel procedure or examination. They are not weight-loss aids. Laxatives come in the form of pills, liquids, foods, suppositories, and enemas. The biggest risk factor in taking laxatives is becoming reliant on them to have a bowel movement.
The different types of laxatives induce bowel movements in different ways and include:
Bulking Agent Laxatives
Bulk-forming laxatives draw water into the stool to increase its mass with water to allow easier movement through the intestinal tract. (12 to 72 hours to take effect.) Natural examples include high-fiber foods such as fruits and vegetables. OTC varieties include psyllium (Metamucil®) and methylcellulose (Citrucel.®)
Emollient laxatives allow fats and water to be absorbed by stool to enable smoother motility through the digestive system. (12 to 72 hours to take effect.). Examples inclue Colace® and Diocto.
An enema is the insertion of a small amount of liquid into the anus to loosen stool. Colonic irrigation involves a lot more water. In this process, a technician flushes up to 16 gallons of water through the colon using a tube inserted into the rectum. Both of these methods induce elimination right away.
Lubricant laxatives make stool slippery, allowing it to move through the intestine more quickly. (Six to eight hours to take effect) Examples include cod liver oil, mineral oil, or MCT.
Osmotic and Hyperosmolar Laxatives
These laxatives absorb fluids into the intestine from the surrounding tissues to soften stool and allow it to move through the GI tract. (30 minutes to six hours to take effect.) Examples include Philip’s® Milk of Magnesia and Miralax®.
These prescription laxatives stimulate the GI tract to increase the frequency or strength of intestinal contractions (not their rhythm) to improve motility and relieve constipation. There are at least 10 of these medications yet only one is approved for use in the US under the trade names Reglan® and Maxeran®. The US has banned the others because of adverse effects.6
These stimulate the intestinal lining to propel the stool along. They provide very quick results. Examples include Ex-Lax®, Correctol®, and Dulcolax®.
Many people believe that the easiest or the only way to relieve their constipation is to resort to laxatives. Laxatives can be harsh on the body and disrupt its natural processes. Because they don’t get to the root cause of constipation, they are only a short-term solution. To truly find relief from constipation, the key is to identify the root cause and address it.
What Helps Constipation Symptoms Naturally?
Functional medicine looks to treat the root cause of the problem. As I mentioned, SIBO is often the underlying cause. Surprisingly, nearly 50% of people with IBS, or irritable bowel syndrome, actually have SIBO. If you think you have IBS, I recommend taking this quiz to find out if SIBO is actually the root cause.
Whether or not the issue is SIBO, while you are tackling the root cause of your constipation, you can start to support natural bowel function by incorporating a few simple dietary changes. These include drinking plenty of water, adding more leafy greens to your diet, and including artichokes in your meals. However, many of the traditional foods suggested for constipation such as prunes, beans, or flax seeds, are high in sugar and/or difficult to digest, making SIBO worse. It’s best to avoid those.
For those who need additional support, a great natural option for supporting healthy bowel function and avoiding constipation is Magnesium Citrate. Magnesium plays a vital role in metabolic functions and supports healthy bowel movements by attracting water in the intestine. Magnesium Citrate helps relax bowel spasms, is non-addictive, and is generally very gentle.
Remember, constipation is never normal. However, if it becomes your constant companion, resolve it by getting to the root cause. You don’t need to accept the bloat and discomfort of constipation from SIBO — or any other cause — as a part of daily life. You can banish constipation and experience the relief of “nature calling” on a regular basis.
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