The patients that land in my office have often been struggling for a long time.

Sometimes over 15 years. 

Some of them have just learnt to live with it. 

Others have spent hundreds, if not thousands, of dollars trying different protocols, tests, supplements and approaches. Each one promising to be the "cure".

Only to see that, time and time again, the symptoms come back. 

So when they reach me they are often frustrated, confused and so over it.

They just want something to work. 

And so when I was thinking about all the reasons people stay stuck, I came up with a list. 

A list of the most important things I would tell someone who was on this journey that would help redirect them towards what actually works. 

Listen, I've been doing this for 10+ years. I've seen all the trends come and go. I've heard all the things people try. And I've even learnt from my own mistakes as a Naturopathic Doctor. 

And this is what I came up with. 

The Top 9 Things You Need to Know About Chronic Constipation

If constipation is your issue, these are the things I would focus on over and above anything else you've heard:

A quick note first: everything here is about functional constipation, which means other causes have been ruled out. This is general education, not individual medical advice.

1. Your constipation likely has more than one cause

Some of it you can change, and some of it you can't. Focus on what's in your control. Get help with the rest. And yes, that can mean medications or over-the-counter laxatives.

There usually isn't one root cause. When one explanation gets all the attention, the other pieces get missed. And I'd say this is among one of the top reasons people stay stuck: eg. chasing SIBO protocols. 

2. Food and constipation is nuanced

Unless you have IBS with pain, food is rarely the main driver.

There may be some intolerances, and those are usually pretty easy to figure out, like lactose intolerance.

But most food reactions in constipation come from the backup. Clear the back up (yes, using laxatives or prokinetics) and most food reactions go away. 

If your list of "safe" foods keeps getting shorter, and you're still constipated, this is a key sign you need to get the poop moving. It's amazing what happens to "sensitivity" when the bowels are moving well. 

3. Fibre matters if you're deficient

Fibre isn't the villain, and it isn't the cure. Whether it helps depends on where you're starting.

So know your baseline. If you don't know it, track it.

If you're under about 25 grams a day, let's build a plan (strategically!! not all at once) to bring it up.

If you're not under, adding more while you're backed up can do more harm than good. So pause, and get support with motility first. 

4. Laxatives aren't a failure

When I say laxatives, I mean both over-the-counter and prescription options, including prokinetics.

You may need them short term. You may need them long term. Dosing and timing matter, so get support. There is a lot to know, and it's rarely as simple as "take this."

These aren't fringe options. The 2023 AGA-ACG guideline for chronic idiopathic constipation made strong recommendations for polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride, and conditional recommendations for fibre, lactulose, senna, magnesium oxide, and lubiprostone. Translated: they are safe and endorsed options for you chronic constipation. Not a last resort. Not something to fear. Get support with knowing which one is right for you, dosing, combination options and how to make them effective (this is exactly why I built the Laxative course- it will help you translate confusion and uncertainty into action and relief).

If you need them long term, let's remove the shame. Some causes we can change, and some we can't. You deserve to be supported and monitored over the long haul.

To date, there's no convincing evidence that laxatives cause damage, dependence, or tolerance. In fact, I'm writing a paper on this right now.

5. Your gut-brain connection matters

Stress didn't cause this, but it shapes it.

How tense you are through the day, how much rest and digest you get, and how your gut and brain are interpreting signals in the gut all play a role. Some of that may be beyond your control right now, which is exactly why you need some tools.

Find what helps your body settle. That could be micro-moments of regulation, adjusted exercise that fits where you are, gut-directed hypnotherapy, counselling, or more down time.

There are lots of options. Find the one that helps you feel more relaxed in your body.

6. Your pelvic floor is the most missed piece

This might be the number one thing I see missed in people who have been constipated for a long time. Some for 20 years.

Many have never had their pelvic floor assessed. Some have had it checked for vaginal health, but never around their bowels, and never adequately treated.

Dyssynergic defecation is when the pelvic floor muscles don't relax or coordinate when you strain to have a bowel movement. Biofeedback is the treatment. It teaches you to relax and coordinate those muscles. In randomized trials, biofeedback worked better than standard therapy (diet, exercise, and laxatives) for people with dyssynergic defecation. I

That's why assessment matters. Without it, you can try everything else on this list and still be missing the piece that matters most for you.

7. Your relationship with food matters

Under-eating, fearing foods, and irregular meals can all slow things down.

This goes beyond eating disorders. I'm also talking about ARFID (Avoidant Restrictive Food Intake Disorder) and disordered eating, including the sneaky ways it shows up: how often you eat, how much you eat, and how much fear you carry around food.

Some of that fear can be completely legitimate. It still matters for your bowels.

If this is a struggle for you, it may be one of the biggest things standing in your way.

8. Your microbiome matters, but SIBO and IMO aren't the first step

Methane can slow transit. In one recent study of 188 adults, higher methane was linked with slow transit, though only about 69 percent of the high methane producers had slow transit.

True overgrowth happens in a small subset of people with risk factors (eg. scleroderma, abdominal surgeries, diabetes, strictures from Crohn's, long-term PPI use etc), NOT everyone with bloating and gas. And chasing a treatment that isn't true leads to not only wasted time & money, but also negative effects on the microbiome. 

So address the foundations before chasing treatment.

Getting things moving, supporting a diversity of fibres, and not letting stool sit in the bowel all help.

9. Understand your diagnosis

Before chasing a root cause, learn what a Disorder of Gut-Brain Disorder (DGBI) means.

Working with someone who understands how multifactorial it is leads to the right treatment.

What I want you to take from this

My goal is to change how chronic constipation currently gets treated.

Too many people are under-managed and misinformed.

I'm here to change that.

Most people don't need to start over.

They need someone to look at the whole picture, work out what's driving their constipation, and strategically address things in the right order (yes, this matters!!).

If you'd like help with that, here are a few places to start:

  • Learn more about why you're still stuck: Watch my Free Masterclass, "Why Nothing Has Worked for Your Constipation"

  • Learn the strategy behind how to use laxatives & prokinetics in a way that actually helps. It includes bite-sized videos and actionable information to help you move towards relief. Grab the course here: "How to Use Laxatives to Get Things Moving"

  • And of course if you're in BC, my 1:1 work is where real transformation happens. Individualized. Strategic. And helps you build a plan that works lifelong, not just for a few weeks. Book a Discovery Call here. 

  • Not in BC, but interested in 1:1 work? Send me a message at info@drlovink.com. You've got options.