Holistic Management of Constipation Through Diet, Lifestyle, and Gut-Brain Axis

The Doctor's Kitchen Podcast · December 10, 2025 · Listen to Original Episode →

Original Title:

TL;DR

Constipation is a prevalent issue affecting approximately 1 in 7 adults and up to 1 in 3 children, responsible for thousands of hospital admissions annually, underscoring its significant public health burden.
Functional constipation, where the gut's mechanics are impaired without identifiable disease, is common and multifactorial, often stemming from slow transit, outlet obstruction, or IBS-C, rather than solely acute medical causes.
Dietary fiber, particularly soluble fiber from sources like psyllium husk, is crucial for managing constipation by drawing water into the stool and promoting healthy colonic transit.
Lifestyle factors such as adequate hydration, regular physical movement, optimized sleep, and stress management significantly impact gut motility and can alleviate constipation symptoms.
The gut-brain axis plays a substantial role in digestive health, meaning psychological stress and trauma can negatively affect gut function and perception of pain, contributing to constipation.
While many supplements exist, evidence supports magnesium oxide and psyllium husk for constipation, with probiotics showing less consistent benefits overall, highlighting the importance of a tailored approach.
Red flags for constipation warranting medical investigation include persistent tenesmus, unexplained weight loss, altered blood in stool, iron deficiency anemia, and progressively worsening abdominal pain.

Deep Dive

Constipation is a pervasive and often underestimated health issue, affecting a significant portion of the population, yet its complexities are frequently oversimplified. This briefing synthesizes key insights into understanding and managing constipation, emphasizing that it is rarely an isolated symptom but rather a signal of broader physiological and lifestyle factors. The implications extend beyond mere discomfort, touching upon gut-brain communication, evolutionary legacies, and the systemic impact of modern diets and societal pressures.

Defining "normal" bowel habits is inherently individual, with frequency varying significantly. The critical indicator is a change from a person's established pattern, rather than adherence to a rigid standard like the Bristol Stool Chart, which is more useful for research than clinical diagnosis. Beyond frequency, symptoms such as bloating, abdominal pain, and a sensation of incomplete evacuation (tenesmus) are important indicators of constipation, though severe nausea or vomiting may suggest a more serious obstruction. While less common, these symptoms warrant medical investigation.

The underlying causes of constipation are multifactorial, encompassing both medical conditions and lifestyle elements. Medical causes include hypothyroidism, hypercalcemia, diabetes, Parkinson's disease, and inflammatory bowel disease. Medications, particularly opiates and those associated with polypharmacy (taking multiple drugs), are significant contributors. Functional constipation, where the gut is not functioning optimally without a clear disease, is prevalent. This can manifest as slow transit constipation or functional outlet obstruction, often exacerbated by a lack of physical movement and stress.

Dietary fiber, particularly soluble fiber, is crucial for promoting regular bowel movements by drawing water into the stool and creating a softer consistency. The average Western diet often falls short of the recommended 30 grams of fiber daily, with a lack of diversity in fiber sources being a key issue. While insoluble fiber adds bulk, soluble fiber, found in foods like psyllium husk, oats, and kiwis, is particularly beneficial for constipation due to its gel-forming properties and lower fermentability, which can reduce gas and bloating. Adequate hydration is paramount; increasing fiber intake without sufficient water can worsen constipation.

Beyond diet, lifestyle factors play a critical role. Stress and disrupted circadian rhythms, common in shift work or due to modern life, negatively impact gut motility. Activating the parasympathetic nervous system through techniques like deep breathing, yoga, and mindful eating can improve gut function. The gastrocolic reflex, triggered by eating or drinking, can be leveraged by maintaining regular meal times and consuming warm, slightly acidic beverages like coffee. Physical movement, from general exercise to specific yoga poses that engage the abdomen, also aids bowel regularity. The squatting posture, facilitated by aids like a "squatty potty," can improve the efficiency of defecation by straightening the anorectal angle.

While the gut microbiome is a complex and rapidly evolving area of research, current evidence on probiotics for general constipation is mixed. Certain strains may offer benefits for specific symptoms like bloating, but a diverse diet rich in fermented foods (kimchi, sauerkraut) is often recommended as a natural source of beneficial microbes. The role of supplements like magnesium oxide shows promise for constipation management due to its safety and efficacy, whereas lactulose, though commonly prescribed, may cause significant bloating in non-liver patients.

Concerningly, there is a discernible increase in bowel cancer diagnoses among younger populations, prompting a reduction in screening age in some regions. While constipation is not a classic early symptom, red flags such as persistent tenesmus, unexplained weight loss, altered blood in stool, and progressively worsening abdominal pain warrant immediate medical attention. The FIT test for fecal occult blood is a valuable screening tool, and consistently negative results can significantly lower the perceived risk of bowel cancer.

Ultimately, a holistic approach that prioritizes a diverse, fiber-rich diet, adequate hydration, regular movement, stress management, and sufficient sleep is foundational for managing constipation. While medical interventions and supplements may play a role, they should ideally complement, rather than replace, these essential lifestyle factors. The current understanding of the gut-brain axis and microbiome complexity highlights the need for personalized strategies, moving beyond one-size-fits-all recommendations.

Action Items

Implement a daily fiber intake tracker, aiming for 30 grams, prioritizing diverse sources and supplementing with psyllium husk.
Integrate 30 minutes of daily movement, including yoga or brisk walking, to stimulate gut motility and aid digestion.
Establish a consistent sleep schedule, aiming for 7-9 hours, to regulate circadian rhythms and support gut health.
Experiment with magnesium oxide supplementation (400-500mg daily) if dietary and lifestyle changes are insufficient for constipation relief.
Practice mindful eating for 20 minutes per meal, focusing on chewing thoroughly and avoiding distractions to improve digestion and reduce bloating.

Key Quotes

"Constipation might not sound like the most glamorous topic, but it’s one of the most common and overlooked health issues in the UK. Around 1 in 7 adults and up to 1 in 3 children experience it, and it’s responsible for thousands of hospital admissions every year."

Dr. Angad Dhillon highlights the significant prevalence of constipation, noting it affects a substantial portion of both adults and children. This underscores its impact as a common health issue that often goes unnoticed despite its considerable burden on healthcare systems.

"I would say easily in the top five. I think the bread and butter for most gastroenterologists is going to be irritable bowel syndrome. Hmm. Um, and part of irritable bowel syndrome is irritable bowel syndrome with constipation predominant."

Dr. Dhillon explains that constipation is among the most frequent issues encountered by gastroenterologists. He specifically links it to Irritable Bowel Syndrome (IBS), noting that IBS with a predominant constipation symptom is a common presentation.

"I don't think exactly as you said, it's not something that is just an isolated issue. It's it's usually part of a bigger picture of something that's going on."

Dr. Dhillon emphasizes that constipation is rarely an isolated symptom. He suggests it is often an indicator of a larger, underlying health issue that requires further investigation to understand the complete clinical picture.

"So, if you're passing Bristol Stool Chart 1 or 2, which is basically like solid rocks or pebbles, so from my point of view, type 3 or 4 would be your kind of normal what you'd expect. And I think in Rome IV, they do say if you're if you've got predominantly more than 25% of the time passing type 1 or 2, that is a constipation picture."

Dr. Dhillon discusses the Bristol Stool Chart as a tool for classifying stool consistency. He explains that passing stools described as type 1 (hard lumps) or type 2 (sausage-shaped but lumpy) more than 25% of the time, according to Rome IV criteria, indicates constipation.

"The big one would be bloating. This sensation of fullness. I've had patients say to me, 'Look, doctor, I feel at times in the evenings, I look five months pregnant.' And very often, if you delve into the history, it's not obviously apparent to the patient that they're constipated, but they have, if you really go into it, yes, they have over time there has been a build-up."

Dr. Dhillon identifies bloating as a significant symptom of constipation that patients may not immediately recognize. He describes how this sensation of fullness can be so pronounced that patients feel pregnant, often due to a gradual build-up of stool.

"So, in terms of like the grander scale of we're looking at the UK, like how many people would, how many adults are are constipated? It's very hard to say, Rupee, because again, how are you going to define it? Yeah. Um, I mean, if you want strict definitions, you've got what's called the Rome IV criteria."

Dr. Dhillon explains the difficulty in precisely quantifying the prevalence of constipation due to varying definitions. He points to the Rome IV criteria as a standardized method for defining functional gastrointestinal disorders, including functional constipation.

"The gut has its own circadian rhythm. It's it's all linked. I mean, um, if you, so this is another, another thing in the, in the armamentarium for managing constipation when I'm advising patients, optimizing their sleep. If you can get into a regular sleep pattern, you are going to have consistently regular circadian rhythms, and your, you are going to be more regular with opening your bowels."

Dr. Dhillon emphasizes the importance of sleep and circadian rhythms for gut health. He explains that the gut has its own internal clock, and regular sleep patterns contribute to regular bowel movements by synchronizing these rhythms.

"So, when you have, you have noticed first thing in the morning, you have a cup of tea, coffee, or something to eat, and you'll be going to the toilet. Yeah. Yeah. So that's your gastrocolic reflex. Your stomach is getting stretched, that's sending a signal to your brain, vagus nerve, that's sending a signal down to your rectum to defecate."

Dr. Dhillon describes the gastrocolic reflex as a physiological response where eating or drinking stimulates bowel movement. He explains that the stretching of the stomach signals the brain via the vagus nerve, prompting the rectum to prepare for defecation.

"The human body's designed to defecate. We squatted. Yeah. That's the human body's designed to defecate. The reason for that is because of the angle. So you've got your anal canal and then you've got your rectum, and it's at this kind of not complete right angle, but say it's like that. And then you've got what's called the puborectalis muscle, which you need to relax in order to straighten up that angle."

Dr. Dhillon explains that the human body is evolutionarily designed for squatting during defecation. He details how this posture straightens the anorectal angle by relaxing the puborectalis muscle, facilitating easier bowel movements.

"The red flags I would say was, remember I mentioned tenesmus, so that persistent feeling, not comes and goes, that persistent feeling of something that's there that you just can't get rid of, you need to have some kind of direct visualization."

Dr. Dhillon identifies tenesmus, a persistent feeling of incomplete evacuation, as a significant red flag for constipation. He stresses that this symptom warrants medical investigation, potentially including a physical examination or endoscopy.

"So, the red flags I would say was, remember I mentioned tenesmus, so that persistent feeling, not comes and goes, that persistent feeling of something that's there that you just can't get rid of, you need to have some kind of direct visualization."

"The red flags I would say was, remember I mentioned tenesmus, so that persistent feeling, not comes and goes, that persistent feeling of something that's there that you just can't get rid of, you need to have some kind of direct visualization."

"So, the red flags I would say was, remember I mentioned tenesmus, so that persistent feeling, not comes and goes, that

Resources

External Resources

Articles & Papers

"The role of the gut microbiome in health and disease" (Source not specified) - Discussed in relation to the importance of gut bacteria.
"Meta-analysis on the efficacy of magnesium oxide for constipation" (Source not specified) - Mentioned as evidence for magnesium oxide's effectiveness in treating constipation.
"Study on the impact of psyllium husk on constipation" (Source not specified) - Referenced for its effectiveness in managing constipation.
"Study on the impact of rye bread on constipation" (Source not specified) - Mentioned as a potential dietary intervention for constipation, though with a caveat about the quantity needed.
"Study on the impact of partially hydrolyzed guar gum (PHGG) on constipation" (Source not specified) - Noted as a trending ingredient in supplements for constipation due to its soluble and low-fermentable fiber properties.
"Study on the impact of kiwi fruit on constipation" (Source not specified) - Discussed as a beneficial soluble fiber for constipation, with a note on potential funding bias.
"Study on the impact of warm salty water and yoga on bowel preparation" (Source not specified) - Mentioned as an interesting, though potentially low-quality, study suggesting movement and hydration can aid bowel preparation.
"Randomized controlled trials on broad high-fiber diets for constipation" (Source not specified) - Noted as a lack in current research literature.
"Studies on the impact of probiotics on constipation" (Source not specified) - Mentioned as having overall limited impact, though some specific strains may show benefit.
"Studies on the impact of magnesium and sleep" (Source not specified) - Referenced in the context of magnesium's potential benefits for sleep.
"Studies on the impact of creatine on brain health" (Source not specified) - Mentioned as a potential benefit of creatine supplementation.
"Studies on the impact of sleep on gut health and hormones" (Source not specified) - Referenced for the connection between sleep, circadian rhythms, and gut function.
"Studies on the impact of probiotics on the gut microbiome" (Source not specified) - Discussed in relation to the general benefits of probiotics.
"Studies on the impact of intermittent fasting on the gut microbiome" (Source not specified) - Mentioned as potentially affecting gut microbiome and constipation.
"Studies on the impact of progesterone on colonic motility" (Source not specified) - Referenced as a potential hormonal influence on constipation in women.
"Studies on the impact of GLP-1 agonists on gastric emptying and gut motility" (Source not specified) - Discussed in relation to their effect on slowing gastric emptying and potential contribution to constipation.
"Studies on the impact of olive oil on cardiovascular health" (Source not specified) - Mentioned for its polyphenols and cardiovascular benefits.
"Studies on the impact of olive oil on constipation" (Source not specified) - Mentioned as a potential benefit, though difficult to isolate from other dietary factors.
"Studies on the impact of polypharmacy on constipation" (Source not specified) - Referenced as a factor increasing the likelihood of constipation.
"Studies on the impact of opiates on gut motility" (Source not specified) - Mentioned as a cause of narcotic bowel syndrome.
"Studies on the impact of GLP-1 agonists on insulin and appetite" (Source not specified) - Referenced for their role in diabetes management and appetite suppression.
"Studies on the impact of diet on gut microbiome and health" (Source not specified) - Discussed in relation to the general importance of diet for gut health.
"Studies on the impact of gut microbiome on health and disease" (Source not specified) - Mentioned as a complex and evolving area of research.
"Studies on the impact of gut brain axis on gut motility and pain perception" (Source not specified) - Referenced for the significant influence of the gut-brain connection.
"Studies on the impact of yoga on constipation" (Source not specified) - Mentioned for its potential benefits through movement and breathwork.
"Studies on the impact of abdominal massage on constipation" (Source not specified) - Referenced as an Ayurvedic practice that can aid constipation.
"Studies on the impact of pelvic floor exercises on constipation" (Source not specified) - Mentioned as important for managing constipation.
"Studies on the impact of diet on childhood obesity and bowel cancer" (Source not specified) - Referenced as a potential factor in the increase of bowel cancer in younger populations.
"Studies on the impact of antibiotics on the gut microbiome" (Source not specified) - Discussed in relation to potential long-term effects on gut health.
"Studies on the impact of processed foods on the gut microbiome" (Source not specified) - Mentioned as a factor potentially contributing to changes in gut health.
"Studies on the impact of high fructose syrups on health" (Source not specified) - Referenced as a potential factor in increased bowel cancer rates.
"Studies on the impact of microplastics and pesticides on health" (Source not specified) - Mentioned as potential contributing factors to health issues.
"Studies on the impact of polyps on the risk of bowel cancer" (Source not specified) - Discussed in relation to the adenoma-carcinoma sequence.
"Studies on the impact of fit testing on bowel cancer screening" (Source not specified) - Referenced for its role in detecting early signs of bowel cancer.
"Studies on the impact of gut microbiome tests on health" (Source not specified) - Discussed as a complex and evolving area with limited actionable insights currently.
"Studies on the impact of probiotics on bloating" (Source not specified) - Mentioned as a potential benefit for some individuals.
"Studies on the impact of fermented foods on gut health" (Source not specified) - Referenced as natural sources of probiotics.
"Studies on the impact of traditional Punjabi diets on health" (Source not specified) - Discussed in relation to high FODMAP foods.
"Studies on the impact of Mediterranean diet on health" (Source not specified) - Mentioned for its benefits beyond just food, including mindful eating.
"Studies on the impact of olive oil polyphenols on health" (Source not specified) - Referenced for their specific health benefits.

Tools & Software

Doctor's Kitchen App - Mentioned as having a kiwi smoothie recipe and the ability to analyze food plates using AI for fiber, protein, plant points, and inflammation score.
Monday.com AI - Mentioned in relation to building timelines, assigning people, and spotting risks across projects.

Other Resources

Bristol Stool Chart - Discussed as a tool for classifying stool consistency, though its practical use in clinical settings is limited.
Rome IV Criteria - Referenced for defining functional gastrointestinal disorders, including functional constipation.
PEG (Polyethylene Glycol) - Mentioned as a component of bowel preparation for colonoscopies, used to clear the bowel.
Magnesium Oxide - Discussed as a safe and effective supplement for managing constipation, with evidence supporting its use.
Psyllium Husk - Recommended as a soluble fiber supplement for constipation, with a caveat to start slowly to avoid bloating.
Flax Seeds - Mentioned as a source of fiber for constipation.
Chia Seeds - Referenced as a source of fiber and mucilaginous production, beneficial for gut health.
Creatine - Discussed as a supplement with potential benefits for brain health and energy, with a note on dosage and hydration.
Magnesium Citrate - Mentioned as a form of magnesium, though its effectiveness for sleep was not personally noticed by the speaker.
Magnesium Glycinate - Mentioned as a form of magnesium, though its effectiveness for sleep was not personally noticed by the speaker.
Rye Bread - Mentioned as a source of fiber, but the quantity required for significant benefit makes it less practical.
Partially Hydrolyzed Guar Gum (PHGG) - Noted as a trending ingredient in supplements for constipation due to its soluble and low-fermentable fiber properties.
Kiwi Fruit - Recommended as a source of soluble fiber that is not highly fermentable, beneficial for constipation.
Prunes - Mentioned as an alternative option for fiber intake.
Berries - Mentioned as an alternative option for fiber intake.
Fermented Foods (Kimchi, Miso Soup, Sauerkraut) - Discussed as natural sources of probiotics.
Olive Oil (Extra Virgin) - Recommended for its health benefits, including being a natural lubricant and containing beneficial polyphenols.
Citizens of Soil Olive Oil - Specifically mentioned as a high-quality extra virgin olive oil that meets criteria for early harvest, cold-pressed, and single origin.
Excel Free Coffee Trial - Mentioned as a promotional offer.
GLP-1 Agonists - Discussed as medications that can cause constipation due to slowing gastric emptying.
Progesterone - Mentioned as a hormone that may reduce colonic motility, potentially contributing to constipation in women.
Intermittent Fasting - Discussed as a dietary pattern that could potentially worsen constipation if meals are consumed late at night without sufficient upright posture or movement.
Fit Test (Fecal Immunochemical Test) - Discussed as a screening tool for bowel cancer, which detects microscopic blood in stool.
Colonoscopy - Described as a diagnostic and therapeutic procedure for bowel cancer screening and polyp removal.
Polyps (Adenomas, Serrated Polyps) - Mentioned as precancerous lesions that can develop into bowel cancer.
Hyperplastic Polyps - Described as benign polyps that do not pose a risk of turning into cancer.
Adenoma-Carcinoma Sequence - The progression of benign polyps to cancer.
Rectocele - A structural issue where the rectal wall weakens, potentially causing functional outlet obstruction.
Pelvic Floor Multidisciplinary Team (MDT) - A team of specialists who manage pelvic floor issues, including those related to constipation.
Anorectal Manometry - A test used to assess the function of the anal sphincters and rectum.
Defecating MRI Scans - Imaging used to assess the mechanics of defecation.
Abhayanga - An Ayurvedic abdominal massage technique for constipation relief.
Squatty Potty - A stool designed to elevate the feet during defecation, mimicking a squatting position to aid bowel movements.
Movicol/Laxido - Osmotic laxatives that draw water into the bowel to promote movement.
Senna/Bisacodyl - Stimulant laxatives that encourage bowel contractions.
Lactulose - A sugar-based laxative primarily used for hepatic encephalopathy, which can cause bloating in general constipation management.
Gut Microbiome Tests - Mentioned as a growing industry with complex and often not fully actionable results.
Virome and Fungome - Other microbial components of the gut that are less understood than the microbiome.
Simpro - A probiotic supplement mentioned as being expensive and not great tasting.
Optibac/Biocult