You eat relatively healthfully, drink enough water and even try to add fiber to your diet — yet your digestive system still seems to be on strike. The reason may not lie only in what you eat.
Constipation is common, and it is not defined solely by infrequent bowel movements. It can also involve hard stools, straining during bowel movements or a feeling of incomplete evacuation. And while diet, hydration and fiber are important parts of the picture, they are far from the only factors that affect bowel function.
In recent years, it has become increasingly clear that the digestive system does not operate independently of the rest of the body. The gut and nervous system are in constant communication, in part through what is known as the “gut-brain axis,” meaning that stress, sleep, physical activity and everyday habits can also affect intestinal motility. So what other factors can contribute to constipation?
Stress starts in the mind — but can also be felt in the gut
Almost everyone knows the feeling of a “nervous stomach” before an exam, an important meeting or a stressful event. But for some people, prolonged stress can actually slow the digestive system.
Under stress, the body activates mechanisms that prepare it to respond to an immediate threat, while digestive activity can change at the same time. When stress becomes a regular part of daily life, intestinal motility may also be affected.
Breathing can play a role as well. Slow, deep breathing helps activate the parasympathetic nervous system, which is associated with rest and digestion. Stress-reducing activities such as exercise, breathing exercises, yoga, meditation or mindfulness may therefore be part of managing the problem, alongside addressing other contributing factors.
Prolonged stress may slow digestive activity
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The gut likes routine — and its signals should not be ignored
The digestive system has a rhythm of its own. Eating at irregular hours, skipping meals, spending long periods sitting and repeatedly ignoring the urge to have a bowel movement can disrupt the body’s natural habits.
One common behavior is putting off going to the bathroom because of work, travel, a meeting or simply a lack of time. When this happens repeatedly, it can affect the body’s natural response to the urge to defecate.
Whenever possible, it is therefore advisable to give the body regular, unhurried time for bowel movements, maintain a consistent daily routine and avoid repeatedly delaying the need to go.
It is not just how much fiber you eat — the microbiome matters too
Dietary fiber is an important part of healthy digestive function, but the issue goes beyond the number of grams consumed.
In recent years, the microbiome — the community of microorganisms living in the digestive tract — has become a major focus of research into gut health. Its composition has been linked, among other things, to digestion and gastrointestinal motility.
However, research in this field is still developing and not all of these connections are fully understood. Rather than focusing on one food or a particular supplement, it is better to look at the broader dietary picture: a varied diet, sufficient fiber from different sources and adequate fluid intake.
Fermented foods are also being studied in connection with gut health, but they are not a magic solution for constipation.
Dietary fiber
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Sometimes you simply need to move more
There is no need to begin an intensive exercise program to make lifestyle changes and add more movement to your day.
Even a daily 20- to 30-minute walk, taking the stairs, stretching or moderate physical activity can make a difference, especially for people who spend long hours sitting.
Movement can also have indirect benefits: It may help reduce stress, improve overall well-being and contribute to a healthier routine. For people who are barely active during the day, the amount of physical movement they get should also be considered among the factors that may affect bowel function.
Sleep can affect what happens in the gut too
Lack of sleep does not just leave you tired the next day. Sleep is connected to nervous system activity, hormone secretion and the body’s biological clock, and the digestive system is also influenced by these rhythms.
When sleep schedules vary significantly from day to day, when people consistently sleep too little or when sleep quality deteriorates over time, a range of processes in the body may be affected, including bowel habits in some cases.
For that reason, when trying to understand the cause of persistent constipation, sleep quality should also be taken into account rather than focusing only on what is on the plate.
Lack of sleep can also affect bowel habits
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When does constipation require a doctor’s attention?
In most cases, simple lifestyle changes are a reasonable place to start. But new or persistent constipation, or constipation that does not improve despite changes in diet, hydration and physical activity, warrants medical evaluation.
A significant and unexplained change in bowel habits that lasts for several weeks should also be checked.
Other warning signs include blood in the stool or rectal bleeding, black stools, significant or persistent abdominal pain, unintentional weight loss, vomiting, fever or an inability to pass gas.
It is important to remember that constipation can sometimes be a symptom of another medical condition, including hypothyroidism, diabetes, pelvic floor dysfunction or the use of certain medications and supplements.
In such cases, the goal is not only to relieve constipation but also to understand what is causing it.
- The writers are Dr. Galina Shenkerman, a specialist in endocrinology and internal medicine and medical director of the Center for Metabolic Disease Treatment (MEDBALANCE), and Tal Alter, a naturopath and head of the center’s naturopathic team.