Constipation isn’t just uncomfortable, it is your body’s indication that something is ‘off’. It may be ‘off’ in the digestive system, detoxification system, endocrine system (hormones), nervous system, sleep-wake cycle and more. However, it is not just about the gut alone, even though the symptoms manifest in the gut.
Short-term softeners like Movicol can help you ‘go’ but they don’t address the root cause(s) and such medications have their own side effects. When you understand the whole journey of food through your gut, you will ‘get to know’ the many root causes of constipation, and how slow bowels can ripple outward, to auto-immune conditions, mental health conditions, even into hormone balance, such as oestrogen dominance.
Let’s travel through your digestive tract and look at what happens at each stop when things go a little ‘off kilter’.
But before we do, let’s determine what ‘normal’ healthy bowels look like. Healthy bowel function is about more than just going ‘regularly’. A few key markers:
- Frequency: ideally one to three bowel movements per day
- Ease: poop should pass without straining or pain.
- Texture and form: soft but shaped.
The Bristol Stool Chart: A quick visual check-in
The Bristol Stool Chart helps you (and your practitioner) quickly describe what you are seeing:
- Type 1: Separate hard lumps, like nuts, very constipated
- Type 2: Sausage-shaped but lumpy, constipated
- Type 3: Sausage with cracks on the surface, ideal
- Type 4: Smooth, soft, snake-like, ideal
- Type 5: Soft blobs with clear edges, tending toward loose
- Type 6: Fluffy, mushy pieces, mild diarrhoea
- Type 7: Watery, no solid pieces, diarrhoea
Goal is Type 3–4, formed, soft, and easy to pass.
When stool sits too long (slow transit), it tends to shift toward Type 1–2; if it moves too fast, it shows up as Type 5–7.
Stop 1: The cephalic phase, where the senses switch on digestion
Digestion doesn’t start with chewing, it starts in your brain. The moment you see, smell, or even think about food, your nervous system flips into the cephalic phase: salivary glands wake up, the vagus nerve signals your stomach to prepare acid, and the pancreas and gallbladder get a ‘head start’.
If you eat while distracted, stressed, or scrolling, this beautiful sensory priming doesn’t happen well.
If this stage falters/by-passed (think eating ‘food on the go’, ‘inhaling’ food etc):
- Less saliva and digestive enzymes are released
- Stomach acid production may be weak
- Food enters the stomach underprepared, setting up later gas, bloating, and slower transit. Slower transit is when food and waste move through the digestive tract more slowly than normal
TIP: pause before meals. Look at your food, inhale its aroma, let your senses switch digestion ‘on’. Even one deep breath and a moment of appreciation helps! A prayer of gratitude for the food on your plate, perhaps? But skipping the cephalic phase, can set you up for slower bowel movements.
Stop 2: The mouth, mechanical digestion and salivary enzymes
Chewing is not just a matter of politeness or boredom; it is a physiological process. Saliva starts starch breakdown and signals your stomach to release acid. If you rush, gulp food, and wash it down with water, coffee, or a beer, big chunks hit the stomach unprepared. The gut does not like to be surprised, it likes to be ‘warned’.
If this stage falters:
- Stomach acid release is weaker
- Large particles strain the rest of digestion
- Gas and bloating may show up further down
These can result in sluggish bowels.
Tip: chew until food is soft, aim for 20–30 chews per bite, and take a few slow breaths before eating to switch on the ‘rest and digest’ message.
Stop 3: The stomach where acid matters
Your stomach acid (hydrochloric acid, HCl) sterilises food, starts proteinProtein is one of the three main macronutrients, alongside fats and carbohydrates, yet for many years it was often the forgotten member of the trio. More recently, protein has become something of a celebrity in the nutrition world, appearing in everything from snack bars and cereals to coffee and desserts. Whilst the marketing can sometimes get a little carried away, the truth is that protein is essential for human health. Every cell in the body relies on it. Protein helps build and repair tissues, supports immune function, forms enzymes and hormones, transports nutrients, and helps maintain muscle mass, particularly as we age. breakdown, and triggers bile and enzyme release. Many people have too little HCl, especially after long-term antacids, stress, or ageing (check out our blog on Acid Reflux).
If stomach acid is low:
- Protein isn’t fully broken down, leading to fermentation, gas and delayed emptying
- The ‘acid signal’ to the pancreas and gallbladder becomes faint, the pancreas doesn’t get a ‘clear strong’ message to release its enzyme-rich alkaline juices, and the gallbladder may contract only weakly. Without the clear communication, digestion slows and motility stalls
- Food lingers too long, adding further to the risk of constipation
Functional testsIf you have ever been told, ‘your blood tests are normal’, not ‘normal’ or not yourself, then you have already discovered one of the reasons functional testing has become so popular. Functional tests are designed to provide additional information about how the body is functioning. They may explore areas such as hormones, digestion, nutrient status, fatty acids, the microbiome, genetics, metabolism, or stress physiology. Think of them as gathering more pieces of the health puzzle, ideally before a dis-ease ‘shows up’. Sadly, most people turn to functional tests, once they have a dis-ease. such as Organic Acids (OAT) for indirect signs, Heidelberg test, stool elastase and steatocrit in a comprehensive stool analysis will provide in insight as to the root causes of constipation.
Stop 4: The pancreas, enzyme power
The pancreas adds enzymes: amylase for carbs, lipase for fats, proteases for proteins.
If enzymes are low:
- Food isn’t fully digested, so more ‘residue’ (undigested material) reaches the large intestine
- This feeds gas-producing bacteria and slows motility
- The stools may be pale, bulky, sticky, and may float.
These can all impact bowel motility.
Tip: support the pancreas with some enzymes and/or with HCL betaine, short-term while root causes are addressed
CORRECT POOPING POSTURE
Stop 4: Liver and gallbladder, the dynamic duo
Bile acts like a detergent, it emulsifies fats, lubricates stool, and carries out toxins including used hormones including a whole host of other functions (more in the dynamic duo webinar)
If bile flow is sluggish or the bile is ‘gunky’:
- Stools can be pale, dry, sticky, or hard to pass
- Fat isn’t digested, you may feel nauseous after fatty meals or notice floating stools
- Old oestrogen and other waste can be reabsorbed …eeeek
The condition of bile and the flow of bile can impact bowel motility.
Functional tests such as a comprehensive stool analysis that look at steatocrit and fat markers are useful to determine issues with this ‘stop’.
You can support bile flow and bile health with bitter greens (rocket, radicchio, dandelion), artichoke, lemon, ginger, ensuring strong stomach acid and gentle movement after meals.
NOTE: if you have/had gall bladder issues such had cholestasis during pregnancy
a family history of gall bladder issues, or have thyroid issues, find that your stools float and can be quite pale, then you may want to pop over to the dynamic duo webinar, and invest in learning how to address sluggish and/or ‘gunky’ bile. Poor bile health and flow is more common than we are led to believe.
Stop 5: Small intestine for nutrient uptake and ‘housekeeping’
This is where most nutrients are absorbed. And between meals, your Migrating Motor Complex (MMC) sweeps leftover food and bacteria along like a housekeeping wave.
If MMC is disrupted (such as by constant grazing or stress):
- Food stagnates, bacteria overgrow (hello, SIBO).
- Gas, bloating, and slowed transit follow
If absorption is impaired, your overall nutrient stores drop and that can slow the gut in several ways. Low magnesium, sodium, and zinc can weaken stomach acid production and peristalsis. Poor iron uptake can contribute to low thyroid function, further reducing motility. And if you are not absorbing fat-soluble vitamins (A, D, E, K) well, the gut may make less protective mucus, leaving the lining dry and sluggish. Together these gaps create a perfect storm for constipation.
Tip: Support MMC by leaving 3–4 hours between meals, avoiding constant snacks, and finish eating 2–3 hrs before bed. Eat a nutrient-dense diet.
Stop 6: The microbiome, your gut ‘buddies’
Your colon is a dense city of microbes. When balanced, they help produce vitamins, protect the gut lining, and aid in stool movement.
But when dysbiosis or SIBO occurs:
- Methane-producing bugs slow motility dramatically
- Some bacteria release beta-glucuronidase, which ‘unpacks’ oestrogen that the liver had already detoxed, sending it back into circulation (hello oestrogen dominance, hello PMS, hello weight gain to greet a few), slowing down metabolismMetabolism is not a calorie-burning furnace that sits somewhere near your belly button, deciding whether you can fit into last year's jeans. Metabolism is the set of chemical processes taking place inside your body every second of every day, keeping you alive. in general, thereby further impacting gut motility.
Functional tests like the comprehensive stool test are valuable in determining dysbiosis and issues with beta-glucuronidase. SIBO breath tests can be used to check hydrogen vs methane-producing bacteria. These tests can then help your practitioner put together a personalised plan for your needs and get your gut moving efficiently.
Stop 8: Large intestine, water balance and fibre
The colon reabsorbs water and electrolytes while shaping the stool.
- Too slow can result in too dry a stool: the longer stool sits, the more water your colon pulls back.
- Too fast can produce loose stools: less water is absorbed
Fibre helps regulate the stool consistency and bowel motility
- Soluble: oats, chia, flax, softens and bulks the stool
- Insoluble: brown rice, veg stalks, nuts, adds bulk and speed
- Prebiotics (food for the microbes): onions, garlic, leeks, artichokes etc, feed the good bugs but be mindful if you are bloated
Hydration tip: drink approximately 30–35 ml per kg body weight daily (2–2.5 L for most adults), but also eat water-rich whole foods such as fruits, veg, soups, stews. Processed foods are dehydrating.
The nervous system link
Digestion only runs smoothly with a well-regulated nervous system. The parasympathetic (rest and digest) system is needs to be activated for the digestive system to function. Stress, trauma, or chronic ‘freeze’ can shut motility down.
Tip: deep breathing before meals, humming or singing, gentle vagal nerve exercises, and eating mindfully will all support the nervous system to be in a more ‘parasympathetic state’ and therefore aid digestion.
Other useful aids whilst the root causes are being investigated/addressed include:
Rapid Relief Homeopathy
- Alumina: no urge, dryness, stool feels soft but won’t pass
- Bryonia: dry, hard, painful; better lying still
- Nux Vomica: frequent urge but incomplete; stress/coffee/late nights
- Opium: total bowel shutdown after shock or meds
- Lycopodium: bloating and gassiness, worse later in day
Smarter support vs quick fixes
- Magnesium supplement, gentle hydration for stool (but if the key electrolytes are out of balance, then magnesium will only aggravate)
- Plain psyllium husk, fibre without additives. Go low and slow and see how you feel
- Belly breaths before meals
- Chew 20–30 times per bite
- Walk after eating
- Leave your mobile phone out of the bathroom
- Squatty potty or footstool
- Gentle yoga & core activation
- Space meals to let the MMC sweep
- Hydrate from both water and whole foods
Your gut also has a clock too aka the melatonin and circadian rhythm
Your gut doesn’t just rely on the brain for cues; it keeps time itself. The cells lining your intestines have their own circadian clocks, and they respond to melatonin, that the same hormone that helps you sleep.
Your gut makes melatonin (in even higher amounts than your brain) and uses it to:
- Regulate smooth muscle contractions and keep stool moving
- Reduce gut inflammation and protect the intestinal lining
- Coordinate with the migrating motor complex so cleanup waves happen at night (as long as you are not snacking in the midnight hours!)
If your circadian rhythm is off, late nights, bright screens after dark, and not enough morning light can all contribute to a drop in your gut’s melatonin production. That can slow motility and worsen constipation.
We use various functional tests to determine melatonin, to see if the body clock is ‘aligned’.
Reset tips: get early morning outdoor light, dim lights/screens at night, have consistent meal times as much as is possible, and a gentle evening wind-down.
A 21st century epidemic, is a sluggish thyroid aka hypothyroidism
A sluggish metabolism means a sluggish gut. Your thyroid hormones (especially T3) help set the pace of nearly every system, including your gut’s peristalsis the rhythmic waves that move stool along.
When thyroid function is low:
- The ‘gut conveyor belt’ slows and transit time stretches from one day to several
- Bile production can drop (further slowing stool and detox too)
- The gut wall may be less active and less lubricated.
You may notice constipation along with fatigue, dry skin, hair loss, weight gain, feeling cold, and brain fog.
Supporting the thyroid when it’s underactive can dramatically improve gut motility.
As you can see, constipation has a plethora of root causes, from hydration and meal timing right down to hormones, thyroid, bile flow, and nervous system health. When you stop chasing quick fixes and start understanding your body’s physiology, you can create lasting change. You don’t have to solve it alone; with the right testing, support, and practical tools, relief is possible and sustainable.
To health!
From the team at the New School Of Nutritional Medicine
Learn about the Founder & Principal of the New School of Nutritional Medicine, Dr Khush Mark PhD, HERE.
