Constipation

from a Functional Medicine Perspective

Constipation is one of the most common digestive complaints, yet it’s often misunderstood and oversimplified. In functional medicine, constipation isn’t just about infrequent bowel movements; it’s a sign that something deeper in the body is out of balance. Addressing it means identifying the root cause and restoring optimal digestive, nervous system, and detox function.

Understanding Constipation Beyond the Surface

Clinically, constipation is defined as having fewer than three bowel movements per week, hard or difficult-to-pass stools, or a persistent feeling of incomplete evacuation. However, in functional medicine, we see it as a communication signal from the gut, pointing to sluggish motility, microbial imbalance, or impaired detoxification.

Chronic constipation can lead to toxin reabsorption, hormonal imbalance (especially estrogen dominance), dysbiosis, bloating, fatigue, and even skin issues. The goal is not just symptom relief but restoring the natural rhythm of elimination.

Root Causes of Constipation

Constipation is rarely caused by one single factor. Some of the most common underlying contributors include:

• Gut dysbiosis (imbalanced gut bacteria)

• Low stomach acid or bile flow

• Dehydration

• Insufficient dietary fiber or fat intake

• Magnesium or electrolyte deficiency

• Chronic stress and vagal nerve dysfunction

• Thyroid dysfunction (especially hypothyroidism)

• Medication side effects (e.g., antidepressants, iron supplements, opioids)

Functional Medicine Strategies for Relief

1. Hydration & Electrolyte Balance

Start with the basics: water and minerals. Hydration keeps stool soft and supports colon motility. Aim for half your body weight (in ounces) of filtered water daily, and include electrolytes from sources like coconut water, sea salt, or mineral drops.

2. Optimize Fiber Intake

Not all fiber is equal. Blend soluble fiber (like chia seeds, ground flax, psyllium, apples, and oats) with insoluble fiber (like leafy greens, celery, and carrots) to create bulk and movement in the intestines. For sensitive individuals or those with IBS, low-FODMAP fibers may be better tolerated.

3. Support Bile Flow and Digestive Function

Healthy bile flow is essential for fat digestion and bowel regularity. Support the liver and gallbladder with foods like beets, dandelion greens, artichokes, and lemon water. Digestive bitters or gentle bile-supporting supplements can also help stimulate peristalsis.

4. Restore the Gut Microbiome

A healthy microbiome regulates motility through short-chain fatty acid (SCFA) production. Incorporate probiotic-rich foods such as sauerkraut, kefir (dairy-free if needed), and fermented vegetables. For those with dysbiosis or overgrowth, targeted antimicrobial protocols may be necessary under practitioner guidance.

5. Relax the Nervous System

The gut and brain are deeply connected. Chronic stress shuts down the “rest and digest” state, slowing motility. Techniques such as deep breathing, vagus nerve stimulation, meditation, yoga, or gentle abdominal massage can help reestablish parasympathetic tone.

6. Consider Natural Supports

• Magnesium citrate or glycinate: Promotes relaxation and motility.

• Castor oil packs: Encourage lymphatic flow and gentle detoxification. Click here to learn more

• Aloe vera juice or triphala: Can naturally support bowel movement and tissue repair.

When to Seek Professional Support

If constipation persists longer than a few weeks, is accompanied by blood in the stool, significant pain, or unexplained weight loss, it’s important to consult a healthcare provider. Functional stool testing (like a GI-MAP) can help identify bacterial imbalances, infections, or digestive insufficiencies contributing to symptoms.

The Functional Medicine Takeaway

Constipation is your body’s way of signaling an imbalance. Rather than masking the symptom, functional medicine works to uncover why it’s happening, whether it’s stress, sluggish bile flow, thyroid dysfunction, or a microbial imbalance, and uses nutrition, lifestyle, and targeted therapies to restore balance naturally.

Your digestive system thrives when supported holistically, through hydration, mindful eating, nervous system regulation, and liver and gut care. True healing begins when the root cause is addressed, not just the symptom.

References

Camilleri, M., Bharucha, A. E., Farrugia, G., & Lembo, A. (2017). Functional constipation. Nature Reviews Disease Primers, 3, 17095. https://doi.org/10.1038/nrdp.2017.95

Müller-Lissner, S. A., Tack, J., Feng, Y., Schenck, F., & Specht Gryp, R. (2017). Levels of satisfaction with current chronic constipation treatment options in Europe – An internet survey. Alimentary Pharmacology & Therapeutics, 45(5), 637–648. https://doi.org/10.1111/apt.13917

Quigley, E. M. M. (2019). The gut microbiome in health and disease. Gastroenterology & Hepatology, 15(3), 143–155.

Tack, J., & Drossman, D. A. (2017). What’s new in Rome IV? Functional GI disorders: Disorders of gut–brain interaction. Gastroenterology, 150(6), 1257–1261. https://doi.org/10.1053/j.gastro.2016.10.031