Can’t beat chronic constipation?

Constipation: When It’s More Than Just Diet and Water

Most people think constipation is just a matter of not eating enough fibre or drinking enough water. But in my clinic, I often see patients who are doing everything right: the high-fibre diet, two litres of water a day and daily exercise — and they’re still struggling.

The reality is that chronic constipation is rarely just a lifestyle issue. It’s often a more complex problem of motility or physics that requires a more sophisticated approach than just buying a bottle of pear juice.

Today, I want to move past the basic advice and look at the unusual causes of constipation, how we actually prevent it, and the advanced treatments we use when standard laxatives fail.

Slow Transit vs Outlet Obstruction

In clinical practice, we look at constipation through two lenses.

Number one: slow transit, where the bowel moves like a slow-moving traffic jam.

Number two: outlet obstruction. That’s when the queue is moving fine, but the exit gate won’t open.

The second category is where we find one of the most common unusual causes — pelvic floor dyssynergia.

This is a problem of coordination where, instead of relaxing the muscles to allow a bowel movement, your body subconsciously tightens them.

You can take all the laxatives in the world, but if the exit is physically braced shut, you just won’t find relief.

This is why I often refer patients for anorectal manometry, which is a specialised test to see how those muscles are actually behaving.

Metabolic, Neurological and Medication-Related Causes

We also have to look at the metabolic and neurological drivers.

Things like an underactive thyroid or high calcium levels can effectively quieten the nerves in your gut. Even common medications for blood pressure, like calcium channel blockers, or iron supplements can be the hidden culprits.

If your constipation started around the same time as a new medication, that’s a conversation we need to have.

Working With Your Body’s Natural Timing

When it comes to prevention, we need to talk about the gastrocolic reflex.

Your bowel is most active about 20 to 30 minutes after a meal, particularly breakfast. Many people ignore that first morning urge because they’re rushing to work or their kids are demanding attention.

If you consistently ignore that signal, your rectum can become hypersensitive. It stops sending signals, and the stool sits there, becoming harder and more difficult to pass.

Prevention isn’t just about what you eat. It’s also about honouring your body’s natural timing and using a footstool to put your anatomy in the correct squatting position.

What Happens When Standard Laxatives Don’t Work?

Finally, let’s talk about treatment.

If over-the-counter options aren’t working, we’re moving to the realm of secretagogues, or medications that actually draw water into the bowel to soften the stool and stimulate movement.

In Australia, we have specific medications like prucalopride for those who haven’t responded to standard laxatives.

For those with pelvic floor issues, the treatment isn’t a pill at all. It’s biofeedback therapy. That’s where a specialisedphysiotherapist retrains your muscles to work in harmony.

Long-Term Constipation Deserves Proper Assessment

The most important thing I tell my patients is that long-term laxative use, when managed correctly, isn’t addictive and won’t ruin your bowel.

What ruins your quality of life is the bloating, the pain and the lethargy that come with chronic backup.

So, if you’ve been struggling for more than three months, it’s time to move beyond the pharmacy aisle and get a formal motility assessment.

Additional videos on a range of common conditions are available to view on the Gastroenterology Specialist Care YouTube channel.

Note, this video is not a medical consultation. Any medical information is general in nature and is not intended to provide individual clinical advice. You should contact your doctor or other healthcare professional in relation to any concerns they may have, as your own circumstances may be different.

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