Ask The GI

Constipation & Bloat… Help!

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Allen: I experience constipation and bloat more than I feel regular and normal. I lead a pretty healthy lifestyle, with the exception of enjoying a few alcoholic beverages and eating out on weekends. I have a very well rounded diet filled with veggies, fruits, grains, and protein. I exercise 5-6 days a week. I avoid dairy as much as possible and eat red meat once a week at most. I drink a tablespoon of Metamucil every day and take a magnesium citrate supplement (200 mg). It helps, but does not seem to be a cure. Taking probiotics didn’t seem to do much either. I’m extremely frustrated and it’s causing a lot of unnecessary stress in my life. Should I see a gastroenterologist? 

Dr. Chutkan: Allen, bloating and constipation are probably the two most common complaints I see in my practice, so you’re not alone! And while some may believe these are minor annoyances, there’s always a cause, and fortunately, almost always a solution too.

Without knowing your complete medical and lifestyle history, but based on the information you provided, the underlying cause of your bloat is most likely constipation (even if you experience a bowel movement daily, you may be experiencing incomplete evaluation, or “tenesmus”) – so treating your constipation should solve the bloating you’re experiencing. I would recommend increasing the daily fiber supplement to 2 tablespoons and also increasing the magnesium citrate to 400 mg since the 200 mg you’re currently taking is a pretty low dose. 

In addition, if you’re not already, try implementing some (or all) of these solutions for constipation, which work wonders for many of my patients:

  • Eat a fiber-rich diet, including lots and lots vegetables. Starting your day off with a green smoothie is a great way to accomplish this. Follow my 1-2-3 rule, 1 veggie at breakfast, 2 at lunch, and 3 at dinner.
  • Drink more water and avoid caffeine-containing liquids, which can be dehydrating. Shoot for at least 3 liters of water daily.
  • Decrease or stop the use of constipating/bloating medications, such as anti-depressants, painkillers, blood pressure medications, vitamins with iron, and antacids. Be sure to check with your doctor before stopping or reducing any prescription medications.
  • Practice good bathroom habits: go when you have the urge to go and even if you don’t, sit on the toilet at approximately the same time every morning to encourage a Pavlovian-type response. Get in and out quickly to avoid sluggish bowel emptying.
  • Create the right environment in your bathroom: the right ambience is essential for having good bowel movements. Temperature, lighting, accessibility, and privacy —all are important.
  • Change your position: squatting is the most natural stance for having a bowel movement. A squatting position helps to straighten the anorectal angle and keeps the knees pressed up against the abdomen, increasing intra-abdominal pressure, which helps to push the stool out. Use a stool a little lower than the height of your toilet bowl to obtain this position.

If these modifications don’t solve your constipation and bloating, it would be a good idea to consider other causes of constipation with your gastroenterologist. There are lots of other reasons, including an under-active thyroid, gluten intolerance, diverticulosis and more. If you’re over the age of 45 a screening colonoscopy to make sure there’s not a structural explanation for your symptoms is also recommended. 

Robynne Chutkan, MD

Robynne Chutkan, MD, FASGE, is the founder of Gutbliss Rx. She is an integrative gastroenterologist and the bestselling author of Gutbliss, The Microbiome Solution, and The Bloat Cure. Educated at Yale and Columbia, she’s been on the faculty at Georgetown University Hospital since 1997 and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice incorporating microbiome analysis and nutritional counseling as part of the therapeutic approach to digestive disorders. An avid runner, snowboarder, and yogi, she is passionate about helping her patients live not just longer lives, but dirtier ones!

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