#1 Reason Why You’re Still Bloated
Let’s get real—bloating is the worst. That uncomfortable, swollen feeling can ruin your day, and it feels like no matter what you do, it just won’t go away. You might have tried cutting out certain foods, adding probiotics, or drinking more water. But what if I told you that most common root cause of bloating that I see in practice = constipation.
Why Constipation Causes Bloat
Constipation and bloating go hand in hand. When you're constipated, waste lingers in your system longer than it should. This build-up can lead to the production of excess gas and make your abdomen feel swollen and tight. It's like a traffic jam in your digestive system, and nobody likes being stuck in traffic.
But First, What Exactly Is Considered Constipation?
Constipation isn’t just about how often you go to the bathroom. It’s also about how difficult it is to pass stools. Here’s the lowdown on what regular, healthy bowel movements should look like (PSA, we’re getting down and dirty with the specifics!):
1. Shape and Form: Ideally, a healthy stool is smooth, well-formed, and shaped like a sausage or a snake.
2. Color: The color of a healthy stool should be a medium to dark brown. This is due to bile from your liver, which helps digest fats.
3. Consistency: Stools should be soft but solid, easy to pass without straining. They shouldn’t be too hard, lumpy or pellet-like OR loose, fluffy or easily break up in the toilet. I like to say the goal = a firm banana texture in the toilet.
4. Frequency: Regularity varies from person to person, but going anywhere from 1-3 times a day is considered normal. If you are skipping days, this could definitely cause bloating, but also interfere with detoxification, and hormone balance.
5. Effort: A healthy bowel movement should require minimal straining and leave you feeling completely evacuated. You shouldn't feel like there's more to come out right after you just went. A sign of incomplete evacuation is if you feel like there’s some left inside, have manually tried to remove stool or have poo stains on your undies after wiping.
Make it stand out
Type 1 and type 2 are common in constipated folks HOWEVER you can struggle with types 5-6 in cases where you have trouble fully emptying.
This stool chart was designed by my friend and colleague, Jenna Volpe RD.
Common Reasons Women Are Constipated - spoiler: It’s not just a lack of fluids & fiber
Hormonal Fluctuations: Women’s hormone levels fluctuate during menstrual cycles, pregnancy, and menopause, which can slow down digestion and bile flow. For example, as progesterone rises in the luteal phase, it relaxes smooth muscle, usually leading to more slowed motility or constipation. Some evidence shows as well that lower levels of estrogen (ie right before your period) can contribute to more bloating and constipation. Hormonal birth control can also play a role in this. Hormonal birth control can lead to multiple mineral deficiencies. Namely, HBC is specifically associated with decreased levels of minerals like zinc, magnesium, selenium & phosphorus. Adequate minerals keep things moving by optimally supporting digestion and gut motility.
Mineral Imbalances: Every single cell requires minerals to make energy, hormones and enzymes. Minerals are crucial for regular bowel movements. When minerals are depleted due to either use of hormonal birth control, diet, or both, risk for constipation increases. A common phenomenon I see in my constipated clients = low sodium, low potassium and low manganese - which affects your ability to make stomach acid, trigger the muscular contractions of the gut and make digestive enzymes, respectively. Why all this mineral deficiency? Our soil is not as rich in minerals as it was years ago, leaving us at risk for deficiencies. Chronic stressors also cause our body to go through minerals more quickly. Mineral depletion can be caused by healthy stressors like regular exercise or unhealthy stressors like chronic anxiety, inflammation, infections and pesticides. Even water filters can play a role - filtering your water via reverse osmosis is great, but you have to make sure you remineralize (as it also removes the minerals!). If you're dealing with constipation, mineral repletion is a solid first step!
Pelvic Floor Dysfunction: When pelvic floor muscles aren't working as they should - it can be difficult to have a healthy bowel movement. If the pelvic floor muscles in the rectum are too tight and unable to relax, it becomes difficult for stool to be passed. While not often talked about, many women are pulling their stomach in and squeezing their rectal muscles throughout the day - this can lead to more pelvic floor tightness and contribute to constpiation. In addition, women who have had abdominal surgeries, injuries or traumas can be left with adhesions which can cause disruption in healthy gut motility. Things I love for pelvic floor problems?! Breath work for gut health.
Unfelt Emotions: Stress and anxiety can literally stop your digestive system in its tracks. Your gut is often called your "second brain" for a reason. The second brain in the gut is called the enteric nervous system. When the body is stuck in a constant state of anxiety ( also known as a fight or flight state), digestive processes are down-regulated. Stress hormones cause the body to shift blood flow from the intestines toward vital organs like the heart, lungs, and brain. As a result, intestinal movement slows down, and constipation can occur.
Low Carb Eating: This is a phenomenon I see ALL THE TIME in practice. Women who are eating generally low carb - ie < 30 grams of carbs per meal. Think of your food like the ‘play dough’ that helps you form your stool! If you ain’t eating it, how are you going to bulk up your poop!? This is a fine-tuned balance of course, because eating too high carb - especially processed carbs doesn’t serve most women either. I find that many women come to me eating something like fruit with bfast and then eating super low carb the rest of the day ie things like GF crackers or GF processed foods as their carbs and missing out on whole food carbs. This is a one way ticket to constipation.
Over Exercising: Over-exercising can put our body into a fight or flight stress state, slowing digestion - especially in the context of an already stressed out person. Exercise is essential for our overall health, but not overdoing it is key. Over-exercising can also cause excess electrolyte loss (see #2 on mineral) - if not repleted this could cause electrolyte imbalance and/or dehydration. Electrolytes like sodium and magnesium, help regulate the movement of fluids in your digestive system, keeping things running smoothly. An electrolyte imbalance can disrupt gut motility, leading to constipation.
Undereating: Similar to #5, undereating in general plays a major role in constipation. Your body will register that it is unsafe because it is not fully fed and it will spike cortisol - leading to a chronic stress response. This is the opposite of what I call, ‘rest, digest, repair, recover, move your bowels’ mode. When you’re stuck in a chronic stress state, overtime the body compensates by going into ‘hibernation’ mode where it will slow everything down to hold onto resoureces - including the movement of the GI tract - leading to constipation.
Bile Flow Stagnancy: Bile is a digestive fluid created by your liver and stored in your gallbladder. Bile helps digest fats and aids in the elimination of waste. If our bile flow is decreased, constipation can occur. Low bile flow can be commonly caused by obesity, aging, vitamin d deficiency, or excess alcohol intake. Excess estrogen or estrogen fluctuations can also reduce bile flow as it can cause cholesterol concentration in the bile, making it thick and sludgier. Another common culprit? A sluggish thyroid. Low thyroid function will cause cholesterol levels to supersaturate in the bile (again, making it thicker). Thicker bile = things don’t move as well = constipation.
How Constipation Impacts Hormone Detox
Constipation doesn’t just make you feel bloated and uncomfortable—it can also mess with your hormones. Your body eliminates excess hormones via your poop. Say hello to your Estrobolome aka estrogen microbiome. Your estrobolome = gut bacteria that play a role in how you detoxify and clear out estrogen.
When you’re constipated, estrogens (and namely other waste products) can be reabsorbed into your bloodstream, leading to an imbalance. This can create a vicious cycle where hormone imbalances cause constipation, and constipation exacerbates hormone imbalances.
