When Nothing Moves – Understanding Chronic Constipation
You strain, you wait, you feel incomplete – and it happens day after day. Chronic constipation affects up to 20% of the adult population, yet many people suffer in silence, assuming it is simply how their body works. At our practice in Zürich Seefeld, I frequently see patients who have been dealing with constipation for years without ever receiving a proper evaluation.
As a general practitioner with a functional medicine approach, I believe that regular, complete bowel movements are a cornerstone of health. When transit slows, toxins are reabsorbed, the microbiome shifts, and systemic inflammation can increase. Constipation is not trivial – it is a sign that something in your system needs attention.
What Causes Chronic Constipation?
Slow transit constipation: The colon’s muscular contractions are reduced, moving stool through too slowly. This can be idiopathic or secondary to medications, hypothyroidism, or neurological conditions.
Pelvic floor dysfunction: The muscles involved in defecation do not coordinate properly – they may contract instead of relax when you try to have a bowel movement. This is more common than most people think and is often missed.
Hypothyroidism: Even subclinical hypothyroidism can significantly slow gut motility. I always check thyroid function in patients with chronic constipation.
Medications: Opioids, certain antidepressants, iron supplements, calcium channel blockers, and anticholinergics are common culprits. A thorough medication review is essential.
Dehydration and low fibre: While these are often oversimplified as “the cause,” they do play a role. However, simply telling a constipated patient to drink more water and eat more fibre is rarely the complete answer.
Dysbiosis and SIBO: An imbalanced microbiome can affect motility, and methane-producing organisms (intestinal methanogen overgrowth) are specifically linked to constipation.
Magnesium deficiency: Magnesium is essential for smooth muscle contraction. Deficiency is widespread and often contributes to sluggish bowels.
Red Flags to Watch For
Seek prompt medical evaluation if you experience a sudden change in bowel habits after age 50, blood in the stool, unintentional weight loss, severe abdominal pain, or progressively worsening constipation despite treatment. These may indicate conditions requiring urgent investigation.
Our Diagnostic Approach
I start with a detailed history of your bowel habits, diet, medications, and associated symptoms. Blood work includes thyroid function, magnesium, calcium, blood glucose, and coeliac antibodies. I may order a hydrogen and methane breath test to evaluate for intestinal methanogen overgrowth. Stool analysis can reveal microbiome imbalances and digestive markers. In select cases, referral for anorectal manometry or defecography helps evaluate pelvic floor function.
What We Do: Treatment That Addresses the Root Cause
Correct underlying conditions: Optimise thyroid function, address magnesium deficiency, review and adjust medications where possible.
Target methane-producing organisms: If breath testing reveals elevated methane, specific antimicrobial protocols can be remarkably effective.
Optimise the microbiome: Targeted probiotics, prebiotic fibres, and dietary adjustments to support a motility-friendly gut environment.
Magnesium supplementation: Magnesium citrate or oxide can support both motility and address underlying deficiency. I tailor the form and dose to each patient.
Pelvic floor rehabilitation: If dyssynergic defecation is identified, referral for biofeedback therapy is highly effective.
Lifestyle and dietary optimisation: Adequate hydration, appropriate fibre types (not all fibre helps constipation), physical activity, and establishing a regular toilet routine.
Conclusion
Chronic constipation is not something you have to accept as your normal. In most cases, identifying the underlying cause – whether it is hormonal, microbial, muscular, or metabolic – leads to effective, lasting relief. If you have been struggling with constipation and want a thorough, root-cause evaluation, I invite you to our practice in Zürich Seefeld.
