Can't go? It could be a sign of chronic inflammation. Here's how to get things moving!
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Examining your bathroom frequency can be a quick, albeit unofficial, snapshot of intestinal health, due to the sensitivity of the gastrointestinal tract. For example, occasional deviations from your normal pooping schedule can often be traced back to things you ate (or didn't eat), a lack of hydration or activity, too much alcohol or increased stress within the past 24 to 72 hours. When one of these is the culprit, bathroom regularity typically returns soon after you resume your usual diet and health habits. But what if you still can't go? Or find yourself gradually pooping less frequently? Low-grade chronic inflammation may be contributing to constipation.

What Is Poop's Connection to Inflammation?

Chronic inflammation is at the root of almost every major health issue affecting Americans today, but can we really blame it for not being able to poop? I write regularly (no pun intended) on inflammation and the benefits of an anti-inflammatory diet and lifestyle, so I'm familiar with the role that inflammation plays when it comes to intestinal diseases. However, I'd never really considered the influence that inflammation may have on run-of-the mill digestive issues like constipation. Yet, it makes sense when you consider the gut-inflammation relationship and the fact that constipation is a common symptom of gut dysbiosis.

Gut dysbiosis refers to an unbalanced microbiome associated with chronic inflammation. In comparison, a "healthy" gut or microbiome contains a diverse and ample collection of good microbes. And a healthy gut serves as a barrier within the lining of the digestive tract that allows nutrients to be absorbed into the body, while preventing many irritants and foreign compounds from entering. When the microbiome gets disrupted (by things like processed foods, added sugars, stress and antibiotics), this barrier is weakened and develops holes. The result is that more foreign compounds are now able to "leak" through these holes into the body, triggering inflammation.

Experiencing constipation doesn't necessarily mean you have inflammation or dysbiosis. Most of the time, the culprit is changes to diet, hydration or lifestyle habits, particularly if your pooping issues are occasional, sporadic and relatively quick to resolve. But if the issue continues or starts to occur more frequently, then inflammation may be an underlying cause.

When to Worry About Not Pooping (or Pooping Less Frequently)

How frequently should you go to stay regular? Answering this question is the first step in determining if and when to worry. From a clinical perspective, constipation is considered less than three bowel movements a week and includes having hard or dry stools that require excessive straining or abdominal distention. But this isn't a great threshold for all since each individual tends to have their own schedule when it comes to pooping frequency. This may be once a day, twice a day or every other day, so using your own "norm" for comparison is often a better indicator.

5 Recommendations to Get Things Moving

Constipation caused or aggravated by low-grade inflammation stems from gut issues. This means that boosting gut health to quell inflammation and to stimulate intestinal muscles may be your best bet to get things moving. Here are five tips to do that!

1. Add fermented foods to your daily menu

Individuals who have issues with constipation on an ongoing basis are more likely to have lower levels of beneficial bacteria from the Lactobacillus and Bifidobacterium genus in their gut. The best food sources of Lactobacillus and Bifidobacterium strains are fermented foods like yogurt, kefir, sauerkraut, kimchi and kombucha. Consuming some daily may be even more important if constipation is related to inflammation and gut dysbiosis.

2. Drink 2 to 4 extra cups of water daily

Staying hydrated is important to managing constipation, regardless of the underlying cause. Consider increasing fluids by 2 to 4 cups a day. While this won't solve your inability to go if inflammation is the root cause, it can help. Additional hydration is needed when increasing fiber intake, and adequate water provides the medium through which the liver and kidneys filter and excrete toxins in the body.

3. Choose higher-fiber foods over supplements

Fill at least three-fourths of your plate with higher-fiber plant foods like vegetables, fruit, nuts, seeds and whole grains. The fiber in these foods (both soluble and insoluble forms) aids in digestion, poop formation and efficient transit through the colon. Most also contain varying amounts of prebiotic fibers, which gut microbes need for energy. While supplements can boost your overall intake, gut microbes aren't able to ferment those fibers to create beneficial compounds like the ones in food.

4. Move each day

Along with hydration and fiber, physical activity encourages regularity by stimulating blood flow and muscles in the GI tract, speeding up poop's transit through the colon. But regular activity also encourages improvements in the number, diversity and metabolic activities of good microbes in the gut. Engaging in some form of activity for at least 10 to 15 minutes each day is also a great way to relieve stress—a factor that can aggravate existing inflammation if not managed.

5. Consider a probiotic supplement

Taking over-the-counter probiotics shouldn't be used as a substitute for eating more plant and fermented foods, but research suggests they may alleviate or lessen the severity of ongoing constipation. According to a 2020 meta-analysis, there's no exact prescription for the strains you need to look for in a supplement (since the strains vary among studies and since needs vary by individual), so your best bet is to choose a multi-strain probiotic supplement that includes several strains from the Lactobacillus and Bifidobacterium families. If you're unsure about starting a probiotic, speak with a dietitian or your primary care provider to decide what's best for you.

Carolyn Williams, Ph.D., RD, a culinary nutrition expert known for her ability to simplify food and nutrition information and the author of two cookbooks, Meals That Heal: 100 Everyday Anti-Inflammatory Recipes in 30 Minutes or Less and One-Pot Meals That Heal (June 2022). She is also co-host of the Happy Eating podcast, which explores the influence that diet and lifestyle have on mental wellness.

You can follow her on Instagram @realfoodreallife_rd or on carolynwilliamsrd.com.