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functional constipation

Joining us today is the famed Lynda Griparic from Love n Guts, a naturopath who specialises in gut health and today we are exploring the multi-faceted condition of functional constipation.

In this episode, Lynda discusses:

  • The criteria for functional constipation
  • The common patient presentation, and no it’s not all gut-related!
  • Common and not-so-common drivers of functional constipation
  • The myriad of treatments we can look at as practitioners

About Lynda:
Lynda Griparic is a Naturopath, Nutritionist, Podcaster, Writer, and Yoga teacher with over 20 years of experience in the health industry. In 2021 Lynda won the prestigious BioCeuticals Integrative Medicine Award for Clinical Excellence. Lynda specialises in digestive health, namely SIBO and constipation.

She has extensive experience in running healthy, effective, and sustainable bowel care programs and has expertise in investigating and treating the underlying causes of gut disturbance. Lynda has an intense interest in poo and she’s also the creator of the delicious BetterMe Tea, a tea designed to promote improved gut health and digestion – assisting those who struggle with constipation and sluggish bowel movements to go to the bathroom with ease.

Connect with Lynda:
Website: 
lyndagriparic.com
Instagram: @Lynda_griparic_naturopath
Youtube: 
grippahrvat

Check Lynda’s podcast channel Love & Guts

References:

Rome Criteria: https://theromefoundation.org/rome-iv/rome-iv-criteria/

GESA Constipation handout:  http://www.huntergastroenterology.com.au/resources/Documents/GESA_Constipation.pdf

Meds that cause/exacerbate constipation:  https://www.nps.org.au/australian-prescriber/articles/managing-constipation-in-adults

Gopal, P et al. 2003, Effects of the consumption of Bifidobacterium lactis HN019 (DR10TM) and galacto oligosaccharides on the microflora of the gastrointestinal tract in human subjects

Eskesen, D., et al. (2015). “Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial.” Br J Nutr 114(10): 1638-1646.

Hayat, U et al. Chronic constipation: Update on management, Cleve Clin J Med 2017.

 Izzo AA, Gaginella TS, Mascolo N, Capasso F. Recent findings on the mode of action of laxatives: the role of platelet activating factor and nitric oxide. Trends Pharmacol Sci. 1998 Oct;19(10):403-5.

Müller-Lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005 Jan;100(1):232-42. doi: 10.1111/j.1572-0241.2005.40885.x

Iovino P, Chiarioni G, Bilancio G, Cirillo M, Mekjavic IB, Pisot R, et al. New onset of constipation during long-term physical inactivity: a proof-of-concept study on the immobility-induced bowel changes. PLoS One. 2013 Aug 20;8(8):e72608. doi: 10.1371/journal.pone.0072608

Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, et al. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011 Jan 7;17(1):105-10. doi: 10.3748/wjg.v17.i1.105

Polymeros D, Beintaris I, Gaglia A, Karamanolis G, Papanikolaou IS, Dimitriadis G, et al. Partially hydrolysed guar gum accelerates colonic transit time and improves symptoms in adults with chronic constipation. Dig Dis Sci. 2014 Sep;59(9):2207-14. doi: 10.1007/s10620-014-3135-1

Giannini EG, Mansi C, Dulbecco P, Savarino V. Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition. 2006 Mar;22(3):334-42. doi: 10.1016/j.nut.2005.10.003

Katsirma Z, Dimidi E, Rodriguez-Mateos A, Whelan K. Fruits and their impact on the gut microbiota, gut motility and constipation. Food Funct. 2021 Oct 4;12(19):8850-66. doi: 10.1039/d1fo01125a

Ducrotte, P., P. Sawant, et al. (2012). “Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome.” World J Gastroenterol 18(30): 4012-4018.

Huebner, J., R. L. Wehling, et al. (2007). “Functional activity of commercial prebiotics.” International Dairy Journal 17(7): 770-775.

Ojetti, V., et al. (2014). “The effect of Lactobacillus reuteri supplementation in adults with chronic functional constipation: a randomized, double-blind, placebo-controlled trial.” J Gastrointestin Liver Dis 23(4): 387- 391.

Teuri, U. & Korpela, R. 1998. Galacto-oligosaccharides relieve constipation in elderly people. Ann Nutr Metab, 42, 319-27

Liu Z, Lin X, Huang G, Zhang W, Rao P, Ni L. Prebiotic effects of almonds and almond skins on intestinal microbiota in healthy adult humans. Anaerobe. 2014(0).

 

 

Transcript

Introduction

Andrew: This is “Wellness by Designs,” and I’m your host. Andrew Whitfield-Cook. Joining us today is the famous, Lynda Griparic from “Love and Guts,” a naturopath who specializes in gut therapy and has learned from the best across our professions. Welcome to “Wellness by Designs,” Lynda, how you going?

Lynda: Well, as I said to you before jumping on, I’m a little bit nervous because it’s you, Andrew, and if I could only, you know, aspire to be as good an interviewer as you are then I will die a happy woman. So I’m very honoured to be on here today.

Andrew: Thank you. Don’t die. Don’t die. Don’t be doing that.

 

Lynda: I don’t plan to anytime soon.

 

Andrew: We need you. I don’t why you’re nervous, I’m not that scary, ugly, but not that scary.

 

Lynda: You’re not scary.

 

Andrew: So, Linda, firstly, like you’ve developed over, you know, quite a few years, “Love and Guts,” and obviously, you’ve got a heartfelt dedication to healing from the gut without. Take us a little bit through your history and what led you to specialize in gut health?

 

Lynda: Well, I was one of the… Back in the day when I graduated as a naturopath, I graduated in 2002 and practiced for about four years, then took a seven-year hiatus. So, and I went to work for a supplement company and we would travel a lot, and I would notice my bowel movements be a bit more compromised when we would travel. So I was interested in gut health overall as just being a naturopath, but with my own experience. But then when I went back into practice my husband said to me, “Look, what do you really enjoy working with?” And I said, “Gut health.” And he said, “Look, where’s you special or what do you wanna specialize in?”

 

And I said, “You know, people really struggle with constipation and it’s so taboo, people are embarrassed to talk about it. Sometimes it can take a few consultations before they really get honest with what’s happening with the human plumbing. And so that’s why I went down the route of constipation. And you probably, I don’t if you know this, the “Love and Guts” podcast, it’s not just focus on directly how we can support gut health, it’s also looking at mind and movement and all those sorts of things, because that is equally as important and can affect gut health as well as constipation. So, that’s a really brief rundown.

 

Andrew: And that’s indeed what we’ll be talking about today, this sort of taboo topic of constipation. What I find really interesting being a nurse there’s this, it’s pretty well known and nurses are pretty well known for being a bit, you know, throw away comments with bowel movements and things like that because we are so used to it. But what I think is interesting is as people age, it almost becomes a topic. It’s really funny. Certainly, between couples it’s, like, “I’m doing a poo now.” It really is like parents and children. It’s really funny. You know, is it trust between partners over years and all of that sort of thing? Probably. But it’s really funny how the topic in particularly elderly people, it becomes a non-issue of discussion. It’s like, “Yeah, yeah. I’m bound up lke you wouldn’t believe.” Like that sort of thing.

 

Lynda: Yeah.

 

Andrew: But most of us, it’s really still this quite a taboo topic, you know. So, I guess first where to start, let’s go through some definitions. You know, is there defined criteria of constipation, the definition of why. You know, take us through these definitions, what they mean.

 

Lynda: And I think it’s important for us to really maybe go through the Rome IV criteria. So if you don’t mind me running through functional constipation and then my thoughts on it, maybe. So the Rome IV criteria, which is, you know, internationally recognized mentions that the functional constipation must include two or more of the following. And that can be straining during more than 25% of defecation, lumpy or hard stools. Sort of sitting at that one to two on the Bristol Stool form are more than 25% of defecation. That sensation of incomplete evacuation, more than 25% of defecations. Sensation of anorectal obstruction or blockage, more than 25% of defecations. Manual maneuvers to facilitate more than 25% of defecations.

 

So that’s digital evacuation and support of the pelvic floor. Fewer than three smooth bowel movements per week. Loose stools are rarely present without the use of laxatives and insufficient criteria for irritable bowel syndrome. Now I’ll try to get you back again. So that’s the definition for functional constipation. And I guess what I would say there is, well, do people feel comfortable not moving their bowels daily? Most of my patients don’t feel comfortable. So when it says, you know, less than three bowel movements a week, I kind of go, well, I would like to see that change to like once a day is what we’re kind of aiming for. A smooth evacuation, no straining, you know, minimal hard lumpy stools, that sort of thing.

 

So that’s where I’m at with the Rome IV criteria. And also you wanna… It sort of branches off into other areas too. You’ve got the Rome IV criteria talking about IBSC, for example. So that subset of people that can experience constipation there. And then you’ve got those that have got dyssynergic defecation or propulsive issues with defecation too. So there’s sort of definitions for those terms as well. That’s functional constipation in a nutshell.

 

Andrew: Yeah. That’s really surprising about how many patients have to digitally evacuate themselves. I mean, that’s a concern. That really is.

 

Lynda: Yeah. I think that’s important for practitioners to know, so they ask that question because that can be quite embarrassing and shameful for people to admit that they’re doing. So sometimes a part of my case intake is asking these really deep sort of questions or really intimate personal questions, “Do you need to use your fingers sometimes to remove the stool?” You know, they’re not gonna offer that information up, generally. You do need to ask that for some… For most actually.

 

Andrew: Yeah. So let’s go through a patient presentation. Like obviously, you’ve got to gain their trust. You’re delving into quite taboo often subjects. And as you said, you know, like, people often feel very uncomfortable, particularly on first meeting going, “G’day, let’s talk about something really intimate.” That’s not the usual conversational style. It’s normally like name, address, what do you do, what are your likes and dislikes. With social interaction, how do you help your patients to feel comfortable about talking about quite personal habits?

 

Lynda: Yeah, I think now though people are seeking my support because they know I work in the space of constipation, so they’re a little bit more open to talking about it. But having said that, lots of people are still not. So I would… Because in that hour initial consultation, there is so much to get through I find that sometimes we might spill off 5 minutes or 10 minutes, but if you have a intake form that they can complete prior to your consultation, that shaves a bit of time and it really starts to get those questions formed in your head about what you wanna ask specifically that patient in that initial consultation.

 

I do ask, you know, their main health concern, what they wanna work on, health history, of course, before I get into their digestive symptoms. And then I get really down into the nooks and the crannies of those particular questions that I want to ask and elaborate on from the questionnaire when it comes to their digestive health. So they’re kind of softened up, almost. But in that, what’s your main health concern, generally, people will say, “Well, I have chronic constipation or I have constipation.” Ask them what that means to them as well, because it could mean so many different things.

 

For someone it may mean, “Well, I go every day, but it feels incomplete and it’s pebbly and I feel bloated and gaseous and all the rest of it.” And then you’ve got someone that’s, like, “I don’t go for sometimes two weeks.” You know? And so you really need to define for them, what does constipation mean? How long has it been going on for as well? So, I soften it up. I kind of edge… Some of the questions I probably wouldn’t ask in that first consultation if it’s not offered up, is things like maybe sexual abuse, physical abuse, because sometimes that can contribute to constipation too, especially with things like dyssynergia and the way that the pelvic musculature responds and how that can affect constipation in our bowel movement.

 

So I may not, I’ll just suss it out and I’ll say, is this a safe space or do they feel comfortable offering up that information? I might even say something of along the lines of, “Have you had a big past stressor or some big trauma in your past that’s created a lot of stress?” And they may offer it up when I mention it like that. So yeah, and then I tend to, as I said, I can go through some of the questions that I ask, but it’s generally, what most people are probably asking. How often do you go? What colour is it? Do you strain? Is there any blood that you passed in the stools? Do you see any food or mucus you know, or as I mentioned, do you use a finger to digitally remove, and all other sort of associated symptoms that they might be experiencing like lumpy stools, like the character of the actual stool.

 

I may use the Bristol Stool Chart, but generally I’ll ask a bucket load of questions. And sometimes when people have come to me, they’ve already gone through that. And so they’re open to talking about everything. They know what to… “I fall on the one to two level of Bristol Stool Chart.” And that sort of thing. So they’re kind of already aware of it. Yeah.

 

Andrew: Right. So I think you may have answered my next question already. I was gonna ask you, how do you sort of categorizing in your intake the, you know, trivial from the remedial to the possibly sinister disorders? Obviously, you can’t see inside the gut. Do you rely on previous scoping and things like that or symptomatology to go, “What’s going on here?” Changes for instance in bowel motions, changes of blood, blah, blah, blah?

 

Lynda: Yeah. Well, I do definitely look for those red flags like melena and blood. So whether it’s bright or dark blood. Like weight loss that’s come on suddenly. Rectal pain, for example, those things. It’s a collaborative effort, I feel, when it comes to constipation, it’s rarely just me giving them nutritional advice and supplementation or movement advice. I often work with pelvic floor physios or gastroenterologists, or I refer on because especially if it’s something that they have tried before, when it comes to diet, they’ve taken laxatives and maybe they’re no longer working, then I will recruit a pelvic floor physio, or a gastro to do further investigation to check if there’s dyssnergia, to do a colonoscopy, those sorts of things. So I think that, yes, there’s red flags, but I will just make sure that I have my network of people working for this person.

 

Having said that, not everyone is open to, straight away, recruiting the support of someone like a pelvic floor physio or a gastroenterologist mainly because maybe they want you to fix it or it’s expensive or they’re a little bit nervous about what a colonoscopy might entail, all of that sort of thing. So I think that there needs to be a big education around why we don’t wanna leave chronic constipation unattended, why it’s important to move your bowels so that they really understand, and also maybe discussing what they might experience in a pelvic floor physiotherapy situation so they can kind of feel a little bit comfortable with that because a good pelvic floor physio won’t be doing a digital rectal exam unless that person’s really comfortable, for example. So they’re really gonna gauge that and they’re gonna obviously create a safe space for this person to do their further investigation. So I think, yeah. Hopefully, I’ve answered your question there. I feel like I’ve completely forgotten that question was.

 

Andrew: But I was gonna ask another question that is that, you know, sometimes a symptom that presents in one area can be a manifestation of some other issue. So, for instance, going through my mind is they present with constipation, but the issue, not necessarily causing it, but leading to it, a factor in that might be something like endometriosis, interstitial cystitis, ovarian cancer, for instance, if you’ve got tenesmus things like that. So like how on the ball… How big is your intake form? Like how do you start questioning people about possible causes?

 

Lynda: Oh, it’s in the… I think we should be doing that in our intake form anyways. It’s not that we are just talking about digestive health. I think the intake form is going to be addressing some of those things, as well as the questions that we ask, you know, prior surgeries, prior diagnosis, for example. You might wanna do some…often you will do blood work that’ll look at say, because hyperthyroidism, for example, can contribute to constipation. So there’s certain things in the blood you wanna be ruling out. So I think that there’s gathering that information, then you’re doing the further testing to establish if there is anything more sinister or a, you know, systemic disease going on. And you’re also asking the questions about, you know, prior history and I think those things, you know, should come up, you know. And I feel like with every consultation, sometimes you’re uncovering more and more and more about the patient.

 

Andrew: For sure. Definitely over time. Now you also touched on something that’s very important, and indeed in your story, you know, you mentioned about traveling a lot and you know, you’re moving around and you sleep in different hotels, which is a new bed, an unfamiliar place. And that smacks…. That tells a story of just how easy it is for even a minor stressor to have a large impact on bowel movements.

 

Lynda: Yeah.

 

Andrew: So for instance, stress, let’s talk about mental health right from trivial to, you know, quite severe, how do you approach this? How do you deal with it?

 

Lynda: Yeah, I think so many different angles. When it comes to mental health, someone might, for example, withhold, have withholding behaviour where they’re fearful of going to public toilets, you know, and not in the comfort of their own home. So they neglect that urge to go to the loo. And then that way, the stool remains in the colon becomes drier and is harder to pass. So that can lead to things like chronic constipation. So addressing that. Addressing, as I mentioned, physical or sexual trauma is important, but again, recruiting people, you’ve gotta recognize your scope of expertise. And so I might recruit a psychotherapist or a body worker if a person feels a bit more like drawn to something like somatic therapy and so where you actually move that trauma through your body versus talk therapy.

 

So I think, you know, getting to know what person’s gonna resonate with, but really getting them to understand the importance of addressing these things when it comes to mental health, because constipation in itself can cause or contribute to things like anxiety and depression. So we wanna make sure that we are addressing chronic constipation so that we’re, you know, preventing those impacts on mental health. What else do… Herbs, of course. So herbs, magnesiums, various supplementation can be really supportive for the nervous system and even things like physical activity. So a sedentary lifestyle can contribute to things like constipation. So making sure that person is moving their body that can support not only bowel movements, but really that colon motility in the gut to allow the… Oh, not, that’s not where I’m going. So yes, it supports bowel movements, but it also is really impactful for mental health.

 

And so really encouraging things like physical movement. And it could just be to start with some walking, which is excellent for improving bowel movements. So vigorous walking, 30 minutes to 60 minutes a day, if they can, you know, so working up to maybe about 45 to 60 minutes. So those are some of the ways that I address mental health supplementation, movement, recruiting the supportive…other health practitioners like psychotherapists or body workers. But also just asking those questions and allowing them to feel really safe. I think even carving out that time to come and see you as a health practitioner is a part of their healing process, feeling heard you know, feeling safe, feeling like they’re worth it and they’re important, you know, is important. So…

 

Andrew: Yeah. Yeah.

 

Lynda: And, I mean, you have previous history of being a nurse. I think about nurses and parents tend to neglect themselves, you know. Maybe not all nurses, but I get a lot of…I’ve got a handful of nurses in the industry that they don’t go to the toilet because they don’t have time and they’re not drinking enough water because they don’t have time. And so… And the doing shift work as well, so it can really impact digestive health. So prioritizing yourself and recognizing that these things are important to get on top of, and that you are no good to anyone when you’re not looking after yourself, you know.

 

Andrew: Yeah. And I would put a stamp on mothers there, they’re traditionally the ones that will give everything of themselves and keep enough or very little for them….Sorry, give everything to everybody else and keep nothing for themselves. Just going on about that mental health issue, it’s really interesting how, like, you know, an acutely anxious episode, stimulus, can sometimes lead to diarrhea, even chronic anxiety can lead to diarrhea. And that typical picture that we… It’s almost like a stereotype of IBS, the diarrhea dominant IBS or SIBO, whatever you wanna call it. But it can also go the other way, particularly if somebody has excessive control, that sort of stuff, and, you know, they have things to do.

 

Lynda: Yes.

 

Andrew: Really interesting how you’ve got to tease apart what could be the possible trigger for that person’s, their constitution, their way of handling life. But I also see this interplay, you know, it’s kinda, like, insomnia where the fear of insomnia can keep you awake. So it’s kind of, like, this anxiety causing constipation and then constipation causing anxiety about being constipated.

 

Lynda: Yes. Yes.

 

Andrew: Where do you intercede?

 

Lynda: People become obsessed. Yep. I do wanna add that…

 

Andrew: So, how do you break that cycle?

 

Lynda: Yeah. How do I break the cycle of them being fanatical about bowel movements and anxious about the fact that they’re not going? Yeah. And what I didn’t mention, just back pedaling to the stress is that, yes, it can have the reverse effect improving…not improving, but creating looser bowel movements. But when you think about stress’ impact on the digestive system, it can slow motility in the small intestine. So then you’re more prone to bacterial overgrowth such as SIBO or IMO, intestinal methanogen overgrowth, and, you know, yes, it can increase the contractions in the small intestine, but that’s really important to note as well, because if we have that overgrowth of bacteria in the small intestine, you can really slow down motility, and methane is known for doing that, especially.

 

How do I tease out that vicious cycle? Oh, that’s interesting. I think it can be really…I think you… To be honest, I think as a practitioner, I want to be looking at their drivers. So I want to be diving deep underneath that, but in the meantime, do the basics. Start with the basics, start to get them to feel better so they get a little bit of momentum. And so they start to, you know, if it’s sleep for example, and they’re ruminating over their bowel movements or whatever it might be, then you wanna be looking at sleep hygiene practices. But you know, I think that it’s, you know, supplementation or movement, mindful defecation, those sort of practices. And if they start to go, “Okay, well this week I went twice instead of once or no times this week.” And so start to get a little bit of momentum, they start to kind of get a bit more excited and more… I guess, their mind is a bit more nourished and they’re a little bit more at ease, but I think… And then while we look at really the underlying drivers.

 

So I think, you know, yes, get them to feel better. We work on the underlying drivers, they feel supported, are all part of the process of, I guess, breaking that vicious cycle. And if it’s something deeper than that, then recruiting or referring on to psychotherapy or those sorts of things I think is really important to again, just working within my scope, but just getting momentum and again, them feeling heard and safe is really important part process of that. I know for myself even trying to fall pregnant back in the day, took us three years. And the moment that I recruited an IVF specialist, I sat at his office with my husband and I walked out and I was like, “Right. I don’t have to think about it anymore. Someone else is looking after it.” Even though, obviously, I have to do the work. Within a week, I was naturally pregnant because I’d completely surrendered and I felt safe.

 

And you hear that quite commonly. So I feel as though, they’re doing something about it, you know, we’re changing the way that they eat. Maybe it’s a way that they always thought was beneficial for them, but maybe not so much anymore. And so, and I think there’s a lot of training around which foods are important for the bowel, because a lot of people have gone down the route of maybe the keto diet or the carnivore diet, or those sorts of things that you go, “Jesus Christ, how do your bowels move?” So I think there’s just like lots of training. There’s just lots of training around people shifting their mindset, you know, on those things. Yeah. Again, I don’t know if that answered your question, but I’m hoping I’ll did a little bit.

 

Andrew: Over your time… You’re mentioning exercising and talking about walking, but over your time in clinic, in practice, have you found different types of exercise might have different impacts on, obviously this is gonna work differently for various people, but perhaps like engaging the core, perhaps bending, you know, the stretching exercises versus just the perambulation. Have you ever looked at this as part of, like, oh, you know, we need to sort of focus on that with you and with this person, another type of exercise with this person? You ever teased out anything that works?

 

Lynda: I guess a few things come up for me when it comes to exercise, if I’m recruiting the help of a pelvic floor physio, and they’ve got something structurally or some pelvic floor musculature that needs to be worked on, or some bowel retraining that needs to happen, then they will often give them some exercises to do that would be beneficial for them as an individual. I think walking is a good place to start. Breath is really important too, no matter what sort of exercise they’re doing. I think if they’re really supporting, they’re not just running through their exercise routine, even if they’re doing weight training and they’re really focusing on breath work and the way that they’re controlling…not controlling, but engaging their diaphragm is really important.

 

But again, I always just start with things like walking. I think that that’s something that they can do that they…The other benefit of that is that they get a bit of nature bathing, they get a bit of, you know, outdoor time possibly. And that again, mental health. So running can cause the opposite sometimes. Sometimes people get looser bowel movements when they run, but not always. I am a bit of a fan of yin yoga too. Not that that’s a very cardiovascular sport, but when someone’s… Often you’ll get the person saying, “I can’t meditate, I just can’t do it.” And so I tend to give them that prescription of try a yin yoga class, or I’ve created some yin yoga videos, because I used to teach yin yoga.

 

And basically, what you do in that class, you sit in a posture for anywhere between 5 to 10 minutes. And so you’re slowly emptying the mind as best we can because we can’t have an empty mind, but you’re allowing the muscles to relax. And you’re sort of killing two birds with one stone. You’re supporting the nervous system. You know, maybe I see it as a bit of a functional meditation, but you’re getting a bit of movement in as well. And you can be quite strategic with how you stretch. You know, you might be doing seal for example, which is just, like, on the floor and opening up you know, the abdomen and stretching that out.

 

And so I think that, you know, it depends on the person. It depends on what’s driving their constipation, if it’s normal, functional constipation then they might be okay with many types of exercises, but if it’s something like dyssynergic constipation or slow transit and you might again need to engage someone, that’s gonna give them specific individual exercises for what they need to bowel retrain. Yeah.

 

Andrew: Yeah. And what about another…

 

Lynda: Kegal exercises aren’t great for everyone.

 

Andrew: No. Right.

 

Lynda: Yeah.

 

Andrew: So, what about other pathological conditions like for instance, thyroid, hemorrhoids, you’ve also got previous surgeries, adhesions…

 

Lynda: Yep. Practice seals.

 

Andrew: You knows they’ve had a stomach stapling or something like that that might be impeding digestion. How do you work around this sort of stuff?

 

Lynda: In regards to exercise or?

 

Andrew: No, no. With regards to general therapy, but also perhaps helping to intercede. Let’s say… I mean, Hashimoto’s is so common. But let’s say somebody’s got hypothyroid, you’ve got their medical therapy and perhaps naturopathic therapy for their thyroid condition. Now you have this constipation issue that’s compounding or it is compounded by their thyroid. Do you find that you sort of work to co-manage these? How does that work?

 

Lynda: Yes. I think it’s important to co-manage these because I think that, especially in the case of thyroid health, you need to be encouraging… You need to have great gut health or good gut health and you need to be encouraging proper elimination of byproducts of hormones like estrogen and those sorts of things so that it doesn’t impact thyroid health and production of thyroid hormones. So I think, yes, you’re using those therapies. So whether it’s pharmaceuticals or naturopathic alternatives to supporting thyroid health, but you’re also using things that help to improve bowel movement function, because that’s equally as important to managing thyroid health.

 

I think it’s almost like a bit of a vicious cycle sometimes. You know, hyperthyroidism can contribute to chronic constipation, maybe chronic constipation can do very similar things to, or impact the thyroid in a negative way. So I think, you know, co-managing them is absolutely important. You don’t want them walking away with a bucketload of supplementation, but there’s so much you can do in the scope of diet, fluid intake. Again, like I keep mentioning pelvic floor physiotherapy, that can work alongside what they’re doing to support the thyroid specifically. Yeah.

 

Andrew: So, I mean, we can talk so much about all of these sort of causal factors and antecedents and things like that. It’s a whole podcast onto itself, but let’s move on to treatments because that’s what you’re famous for. You’ve learned from the best across the professions. So take us through what you find works for constipation. Where do you start? What do you use to get a result fast? Not necessarily a plus plus plus plus, but to get a result. And then how do you sort of fashion in the other aspects of their treatment plan?

 

Lynda: Yeah, I think when you first see someone you’re doing that thorough case history, asking all the in depth questions, and then whilst you’re doing that further investigation or waiting for colonoscopy or pelvic floor physiotherapy results and blood work, then you wanna be… While you’re waiting for that, the first things that I’ll sort of get them to use would be possibly a magnesium formula. Contrary to popular belief, I don’t tend to use oxide to be honest, I tend to use bisglycinate or chelate. And mostly because I feel as though we’re supporting the nervous system, as well as, you know, supporting bowel movements, not just getting in there and creating an osmotic sort of laxative effect. Like we’re getting a bit more and often these people are a bit stressed or anxious anyways, not always, but often.

 

I’ll tend to use a prebiotic of some sort. So the potential prebiotic partially hydrolyzed guar gum is generally my first point of call only because it’s tolerated by most. And if I suspect SIBO and/or IMO and I’m waiting for those results, I don’t wanna be giving them maybe inulin or FOS, which can create more gas or more issues and discomfort, digestive discomfort for someone. So I wanna be careful with what I’m giving them in regards to prebiotics. GOS can be generally tolerated by most two. So partially hydrolyzed guar gum or GOS will be given for those. And I guess it just depends on the person and what’s driving them. I’ll often, probably about 98% of the time with the time that I spend with a patient, there will be at some point that I will get them to engage their pelvic floor physio.

 

If it can’t be fixed with just that normal transit constipation, so if their diet is okay, they’re getting enough fibres, they’re getting enough polyphenols and probiotics, kind of looking at 25 to 30 grams a day. Most people don’t do that. If they’re getting enough water… Would you believe… I just, it boggles my mind. People come to see me and they’ve had chronic constipation for a long time and then maybe having a glass of water. And it’s like, these are the foundational things. Having said that some people are nurses, having said that some people might have a prolapse and/or they have urinary incontinence and they’re a bit frightened. So you kind of wanna work with the pelvic floor and those sorts of things.

 

So, if the functional stuff is covered, the basics are covered, movement, water fibre intake then… And also just retraining on where they can find these sorts of foods, these prebiotic fibres, these fibres, these resistant starches, because these types of foods, resistant starches, go on to feed the bacteria that produces these short chain, fatty acid like butyrate and propionate, which help with colon motility, so with peristalsis. So those that come to me that are having, like, a very carbohydrate deficient diet may be experiencing more constipation than someone that is introducing or having more nuts and seeds and legumes and some grains and those sorts of things, which can kind of frighten people to reintroduce these things. You just wanna kind of take it slowly.

 

As I mentioned if, if there’s any red flags then a gastroenterologist is engaged or if we’re just not getting anywhere, when it comes to pelvic floor physiotherapy work or the basics, then I’ll engage a gastroenterologist. What else do we do? Movements as I mentioned, so that’s really important. Different types of supplements as we get some of those results back. So maybe in regards to SIBO treatment. So looking at reducing especially that methane picture that IMO, intestinal methanogen overgrowth picture because methane slows mortality.

 

There are things that we can use as part of our SIBO treatment to reduce that. And that could be that… One of those things could be that partially hydrolyzed guar gum as well as, you know infliximab or, you know, some of these other natural alternative, like… Yeah, I don’t wanna be mentioning any names here, but you know, some herbs like oregano or berberine and various things to support that. So it really depends on what’s happening for someone, but even the probiotic strain DSM 17, I can never get right, lactobacillus reuteri, DSM 17. I can’t remember the name anyways, but that helps to bring down methane over production too. So it really depends.

 

We use the functional, the basics and then see how we go with that, but engage a pelvic floor physio, and then go into say, if it’s more of a secondary functional chronic constipation like medication use or something like systemic disease, then you wanna be referring on or, you know, investigating that for, like, multiple sclerosis or diverticular stricture, or even blockages like diverticular stricture or colon cancer. Those things are important to refer on.

 

Andrew: Yeah. Diverticulitis, there’s something we never ever talk about.

 

Lynda: Yeah.

 

Andrew: Amazing. Lynda, just, we have to cover briefly treatment outcomes. How do you plan them? What do you sort of gauge? What do you plan with your patients? And also where can we learn more?

 

Lynda: Our treatment outcome, I guess when I’m engaging a patient, I’m letting them know that we are going to be addressing those symptoms and getting movement as best we can with the basics, starting with the basics. We are recruiting our…we’ve got this collaborative thing going on with our other practitioners. It really depends on what’s going on for someone, how long it’s going to take to rectify a… Excuse the pun, and rectify an issue such as chronic constipation. But I think what practitioners need to be aware is that you really wanna give things at least a couple of weeks, not just say it’s not working within a couple of days or a week. You really wanna give things a couple of weeks to get going and that’s in regards to supplementation or, you know, movement or foods and water and those sorts of things.

 

Yeah, so supporting what’s going on for them, treating obviously, finding the drivers. So really establishing what those drivers are, working on those drivers. And in regards to things like SIBO, making sure that there’s no relapse after there’s treatment, and then maintenance. So just ensuring like a wellness sort of diet, like a Mediterranean would probably be the best when it comes to diet, ensuring adequate water intake is maintained. If mental health needs to be addressed ongoing, then ensuring that you’re doing that. And then just a check in as they need to. So, you know, you don’t wanna be with them forever. So you may need to move on, but you just wanna be able to check in every couple of months or whatever to see how they’re going and to see how they’ve just not fallen back into old behaviour, or they’re doing their exercises and doing that bowel retraining work.

 

Andrew: And where can we learn more? Certainly, from “Love and Guts” podcasts. You’ve got a host of experts that you’ve spoken to.

 

Lynda: Yes. So “Love and Guts” podcast. I’m happy to pop in the show notes or provide for you the interviews that are probably more relevant. So the ones that I’ve done on dysfunctional constipation and pelvic floor and those things, and I’m happy to send through some case studies on those particular things that have known to really support functional constipation like prebiotics funders and you know, those sorts of things. And yeah, that’s where you can find me on my website, lyndagriparic.com.

 

Andrew: Cool. Lynda Griparic, thank you so much for joining us. I was so excited when you said that you’d be on the show because you are quite famous out there with your “Love and Guts” podcast. Indeed, a couple of my friends were so excited to speak on your podcast. So I think it’s really funny…

 

Lynda: Excellent.

 

Andrew:  how you’re going.

 

Lynda: She’s coming on this Friday.

 

Andrew: Thank you so much. So… Oh, again.

 

Lynda: Yes, again.

 

Andrew: So, thanks for taking us through just some of the important points of constipation, how we can intercede to help these people. because they’re very often in a lot of pain, there’s a lot of embarrassment and it’s an ongoing issue, which we see more and more in our community. Even though we tend to talk about diarrhea much more often, constipation I feel is probably a bigger issue out there in the community. Thanks so much for taking us through these important points today on “Wellness by Designs.”

 

Lynda: You’re very welcome, Andrew. Thanks for having me on I’m truly, truly honoured.

 

Andrew: It’s our pleasure. And thank you for joining us. Remember you can find all the show notes and we will put ample up there because Linda has a huge repertoire. So, we’ll put them up on the Designs For Health website. You can catch up on all the other podcasts there as well. Thanks so much for joining us. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”