Understanding and Utilizing the Gut-Brain Axis for Constipation Relief

This article has been reviewed for accuracy by MedBridge instructor and pelvic floor disorder expert Cynthia E. Neville, PT, DPT, WCS.

Constipation, a common yet often overlooked condition, affects a significant portion of the population, leading to discomfort and a decreased quality of life. While dietary and lifestyle adjustments remain foundational for managing constipation, emerging research is demonstrating the pivotal role of the gut-brain axis in gastrointestinal (GI) health. The complex communication network between the digestive system and the brain offers important insights and therapeutic avenues for those suffering from constipation, particularly when it’s linked to stress or psychological factors.

The Gut-Brain Axis: A Two-Way Street

The gut-brain axis refers to the bidirectional communication pathway that connects the enteric nervous system (ENS) of the GI tract with the central nervous system (CNS). This pathway is instrumental in regulating GI function, including motility, enzyme secretion, and blood flow. The ENS, often dubbed the “second brain,” contains hundreds of millions of neurons that directly influence gut activity. Conversely, the CNS can affect the ENS, modulating GI symptoms and behaviors through stress and emotions.

Recent advancements in neuroscience and gastroenterology have provided greater clarity into how this axis plays a crucial role in the development and exacerbation of constipation. For instance, chronic stress and anxiety can lead to alterations in gut motility and secretion, contributing to constipation symptoms. Additionally, the gut microbiota, a key player in the gut-brain axis, influences gut health and can be affected by stress, diet, and antibiotics, further impacting bowel movement regularity.¹

Psychological Factors and Constipation

Psychological stress is a well-documented factor in exacerbating constipation.² The stress response triggers the release of corticotropin-releasing factor (CRF), which has been shown to alter gut motility and sensitivity. During periods of stress, the body’s “fight or flight” response can suppress digestion and slow down the movement of food through the GI tract, leading to constipation.

Moreover, conditions such as anxiety and depression are commonly associated with functional GI disorders, including constipation.³ The bidirectional nature of the gut-brain axis means that not only can psychological stress lead to constipation, but chronic constipation can also contribute to stress, anxiety, and reduced quality of life, creating a vicious cycle.

Therapeutic Approaches Targeting the Gut-Brain Axis

Understanding the gut-brain axis opens up new therapeutic possibilities for managing constipation. Here are some strategies based on the latest research:

• Mindfulness and stress reduction: Mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) have shown promise in managing functional GI disorders by reducing stress and improving GI symptoms. Practices such as yoga and meditation can also help alleviate stress, potentially improving constipation.
• Dietary modifications: Prebiotics and probiotics can influence the gut microbiota composition, positively affecting the gut-brain axis. Incorporating these into the diet may improve GI function and symptoms of constipation.
• Exercise: Regular physical activity has been shown to improve mood, reduce stress, and enhance gut motility, making it a beneficial intervention for constipation relief.

Future Directions

The exploration of the gut-brain axis is still in its infancy, with much to learn about its implications for constipation and overall GI health. Additional research is needed to further illuminate the mechanisms underlying gut-brain communication and to develop targeted interventions that can effectively address the psychological components of constipation.

However, we do know that the intricate relationship between the gut and the brain offers an important lens through which to understand and treat constipation. By addressing both the physical and psychological aspects of this condition, healthcare professionals can provide a more holistic and effective approach to care.

References

1. Chen QY, Li N, Jiang J. (2021). Relationship between chronic constipation and brain-gut microflora axis. Zhonghua Wei Chang Wai Ke Za Zhi. 25;24(12):1048-1053.
2. Simrén, M., Törnblom, H., Palsson, O. S., & Van Oudenhove, L. (2019). Psychological stress and stress-resilience in patients with functional gastrointestinal disorders. Gastroenterology, 156(7): 1815-1827.
3. Sarah Ballou, Jesse Katon, Prashant Singh, Vikram Rangan, Ha Neul Lee, Courtney McMahon, Johanna Iturrino, Anthony Lembo, Judy Nee (2019). Chronic Diarrhea and Constipation Are More Common in Depressed Individuals. Clinical Gastroenterology and Hepatology, 17(13): 2696-2703.