Long-Term Constipation: Causes and Solutions

According to a study presented at the Alzheimer’s Association International Conference in July, chronic constipation (i.e., not having a bowel movement for three-plus days) was associated with a 73 percent higher chance of subjective cognitive decline—or the equivalent of three years of advanced cognitive aging—compared to participants who had a single BM daily.

To unpack this info, we reached out to Kenneth Brown, MD, a board-certified gastroenterologist based in Plano, Texas. Ahead, see if constipation actually worsens cognitive function and how to achieve real relief from brain-bowel blues in no time.

The link between long-term constipation, cognition, and mood

According to Dr. Brown, constipation doesn’t directly cause cognitive impairment. Instead, it’s symptomatic of underlying causes, such as:

• Side effects of medication
• Dehydration
• Underlying health conditions, such as hypothyroidism

Moreover, he says recent research illustrates that gut imbalances (aka dysbiosis) are often at play when constipation and issues with cognition intersect. “With a healthy microbiome, anti-inflammatory bioactive metabolites keep inflammation down and can cross the blood-brain barrier,” Dr. Brown explains. “The exact opposite happens where an inflamed gut can produce inflammatory cytokines. These can have a direct effect by crossing the blood-brain barrier, leading to localized inflammation in the brain, resulting in decreased production of neurologic transmitters and increased oxidative stress.”

When GABA, serotonin, and dopamine levels nosedive as a result of chronic inflammation, cognitive function may be impacted if this continues long-term. “Over time, this can result in deposits of amyloid proteins and neurofibrillary tangles, causing increased risk of dementia,” Dr. Brown says.

It’s not just your ability to process and memorize information that’s at stake, however. “When an individual experiences constipation, it can trigger a series of effects on overall well-being and indirectly affect the brain,” Dr. Brown shares. “The discomfort and bloating associated with constipation can lead to mood disturbances, which can amplify stress and anxiety levels.” Simply put, long-term constipation can create a domino effect that has the potential to adversely impact your mental health, mood, and energy, as well.

4 game-changing tips to overcome long-term constipation

Above all, if you want to keep your gut and brain in fighting shape for years to come, don’t snooze on addressing signs and symptoms: Preventative care is key. “People with Alzheimer’s often start having gastrointestinal problems—specifically bloating and constipation—many years before developing dementia,” he says. On the flip side, just because you’re constantly constipated doesn’t mean you’re guaranteed to struggle with cognitive impairments in the short or long term. The point is that it always pays to be proactive.

Naturally, making constipation a long-lost memory is easier said than done. But you’re in luck: Dr. Brown has some surprising insights and actionable tips to make significant strides that will benefit your bowel movements and brain health alike.

1. Find the underlying cause

“This may be the canary in the coal mine,” says Dr. Brown. However, with the help of your healthcare team, you may be able to ascertain or rule out specific causes of constipation, like side effects of meds or thyroid imbalances. If you get the all-clear on these, you may discover that you’re actually dealing with dysbiosis or intestinal inflammation, and can make the appropriate dietary and lifestyle adjustments from there.

2. Be strategic with your fiber intake

Though fiber is a friend for many—and something that the majority of Americans don’t get enough of daily—it can actually be a foe for those struggling with constipation. “If you do not have a healthy gut microbiome, then fiber may cause bloating and discomfort,” Dr. Brown cautions. Specifically, he calls out insoluble fiber (top sources of which include whole grains and cruciferous veggies like Brussels sprouts, broccoli, and cauliflower), as a potential trigger, especially for those with small intestinal bacterial overgrowth, aka SIBO.

“If you do not have a healthy gut microbiome, then fiber may cause bloating and discomfort.”
—Kenneth Brown, MD, board-certified gastroenterologist

To work around this, he suggests opting for psyllium husk, a type of soluble fiber that dissolves in water. Integrate it into your diet in small doses, increase intake gradually, and drink plenty of H2O to avoid further digestive discomfort.

3. Nourish your microbiome (and mind) with polyphenols

More mindful fiber intake aside, Dr. Brown highlights how important it is to get large complex polyphenols in your diet. “Our microbiome metabolizes these large polyphenols into many bioactive metabolites, including anti-inflammatory, anti-aging, and promotility molecules,” he shares. “A clinical study examined how one of the largest and most complex polyphenols, quebracho colorado, and chestnut produced more beneficial metabolites than inulin, the gold standard [of soluble] fiber.”

Fruit and vegetables, spices, tea, and coffee (!) are also abundant sources of polyphenols; whole grains and legumes make the cut, too. In addition, polyphenol consumption is associated with cognitive benefits (though further research is needed to establish conclusive links).

4. Prime yourself for “the go”

To help kick constipation to the curb, Dr. Brown says you’ll want to take advantage of the gastrocolic reflex… which is what, exactly? “When fluid or solid hits your stomach, it sends a signal to your colon that you need to make room for the day’s food,” he explains. “The key here is not to ignore that urge to go [and to] plan around this physiological process.” Basically, when your body is telling you it’s time to poop, you should have the agency to do so.

Dr. Brown provides the example of drinking coffee—which can stimulate BMs—during your commute. If you sip on the subway or in your car and routinely resist the urge to poop, “it can train your colon not to go, leading to chronic constipation,” the gastro warns. To avoid this issue, aim to drink your coffee at home or once you arrive at your workplace where you can access a bathroom.

Parting tip: Dr. Brown suggests investing in a footstool for your home bathroom to facilitate more successful bowel movements. (Another sign of constipation is that you feel like you haven’t entirely—for lack of a better term—unloaded.) With your feet elevated, knees above your hips, and by leaning slightly forward, “This position helps the rectum to straighten out and helps to have larger, more effective bowel movements so you can fully evacuate.”