What Is Chronic Constipation?

Chronic constipation is generally defined as having three or fewer bowel movements per week, or persistent difficulty passing stool — straining, hard or lumpy stools, or a sensation of incomplete evacuation — lasting longer than three months. It's more than an inconvenience: left unaddressed, it can cause ongoing pain and lead to secondary complications.

Common Symptoms

Beyond infrequent or difficult bowel movements, chronic constipation often shows up as abdominal pain and cramping, bloating and distention, acid reflux, a persistent feeling of fullness, nausea, and reduced appetite.

Getting to the Root Cause

As a gut naturopath in Toronto, when I assess chronic constipation I look well beyond "eat more fiber." A thorough workup considers several possible drivers:

1. Thyroid function — Hypothyroidism can slow digestion and lead to constipation.

2. Gut motility issues — Dysfunction in the gut's nervous system can result in reduced or uncoordinated peristalsis (the muscle contractions that move stool through the intestines).

3. Nutrient deficiencies — Magnesium deficiency, in particular, can affect muscle tone, making it harder for the bowel to contract and move stool effectively.

4. Pelvic floor dysfunction — Tight or uncoordinated pelvic floor muscles can make stool physically harder to pass, even when everything else is functioning normally.

5. Hemorrhoids — Pain from hemorrhoids can lead people to delay or avoid bowel movements out of fear, creating a vicious cycle: fewer bowel movements, harder stool, and worsening hemorrhoids.

6. Dietary habits — Low hydration and inadequate fiber intake.

7. Low physical activity — Movement helps stimulate healthy bowel motility.

8. Gut microbiome imbalance — Disruptions to gut bacteria are increasingly linked to constipation.

9. Celiac disease — Constipation can be part of a non-classic presentation of celiac disease, especially in children and in cases that don't resolve fully with diet changes alone, so screening for it can be an important part of the workup.

Our Naturopathic Approach

Care starts with a full intake — understanding your medical history, lifestyle, and symptom pattern — followed by diagnostic bloodwork (checking nutrient levels and thyroid function, among other markers) to help identify what's actually driving your symptoms.

From there, treatment is individualized: dietary and lifestyle modification, targeted natural treatment, and referral to pelvic floor physiotherapy or your physician when appropriate.

Beyond Laxatives: Why Root-Cause Care Matters

Laxatives such as PEG 3350 (sold under brand names like RestoraLAX) are among the most commonly used treatments for chronic constipation, and they can offer real short-term relief. But a more holistic approach — finding the root cause, supporting the pelvic floor, replenishing depleted nutrients, and supporting motility — tends to produce more sustainable, lasting results.

What Happens When Chronic Constipation Goes Untreated

Chronic constipation that isn't addressed doesn't just stay put — it can set off a broader chain reaction. Slower transit time gives bacteria more opportunity to overgrow in the small intestine, a condition known as SIBO (small intestinal bacterial overgrowth). SIBO can irritate the gut lining and further disrupt the gut microbiome, and it's associated with impaired absorption of key nutrients — including vitamin B12, fat-soluble vitamins (A, D, E, K), and minerals like calcium and iron. The result can be a self-reinforcing cycle of nutrient malabsorption and deficiency that makes constipation harder to resolve on its own.

Because of this, screening for SIBO, gut inflammation, and nutrient status is an important part of a thorough naturopathic workup for chronic constipation — not just an afterthought.