Gastroparesis and Constipation - Have both?
Are you suffering from gastroparesis and constipation at the same time? What an uncomfortable combination, right? It’s like a traffic jam that starts at the stomach and continues on for miles. The food is just crawling along the tract, barely moving until, bam! It hits a standstill near the end of the line.
Gastroparesis is basically a slowing of stomach emptying that isn’t caused by a physical obstruction. If you’re interested in reading more about this condition in detail, you can read my blog article on gastroparesis, where you’ll also find tips for dealing with its symptoms.
I’m sure everyone is familiar with the term constipation. However, it does mean different things to different people. For some, constipation means you’re pooping much less often than you’re used to, and for others, you’re pooping less often than you think you should be. It’s safe to say that constipation involves passing hard, lumpy, infrequent stools; feeling like you’re not fully clearing everything out when you have a bowel movement; feeling backed up and bloated; or pooping fewer than 3 times per week.
Why would gastroparesis and constipation show up together?
There are several possible reasons that these would show up together. One could be that constipation started first and that caused the gastroparesis. A small study involving healthy subjects demonstrated that purposely withholding a bowel movement for several days causes the stomach to empty slower.
But the reverse can also be true. Food that empties from the stomach at a very slow rate can result in constipation because of the small volumes slowly being delivered to the colon throughout the day. This makes forming the stool a slow process, so bowel movements are less frequent.
Another reason that gastroparesis might cause constipation is also related to the small amount of food people can comfortably eat when they have slow gastric emptying. Typically-sized meals entering the stomach trigger something called the gastrocolic reflex. This is communication between the stomach and the colon. The stomach is letting the colon know that food will be coming down there soon, so make room. This stimulates the urge to poop. Small amounts of food may not trigger this.
Many people deal with only one of these conditions though. According to one large study, only about a third of people with confirmed gastroparesis also have severe or very severe constipation. A larger number of people complained of symptoms of both, but the gastroparesis was not confirmed when gastric emptying studies were done on many in this group.
There is a much stronger link between slow small intestinal and colonic movement and severe constipation than gastroparesis and constipation. And, yes, it’s possible to have all 3 – slow stomach emptying, slow intestines, and constipation.
Why this is important
Your healthcare team must be aware of both your gastroparesis and your constipation. If only the gastroparesis is addressed, you still may not feel any better due to the constipation symptoms. Both issues should be treated as they probably affect each other.
This combination of problems is serious since many people with these symptoms lose weight unintentionally. This can lead to nutrient deficiencies, malnutrition, fatigue, and a poor quality of life.
Case example
Here’s an imaginary example of this situation. Let’s say a 42-year-old female has had chronic constipation since childhood. In the past 5 years, she has developed symptoms associated with gastroparesis that seem to be getting worse, such as gastroesophageal reflux (heartburn), becoming full after only a small amount of food, belly pain, nausea, and vomiting.
This is serious since many people with these symptoms lose weight unintentionally. This can lead to nutrient deficiencies, malnutrition, fatigue, and a poor quality of life.
In this fictitious case, the patient is not aware that her constipation is caused by a pelvic floor muscle dysfunction, which makes having a full bowel movement difficult. Her chronic constipation then led to her gastroparesis. So no amount of tips to ease her slow stomach emptying symptoms will lead to relief until the cause of her constipation is addressed.
Working on the pelvic floor dysfunction would be the starting point. In this case, I refer my clients to a pelvic floor physical therapist for evaluation and treatment if I suspect this is involved.
Some things you can try to improve your symptoms
Where does treatment start when you have both gastroparesis and constipation? Should you treat one of them first, or both at the same time?
It’s reasonable to make some changes that will improve both of these gastrointestinal (GI) conditions at the same time. There are long lists of options for treating each of these separately. Different tips will work for some people and not others, so care should be individualized.
Here are just a few gastroparesis and constipation tips to consider:
Work with a dietitian to add fiber or adjust the type of fiber in the diet.
Reduce fried foods, spicy foods, and foods with a lot of roughage.
Eat small, frequent meals.
Try blenderized soups or smoothies.
Eat foods known to help with constipation, such as kiwifruits.
Make some lifestyle changes, such as movement and stress reduction.
Ask your GI doctor to perform a digital rectal exam, especially if you have diarrhea or constipation or both.
Assemble a team to provide different perspectives and options. This would ideally consist of a GI doctor, a GI dietitian, and often a GI psychologist.
Fast-action steps
These are just a snapshot of the possible solutions for you to try if you are dealing with both gastroparesis and constipation. You can add me to your healthcare team for a coordinated and personalized approach to solving your GI problems.
We dietitians have many tools in our toolboxes, and I’d love to help. Schedule a free 20-minute consultation to discuss your GI issues and goals.