For some people, it is possible to suffer from both constipation and diarrhoea. Here we aim to discuss the reasons behind this in terms of potential triggers and causes, and how someone may help to alleviate their symptoms.
Causes of constipation and diarrhoea
There are potentially a few different reasons why people may suffer with oscillating symptoms of constipation and diarrhoea. If you are suffering from both constipation and diarrhoea I'd firstly highly recommend seeking advice from your GP in order to receive an accurate diagnosis. There are some more serious conditions that can cause such fluctuations in symptoms including diverticulitis and ulcerative colitis.
Fluctuating symptoms of constipation and diarrhoea can be confusing and frustrating
The most likely cause for a history of both constipation and diarrhoea is a condition known as IBS (Irritable Bowel Syndrome). IBS is the umbrella term used by the medical profession to describe a combination of digestive symptoms ranging from constipation, diarrhoea, bloating and abdominal discomfort. IBS is not life threatening, but it can be extremely unpleasant and inconvenient for the sufferer. IBS tends to be categorised into 4 different types, IBS-C is predominantly symptomised by constipation, IBS-D is typically diarrhoea dominant and IBS-A is alternating constipation and diarrhoea. The fourth category is referred to ‘Unsubtyped irritable bowel syndrome’ (IBS-U), denoting people with IBS symptoms but with insufficient change in the character of their stools to fit into any of the other categories. Approximately a quarter to a third of all people fall into each group.
Most conventional treatments for IBS are designed to control either diarrhoea or constipation, and as people in the IBS-A group with the most variable symptoms don’t fit easily into treatment groups for research studies, there is little research into the best way of alleviating their symptoms. It is therefore even more important to treat each case individually, and attempting to identify the specific triggers for each individual.
There is no actual known cause of IBS, and as a result no specific treatment so GP's tend to address the symptoms with a variety of medications. Natural health practitioners tend to try to get to the cause of the symptoms by working out what may be driving those symptoms in each individual. To help determine whether you are suffering from IBS you can read Nicola's write up, 'Do I have IBS?'
IBS sufferers, specifically those with symptoms of both constipation and diarrhoea, may experience a variety of triggers for their condition. Some women for example may suffer from constipation more depending on the time in their menstrual cycle, (if this is the case see this piece on alleviating constipation during your period.) Many people find that stress acts as a trigger for IBS, and may cause fluctuating constipation and diarrhoea symptoms in some. Food is often a significant driver for IBS symptoms and it may be helpful to seek advice from a nutritional therapist or naturopath in order to help identify certain foods that may be driving your symptoms.
The bacteria in our gut plays a significant role in the health of our digestive system and it is known that dysbiosis, an imbalance in our gut flora, may cause varying symptoms such as constipation and diarrhoea. You can read more about the role of prebiotics and probiotics in terms of gut health here.
A condition to be aware of that may seemingly appear to be a fluctuation of constipation and diarrhoea is known as Bypass (or Overflow) Diarrhoea. This occurs when a hard plug of stool in the lower bowel (faecal impaction) prevents a proper evacuation of faeces, and only the more liquid stool from higher up in the bowel can then be passed. In this instance, it is particularly important to avoid certain medications which may slow the bowel down, as these could in fact make the condition worse. Equally, long-term use of laxatives can cause the muscles to 'forget' how to function properly and as a result the bowel is not able to pass a harder stool, potentially leading to impaction. It would therefore be important for the GP or healthcare practitioner to take a thorough case history and ensure a proper diagnosis before prescribing the patient with medication as this could further worse the problem. There are many natural remedies for constipation someone may like to try before taking prescription medications.
Bypass diarrhoea (also known as overflow diarrhoea) commonly affects children. Impaction, as mentioned above, means that the bowel is effectively blocked by a large amount of hard stool. If a large stool gets stuck in an enlarged rectum, the urge to go to the toilet is reduced, as well as the required strength required to pass the stool. As a result more stools build up behind the impacted stool in the rectum and some of this stool becomes runny and may leak out of the anus. In children it is fairly common for the stool to leak into underwear and bedclothes and parents may mistakenly believe the child is suffering from diarrhoea. It is therefore important that people understand the symptoms of constipation and are able to recognise if it is something they are experiencing. This will hopefully mean that the symptoms can be treated before faecal impaction should occur.
You can read more information about children and constipation here.
Bypass diarrhoea may be a symptom of faecal impaction, an unpleasant condition that requires medical attention
How to improve your symptoms
In order to help find the suitable treatment for your symptoms, it is necessary to get to the root cause of the problem and what may be driving them. As everyone is unique with different triggers for their symptoms, there is unfortunately no 'one size fits all' method in relieving symptoms of constipation and diarrhoea.
IBS is typically treated by the medical profession with a combination of laxatives, antispasmodics (muscle relaxants) to help reduce abdominal cramps, and anti-motility medicines to help reduce diarrhoea. Although medication may be effective in treating the symptoms, it does not help to identify what may be driving them. Medications can also carry less than desirable side effects. Naturopath Lou Bowler has previously written about using laxatives for constipation.
Laxatives are a common medication recommended by GPs for treatment of constipation
In people suffering from alternating constipation and diarrhoea,and where faecal impaction is considered to be the cause, conventional treatment is with laxative use. This aim to bulk and soften the stool, helping to make them easier to pass. In rare cases, it may be necessary for someone to receive treatment in hospital using medications to help empty the bowel, called enemas, which are given via the rectum. In some very hard to treat cases, a general anaesthetic may be required and the bowel would be cleared out manually by a surgeon.
There are also other natural alternatives to try, particularly with regards to dietary changes that can be very effective in helping to reduce constipation. Preventing dehydration by drinking plenty of water is key to reducing ongoing constipation, as well as ensuring a diet high in fibre from eating plenty of fresh fruit and vegetables. For those suffering with both constipation and diarrhoea it is important to manage your fibre intake to help balance your symptoms - eating adequate fibre to help relieve constipation yet not too much which may trigger diarrhoea. Try keeping a food diary, preferably calculating the amount of fibre in your daily food intake, in order to help you identify the right balance. Ensuring mild constipation is treated effectively is important in order to prevent the problem becoming more long term and potentially leading to faecal impaction which is both unpleasant and can be tricky to accurately diagnose.
Figs are just one of the many recommended foods to help ease symptoms of constipation
In terms of reducing symptoms of IBS (Irritable Bowel Syndrome), there are again many different natural routes people can take to help improve their symptoms of alternating constipation and diarrhoea. Find out more about natural remedies for constipation here in naturopath Megan's write up.
As it the case for all natural medicine, prevention is far better than cure and there are plenty of healthy habits one can adopt to support a health and happy digestive system, and avoid the symptoms of constipation and diarrhoea. It is often a case of trial and error and trying different methods and remedies in order to determine what works for you as an individual. Nutritional therapist Nicola Shubrook has featured here 5 foods to help relieve constipation, which you could try on days that you feel 'blocked up' (and best avoid on the days where the opposite is the case!)
If you suffer from both constipation and diarrhoea and have found any natural remedies especially helpful, we would love to hear about it. Please let us know by commenting below.