What is the problem? There definitely is a problem, even if knowing what we know of the problem won’t help you move your bowels any more frequently yet. And of all these “problems,” we don’t know which is the primary problem, if any of them! I guess what I’m saying is, it’s good to know, but I’m sorry it won’t help you. Advances in science occur in spurts, and then it takes time to shape these advances into hypotheses and then theories. Even then, we may arrive at an incomplete understanding–as we may have in leading you to believe “fat is bad for you.”
I will describe in a later post how I use this and other information to try to gain any edge I can on my bowel function.
Please let me know if any of these links don’t work, please. It is fascinating information, and if it may help you with your disease process, I’d like to make sure you can read it!
- Less Interstitial Cells of Cajal (ICC). Normal movement of the GI tract requires interstitial cells of Cajal. These cells act as pacemakers and signallers between autonomic nerves and smooth muscle, causing the colon’s neurons to fire and bring about peristalsis, and alterations in their number and function are thought to bring about drastic functional changes. Decreased ICC numbers and abnormal integrity are considered a hallmark in the gut disorders of diabetic gastropathy and slow transit constipation. (1, 2, 4)
- Increased number of mast cells. Mast cells are immune cells which are often found in connective tissue, particularly in sites where there is close interaction with the “outside world”—the external environment—like in the GI tract. They are often associated with allergic responses, including food allergies. In the GI tract, mast cells are preferentially located next to nerve terminals in the region known as the lamina propria and play an important role in the regulation of gastrointestinal visceral sensitivity, vascular permeability, and motor function. Interestingly, they have also have been found to be elevated in many cases of irritable bowel syndrome. (1,3)
- Abnormal neurotransmitters and response to these neurotransmitters , including but not limited to– serotonin, vasoactive intestinal peptide, and substance P. (1, 3, 4, 9)
- Too many progesterone receptors. Progesterone slows the GI tract down. It does this, in part, by decreasing the effect of acetylcholine (the neurotransmitter that, in the bowel, leads to increased peristalsis) and serotonin. This may explain why constipation may worsen during pregnancy and at certain times in female cycles. Check. (1, 5)
- Reduced Substance P Fibers. Substance P brings about an increased GI motility effect. (1)
- Less neurons immunoreactive for ChAT. Basically saying there are less neurons sensitive to acetylcholine, which is necessary for peristalsis. (6)
- More neurons immunoreactive for NOS. Basically saying that there are more neurons sensitive to nitric oxide (NO), a substance that allows the distal gut to relax as peristalsis occurs. Having more NO sensitive neurons will make the gut more likely to be “relaxed” rather than peristalsing. (6)
- Less neuron density (50% less), decreased neuron numbers, reduced number of ganglia, reduced number of cells per ganglion, and reduced enteric glial cells. (6, 9)
- Reduction in high amplitude propagating contractions and a disruption of the coordinated peristaltic activity. Basically saying that there are less of the sweeping contractions that bring about defecation and that the whole system just is not coordinated at all like in normal person. (6)
- Weaker contraction to acetylcholine in the colon. (7)
- Relaxation to adrenalin stronger than a normal colon. (7)
- Possible antibodies to GnRH with decreased GnRH and its receptor in enteric neurons. GnRH is gonadotropin releasing hormone. (8)
- Excitatory nerve fibers present in the circular muscle are deficient in tachykinins and encephalin. (9)
- Expression of c-kit mRNA and c-kit protein was also found to be significantly decreased, which may lead to reduced interstitial cells of Cajal. (9)
In summary, your gut (and mine) doesn’t move, and we aren’t sure exactly why. However, there are MANY identifiable differences in a gut with slow transit constipation and a normal gut. The unique nervous system of the gut is disordered, in both the neurons, hormone production, hormone processing, and the supporting cells for the neurons.
More posts to follow along this topic: What could cause this problem? What I personally do about it. The role of butyrate and short chain fatty acids (SCFA) on the gut/my Metametrix result for SCFA.
Take care,
Terri
Citations:
(1) This requires a log-in. So you may not be able to pull this little review article up: http://www.medscape.org/viewarticle/770638_3
(3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033552/
(4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710411/#!po=11.363
(5) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2011.01705.x/full
(6) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2008.01165.x/full
(7) http://www.ncbi.nlm.nih.gov/pubmed/12397730
(8) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885307/#!po=63.0435
(9) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710411/#!po=11.3636 (I really liked this article for pulling things together and giving me leads to follow.)
The HSD 
Thanks for using your time to benefit others with more knowledge. This affects people in their quest to become athletic. I’m adding your blog to my Wordrpess Community Blogroll. Keep in touch!
Thanks for reading and leaving a comment. I appreciate it. I think anything that makes our function and psychology improve certainly plays a role in allowing us to be more athletic. I will be over when I can to check out your blog. Thanks again and have a good week.
Pingback: But What Causes All of Those Changes Found in Chronic, Severe Constipation? | the homeschooling doctor
Great list! I am looking forward to see where you go with this 🙂
Nowhere fast.
Pingback: Butyrate and Constipation | The HSD
Hi Terri,
How ironic to be corresponding to a person named “Terri” and the topic of conversation is constipation. I too am a Terri and constipation is an issue that has likewise plagued me most of sixty years from early on in my childhood. Over the years, I have faulted my grandmother for contributing to my life-long battle with the condition. My grandmother was a beautiful, loving and caring person who I loved dearly. She was a Nebraska farm woman who was born in 1909 and had wanted to be a nurse. I had come to believe that she was practicing nursing on me and my brother when every Friday night (until I was age 6 or 7) she would dose us with mineral oil and then bring out her “dreaded little red plastic bag” and administer a weekly enema to us. One thing that has always stuck out in my mind was that my grandmother was a little old lady that looked like she was 9 months pregnant. I remember her so vividly as a tiny petite woman (5’2″) who had this huge, distended, rock hard belly. Now that I am older and wiser, I have come to realize that she too must have suffered from constipation and bloating throughout her life which probably played out in her being so fanatically concerned with our BMs. I can’t recall being constipated in my teens but have struggled with constipation all these years since my early 20’s and have always felt that my grandmother was somewhat responsible for the onset of my constipation woes.
I myself am now past menopause and have reached a point where it’s not just constipation that I suffer with but intolerable abdominal distension and bloating. I am 5’6″, always very active and athletic and have been thin like a greyhound my entire life. I have never been bulimic or anorexic but instead have been blessed with a high metabolism and have always enjoyed eating and drinking whatever I wanted and have stayed skinny all the while. I grew up in an era without the internet and the bounty of information available so I never made the association that what I ate could contribute to my constipation and never tried to limit myself diet wise.
Over the years, I have tried every OTC laxative brand that ever was produced and was at a loss when Miralax quit working for me. In October 2013, I had a terrible gastric attack that left me in pain for 24 hours – in retrospect it may have been a twisted colon. I went to a GI specialist explaining my lifelong battle with constipation and ended up having a colonoscopy and an upper GI as well. The biopsy results ruled out H. pylori and celiac disease and indicated mild gastritis a small duodenal ulcers. The GI prescribed Prilosec and told me to continue to use Miralax on a daily basis – both recommendations left me totally frustrated. I didn’t bother with the prilosec but instead purchased the HCL to increase the acid production in my stomach since I am borderline low thyroid and acid production routinely decreases with age – so far, the pain has not reoccurred. These past few months, I have made some progress with the constipation by eliminating dairy and whole wheat grain from my diet, supplementing with magnesium and vitamin C, incorporating soaked flax and sunflower seeds into my morning smoothie or oat bran cereal, eating olive oil, almond brand butter and coconut oil, adding HCL and Enzymedica digestive enzymes (good stuff!) remembering to chew my food thoroughly and trying not to eat but every 4 hours. While my stool has improved and I am more regular, the bloating and abdominal distension persists. At this time I would love to be able to afford a stool test like you did and a SIBO breath test to test for excess methane bacteria (associated with constipation). I am thankful, however, that the colonoscopy did provide revelation as to “why I am constipated” and that is I have a REDUNDANT COLON which basically means my colon is longer than the norm. Researching this on the internet, I have found that a redundant colon can be a genetic abnormality or created as the result of gastric surgery, constant constipation, and other health reasons. When I think of my grandmother and the time spent since childhood dealing with constipation, I realize that I most likely was born with a long colon and predisposed to constipation from a young age. There is little that can be done about a redundant colon short of surgery which may be why the GI doc did little more than note I had a long colon and prescribe more Miralax. But it has been a big thing for me – knowing exactly WHY I AM CONSTIPATED. I feel so bad now when I think of my poor little grandmother and how difficult her struggle must have been back then at a time with even more ignorance and limited medical knowledge regarding constipation and no alternative internet blogs for support.
I am fortunate to know the root cause of my constipations because it rules out other causes and provides a better plan of attack knowing specifically what I am dealing with. I happen to google your blog because further internet research revealed that a redundant colon is usually associated with slow-transit constipation and I was looking for ways to deal with this. Perhaps this will be useful information to you and you may want to research further and add redundant colon to your list of slow transit constipation causes. I apologize for the long post but I have gained much knowledge reading other peoples stories so I felt the need to reciprocate. I, like so many others, appreciate your efforts to educate and inform. I found the resistant starch and butyrate bacteria connection fascinating. There is a lot of good information out there regarding resistant starch and butyrate that I never would have researched without happening upon your blog. So you know – I purchased potato starch yesterday, started the PS regiment last night, had a BM this morning and am so very anxious to see where this takes me! Thanks again for your excellent insight and putting this information out there. Sincerely, Terri O.
Terri, Thanks for sharing your story with pretty much life-long constipation. I, too, am exceptionally grateful for those unknown people who were willing to discuss this issue on the internet so people like you and me could glean information! Without technology, I know my GI would only have worsened, along with all the other simple health issues that were starting to tally up for me. Your story raises my curiosity about any familial tendencies for slow transit constipation and also about redundant colon. I have read a little on redundant colon, and I will move it up the list of things to read. My constipation research has halted right now as I am pregnant, my GI tract is very unpredicatable, and I am sticking to just some magnesium and vitamin C as meds that should not cause any issues with the baby. No self-experimentation right now. 🙂 Regardless, my GI tract works better now than it ever has. Would love to hear how the potato starch ends up! Some people have tried experimenting with all kinds of other starches that would lead to butyrate production with initial success, but I’ll have to check back in and see where it ended up.
I do feel bad for your grandmother, doing the best she could with what she had and knew. But poor you! Mineral oil! The red bag weekly! I also have bloating that developed in my mid-thirties. I personally think that my life-long constipation and poor forward sweeping motion allowed for SIBO and FODMAP issues. Maybe had I gained the edge I have now and gotten my GI tract moving somewhat regularly, I wouldn’t have run into the bloating/SIBO/FODMAP issues. But I don’t know. (Like you, too, I have always been thin, active, and ate whatever I wanted–and I liked sweets!) I did try the SIBO regimen, but it came back–so treatment isn’t a cure-all for sure. So now, if I’m strict with food triggers/FODMAPS, I can keep the bloating down. But there’s only so much will-power I have and so many nutritious foods that should be eliminated!!!!!! So once the baby is born, equilibrium attained again, I will start trying to figure out what to do again about my GI tract.
Well, anyhow, I will see where my GI stands after the baby, and then I will get back on the trail. 🙂 I’m still eating GAPS/SCD/Paleo/Autoimmune Paleo/whatever you want to call it. Still magnesium and vitamin C. Potato starch made me sick early on (but so did everything) and I couldn’t bring myself to go back yet. Oh, before I close, you may want to read about iodine. I’m working on some posts about it now, but since it’s so controversial and uncertain, I’ll play the safe game. But there’s a lot of interesting stuff to think about, especially given your thyroid history.
Hope you are in good spirits and all is well. Thanks again for “stopping by” and offering some insider information. ~~ (The Other) Terri