But What Causes All of Those Changes Found in Chronic, Severe Constipation?

Okay.  Great.  The slow movement of the colon in slow transit constipation occurs for a real reason.  There’s actually objective findings.  Super.

BUT WHAT CAUSED IT?  Here is where all of the great leads die.  All the fun and learning to get to this point–a hard, cold, concrete wall.  The etiology is unknown.  Don’t know.

Is there one of those changes discussed in the last post that could be a primary cause?  Or do these changes happen because of a discrete problem we haven’t connected and put together yet?  Or, more likely in my mind, are the changes a result of a multi-hit process in some of us?  I have had a problem with this since childhood, worsening, however, through the years.  Did it start as a dairy intolerance leading to inflammation?  The inflammation and food intolerance leading to constipation?  Constipation leading to chronic distention on the bowel wall?  Then worse constipation.  With the slowed transit did the bacterial flora get disturbed and changed?  Or did I have poor bacterial flora which in some way or other led to inflammation, constipation, distention, and worsening constipation?  I don’t know.  The hypotheses are endless for now.

  • Food sensitivities:  Would these be a source of chronic inflammation in the bowel which could bring about these insidious cellular changes?  Particularly if it was to something common like wheat, dairy or eggs?  I certainly don’t have an answer to this.  But studies do support food intolerances leading to severe, chronic constipation.  This next link is an excellent review article.  It starts out talking about cow’s milk and constipation, but near the end it starts talking about multiple food intolerances leading to constipation.  They go on to discuss inflammatory changes seen in chronic constipation patients, such as eosinophilia of the rectal mucosa.  (Full text, Review article: chronic constipation and food hypersensitivity –an intriguing relationship.)
  • Genetics:  Are you kidding me?  Of course!  Everything’s in your genes, slow transit constipation is no exception!  Researchers found an abnormal chromosome 1 in enteric neurons and glial cells.  (Abstract: Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation.)  

These are the ones I found research supporting.  Fiber has been a mixed bag.  Bacterial flora is just starting to get sorted out.  So for now, this is it.  We are learning the structural, cellular, and hormonal changes that occur in slow transit constipation.  But we don’t know what initially causes all of it.

“Unfortunately, to date data are lacking on the possible factors causing neurenteric abnormalities in constipated patients. The current hypothesized mechanisms (often originating from experimental animal models) imply abnormalities in glial trophic factors leading to neural degeneration, and enteric localization of infective agents (bacteria, virus, prions) causing more or less selective degeneration of specific neurenteric cell populations (particularly EGC), whereas genetic factors or neurodegenerative changes due to aging seem to play a lesser role.”   (Full text,   Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out.)

Citations are mostly links within the post.  Let me know if the links don’t work, please:

(1) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2008.01109.x/full

Next up when time allows, what I think about as I approach this problem personally and the Metametrix report on short chain fatty acids/butyrate stuff.


6 thoughts on “But What Causes All of Those Changes Found in Chronic, Severe Constipation?

  1. IrishMum

    I have had this problem from childhood too. I remember my mum taking me to the doctors a lot with severe pains caused by extreme constipation. The doctor always said the same thing, ” There is nothing wrong with her”, idiot.

    1. thehomeschoolingdoctor Post author

      “There’s nothing I can do” is a far cry from “There is nothing wrong.” Sorry. Geesh, I wonder even now if all they teach is fiber, water, and vegetables/fruits in medical school and residency. It is a frustrating problem, and clearly starts in childhood for some people. Seems like it ought to be a simple fix, doesn’t it, but not turning out to be so! Stupidly, I wonder how this problem will progress when I am quite old.

  2. Linda

    Don’t know if you have looked at tick-borne infection as a possible cause yet. We didn’t either until my daughter had the IGeneX test for Lyme done after a history of years of stomach problems. Started with gas pains that come out of nowhere one fall and which worrsened as the years went by to a long, long list of food sensitivities, motility problems, and an impacted colon with no apparent reason. Tried everything, did all kinds of tests, supplements, colonics, tested for SIBO, diets like GAPS and nothing helped. Finally, one smart G.P. suggested (because he had been learning about Lyme and had gone to the Toronto ILADS Conference – thank goodness he had!) that we really should pay to get the IGeneX Test for Lyme done. He said he had found out that the standard C6 Elisa was unreliable so we really needed to do the IGeneX test. We were shocked when the results were positive after years of seeing doctor after doctor and no one thought of it! Shame she had to suffer so long but now she is on treatment. Test results pulled a diagnosis together as there were lots of other “mysterious” symptoms by this time, too. Have a look at Dr. Sher’s article here: http://www.thehumansideoflyme.net/viewarticle.php?aid=62
    It may not fit for you but it’s a suggestion.

    1. thehomeschoolingdoctor Post author

      Hi, Linda! Thank you so much for that great comment! Luckily (and knock on wood), my GI tract has really turned around the last several months. What I am doing seems to be working (ahem, every day now 🙂 ). However, others reading this comment may not be having such luck and may need other paths to investigate so I am glad you were able to comment. Is the treatment helping your daughter do you think (obviously it probably is or else you wouldn’t have left such a nice comment)? Any particular symptoms respond better than others to the treatment (i.e., constipation more so than food sensitivities, etc)? I read a lot of the article (until the kids interrupted, ha!), and I am intrigued; Dr. Sher has a nice write-up with lots of sources to check out. Lots of new information for me to think about and process; Lyme’s is one of those highly contentious areas of medicine, so nebulous.

      Thanks again for the comment, and I hope all those mysterious symptoms are soon only distant memory. Take care! ~~Terri

  3. Pingback: Butyrate and Constipation | The HSD

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