the Link Between Constipation and Psychological Factors

Constipation and Psychological Factors

Hello Dr.
Wang,
I would like to ask if constipation can be caused by psychological factors.
Since middle school, I have often overeaten, which led to discomfort in my stomach.
During class, I would feel a strong urge to use the restroom but was too afraid to raise my hand and ask the teacher, so I held it in.
At that time, I frequently visited a gastroenterologist and developed a dislike for using the restroom, which gradually resulted in constipation.
Last year, I realized this issue and wanted to change my bathroom habits.
I started eating more fruits and vegetables, drinking 2000-3000cc of water daily, and going to the restroom on a schedule.
Initially, it was very frustrating as I would only pass pellet-like stools, so I began eating bananas and drinking milk and yogurt.
It worked at first, but over time I became immune to it.
Sometimes, when I go several days without a bowel movement, I would buy medication from the pharmacy (though I try to avoid it).
Now, I have fewer pellet-like stools, but I still don't go to the restroom often—about 2-3 times a week, and the amount is not much.
Sometimes, I haven’t eaten much, but my stomach feels bloated.
I have seen both traditional Chinese medicine and Western medicine, but neither has been effective, and I particularly dislike seeing Western doctors because they usually just prescribe laxatives, which typically lose their effectiveness after one use.

Additionally, I don’t eat much daily.
Eating too much rice or greasy, fried foods makes me feel guilty, and sometimes I even induce vomiting after overeating.
This is partly due to my fear of gaining weight and partly because I have poor digestion.
Sometimes, eating too much makes it even harder to have a bowel movement.
However, I have noticed that whenever I am home alone, listening to music or thinking about something, I suddenly feel the urge to go.
But if I am in a bad mood or angry, even drinking a whole bottle of 900ml of milk won’t help me have a bowel movement.
So, I am wondering if constipation is related to psychological factors? After all, some people also experience diarrhea when they are nervous.
Which clinic should I visit to improve this issue? Thank you.

lulu, 20~29 year old female. Ask Date: 2007/06/10

Dr. Wang Zhengzhong reply Family Medicine

Hello, based on your description, you feel a strong urge to use the restroom during class but are hesitant to raise your hand to inform the teacher, which leads you to hold it in and gradually causes constipation.
You also mentioned that you don't seem to enjoy consuming high-fiber foods, so I recommend increasing your intake of high-fiber foods.
Additionally, from your experience, I noticed that whenever you are home alone, listening to music or recalling certain thoughts, you suddenly feel the urge to have a bowel movement.
However, if you are feeling upset or angry, even drinking a whole 900ml bottle of milk does not help you to have a bowel movement.
I suggest engaging in leisure activities such as spa treatments, swimming, or jogging to relieve work-related stress and the tension of your daily life.
I believe you may have irritable bowel syndrome and recommend consulting a gastroenterologist.

Reply Date: 2007/06/10

More Info

Constipation is a common gastrointestinal issue that can indeed be influenced by psychological factors. Your experience highlights a significant connection between mental health and digestive health, which is increasingly recognized in the medical community.
Firstly, it’s important to understand that the gastrointestinal (GI) system is closely linked to the brain, often referred to as the "gut-brain axis." This connection means that psychological states such as anxiety, stress, and depression can significantly impact bowel function. In your case, the history of feeling anxious about using the restroom during school may have contributed to a learned behavior of withholding bowel movements, which can lead to constipation over time. This is a common phenomenon where individuals may suppress the urge to defecate due to social or psychological pressures, leading to a cycle of discomfort and further constipation.

Your efforts to improve your diet by increasing fiber intake through fruits and vegetables, as well as staying hydrated, are commendable steps toward alleviating constipation. However, it’s also crucial to address the psychological aspects of your condition. The fact that you experience changes in bowel habits based on your emotional state—such as feeling the urge to defecate when relaxed at home with music, but not when stressed—suggests that your psychological state plays a significant role in your bowel function.

In terms of treatment, it may be beneficial for you to consider a multidisciplinary approach. Consulting with a gastroenterologist can help rule out any underlying physical issues contributing to your constipation. They can provide guidance on dietary changes, lifestyle modifications, and possibly recommend medications if necessary. However, since you have expressed a preference against traditional Western medicine, you might want to explore alternative therapies, such as acupuncture or herbal medicine, which some individuals find helpful for digestive issues.

Additionally, addressing the psychological components of your constipation is equally important. Seeking help from a mental health professional, such as a psychologist or counselor, can provide you with strategies to manage anxiety and stress, which may, in turn, improve your bowel habits. Cognitive-behavioral therapy (CBT) is particularly effective for addressing anxiety and can help you develop healthier coping mechanisms regarding food and bowel habits.

You mentioned feelings of guilt associated with eating, which can also contribute to disordered eating patterns, including binge eating and purging. This cycle can exacerbate gastrointestinal issues and lead to further complications. A registered dietitian specializing in eating disorders could provide valuable support in developing a healthier relationship with food and addressing any underlying issues related to body image and self-esteem.

In summary, constipation can indeed be influenced by psychological factors, and your situation exemplifies this connection. A comprehensive approach that includes both gastrointestinal and psychological support may be the most effective way to address your concerns. By working with healthcare professionals from both fields, you can develop a tailored plan that addresses both your physical and emotional health, ultimately leading to improved bowel function and overall well-being.

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