Chronic Constipation: The Real Causes and How to Fix It Naturally

15 Jun

By Joana Amram — Registered Nutritional Therapist (ANP/APENB), CNM London
Gut health & digestion · Lisbon & online · joana-amram.com

You've added fibre. You drink plenty of water. Maybe you've tried laxatives, prunes, magnesium, every tip on the internet. And still — things don't move the way they should.

If that's you, here's something important: chronic constipation that doesn't respond to the usual advice often isn't about fibre or water at all. It's about how your gut is moving — and that has deeper drivers.

What constipation actually is

Constipation isn't just infrequent bowel movements. It's stool moving too slowly through the colon, so too much water gets reabsorbed and everything becomes harder to pass [1]. The real question is always: why is it moving slowly?

Why fibre and water sometimes make it worse

This surprises people. Fibre helps some types of constipation — but if your gut motility is genuinely slow, piling on more fibre can add bulk the gut can't move, leading to more bloating and discomfort, not less. Fibre is a tool, not a universal answer, and using it blindly can backfire.

The real root causes

When constipation is stubborn, one or more of these is usually involved:

Slow gut motility. The muscular waves that move things along can weaken — this is the core mechanism in slow-transit constipation, and it often involves the gut's own nervous system [1]. It can be driven by stress, low thyroid function, or a sluggish nervous system.

Stress and the nervous system. Your gut moves best in a calm, "rest and digest" state. Chronic stress keeps you in "fight or flight," which slows everything down.

Low thyroid function. An underactive thyroid is a classic, often-overlooked cause of slow transit.

Gut bacteria imbalance. The microbiome plays a real role in motility and stool formation; an imbalance can contribute to sluggishness.

Fluid handling, not just intake. Sometimes it's less about how much you drink and more about how the gut is handling fluid and electrolytes along the way.

Pelvic floor and mechanics. Sometimes the muscles involved in actually passing a stool aren't coordinating well — a different problem from slow transit, and one worth identifying.

Why laxatives aren't a long-term answer

Laxatives can help in the short term, but they don't address why things slowed down — and some types, used long term, can leave the gut more reliant on them. The goal is a gut that moves on its own again.

A root-cause approach

Because the drivers are so different from person to person, there's no single fix. What helps is identifying your pattern: when it started, what else is going on (energy, stress, thyroid, other gut symptoms), and how your gut is actually moving — working alongside your doctor. Constipation is often connected to the wider gut picture, which is why it overlaps with conditions like IBS.

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You can read more about how I work with digestive symptoms on my services page.

This article is for educational purposes and is not medical advice. Always work with your doctor for diagnosis and before making changes to your care.

Frequently asked questions

Why doesn't fibre fix my constipation?
If your gut motility is slow, adding more fibre can add bulk your gut struggles to move, sometimes worsening bloating. Fibre helps some types of constipation but not all.

What causes constipation that won't respond to anything?
Stubborn constipation often involves slow gut motility, stress, low thyroid function, or a microbiome imbalance — drivers that fibre and water alone won't address.

Are laxatives safe to use long term?
Laxatives can help short term but don't address the underlying cause, and some types can lead to dependence over time. The aim is to restore the gut's own movement.

Can I work with you online if I'm not in Lisbon?
Yes. I support clients online in English, Portuguese, Spanish and French, as well as in person in Lisbon and Estoril.

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