If you are struggling with constipation whether it’s hard stools, infrequent bowel movements, or the feeling that you can’t fully empty your bowels  you are not alone.

Many patients I see in clinic describe the same pattern:

They feel bloated after meals, uncomfortable throughout the day, and often go several days without a proper bowel movement. Some rely on laxatives just to feel some relief, while others feel like they are “going”, but never fully empty.

If this sounds familiar, there is usually a reason.

How common is constipation?

Constipation is one of the most common digestive complaints in the UK.

• It is estimated to affect around 1 in 7 adults
• Up to 30% of people with IBS experience constipation as a dominant symptom
• Women are affected more frequently than men

Despite how common it is, many people are told it is “just IBS” — without any investigation into the underlying cause.

What is constipation?

Constipation is typically defined as:

• fewer than three bowel movements per week
• hard, dry, or difficult-to-pass stools
• straining during bowel movements
• a feeling of incomplete emptying

However, in clinical practice, it is often more complex.

Some patients go daily but still feel blocked. Others alternate between constipation and diarrhoea a pattern commonly seen in IBS.

Why am I constipated?

Constipation is rarely just about fibre.

In clinic, it is usually caused by a combination of factors affecting digestion, gut bacteria, and motility.

1. Slow gut motility (a key driver)

The digestive system relies on coordinated patterns of muscular activity to regulate how food and waste move through the gastrointestinal tract. One key component of this is the migrating motor complex (MMC) —a cyclical pattern of contractions that occurs between meals and helps clear residual material and bacteria from the small intestine.

When gastrointestinal motility is impaired:

• transit through the colon slows
• more water is reabsorbed from the stool
• stools become firmer, drier, and more difficult to pass

This process —known as slow transit  is a well-recognised mechanism in chronic constipation and is frequently seen in patients with functional gut disorders such as IBS.

Emerging research also suggests that factors such as methane-producing gut microbes may further slow intestinal transit, helping to explain why some individuals experience persistent constipation alongside bloating that does not improve with fibre alone.

2. Methane SIBO (often missed)- Small Intestinal Bacterial Overgrowth

One of the most overlooked causes of constipation is methane-dominant SIBO.

Methane gas has been shown in research to:

• slow intestinal transit
• reduce gut motility
• increase constipation severity

Patients with methane SIBO often present with:

• persistent constipation
• significant bloating
• a feeling of heaviness after meals

This is frequently missed in standard NHS pathways.

3. Gut dysbiosis and microbial imbalance

An imbalance in gut bacteria can affect:

• stool consistency
• fermentation patterns
• bowel regularity

Certain bacteria can produce gases that slow the gut, while others help stimulate movement.

When this balance is disrupted, constipation can develop.

4. Poor digestion and low stomach acid

If food is not properly broken down in the stomach and small intestine:

• it can ferment in the gut
• contribute to gas and bloating
• disrupt normal bowel movements

This is particularly common in people taking acid-suppressing medications or under chronic stress.

5. Diet and hydration

Diet still plays a role, but it is often misunderstood.

Common contributors include:

• low fibre intake
• inadequate fluid intake
• highly processed foods

However, increasing fibre alone does not always solve the problem — and in some cases, it can worsen symptoms, particularly if there is underlying SIBO.

6. Stress and the gut-brain connection

The gut and brain are closely linked through the gut-brain axis.

Chronic stress can:

• slow digestion
• alter gut motility
• worsen IBS symptoms

Many patients notice their constipation worsens during periods of stress or anxiety.

How to relieve constipation naturally

1. Support gut motility

One of the simplest but most effective strategies is meal spacing.

Eating meals 3–4 hours apart allows the migrating motor complex to function properly.

Constant snacking can interrupt this process and slow gut movement.

2. Improve digestion

Supporting digestion can reduce fermentation and improve bowel function.

This may involve:

• eating slowly and chewing thoroughly
• avoiding eating late at night
• supporting stomach acid and digestive enzymes where appropriate

Better digestion means less undigested food reaching the colon — and less fermentation.

3. Use fibre strategically

Fibre is often recommended, but the type matters.

Some people benefit from:

• soluble fibre (e.g. oats, flaxseed, chia seeds)

However:

• excess fibre can worsen bloating in some individuals
• insoluble fibre may irritate sensitive guts

This is why a personalised approach is important.

4. Stay hydrated

Water plays a crucial role in stool formation.

Without adequate hydration:

• stool becomes dry
• bowel movements become more difficult

Aim for regular fluid intake throughout the day rather than large amounts all at once.

5. Magnesium support

Magnesium can be particularly helpful for constipation.

It works by:

• drawing water into the bowel
• relaxing intestinal muscles

Forms such as magnesium citrate or glycinate are often used in practice.

6. Address the root cause

If constipation is ongoing, it is important to look deeper.

Underlying causes may include:

• SIBO
• gut dysbiosis
• food intolerances
• hormonal factors

Simply treating symptoms without addressing the cause often leads to recurrence.

Case study

A 34-year-old female patient came to clinic with:

• constipation for over 5 years
• bloating after nearly every meal
• reliance on laxatives
• fatigue and brain fog

She had previously been told she had IBS.

Further testing revealed methane-dominant SIBO.

After targeted treatment, including dietary changes and antimicrobial support:

• bowel movements normalised
• bloating significantly reduced
• energy levels improved

This is a pattern I see frequently —where constipation is a symptom of an underlying gut issue rather than a standalone condition.

When should you consider testing?

It may be worth investigating further if you experience:

• chronic or long-standing constipation
• bloating after eating
• incomplete bowel movements
• constipation alternating with diarrhoea
• symptoms that do not improve with diet alone

Tests such as:

• SIBO breath testing
• comprehensive stool analysis

can help identify underlying imbalances.

Constipation and IBS

Constipation is a common subtype of IBS (IBS-C).

However, IBS is often a label rather than a diagnosis.

Many patients are told they “just have IBS”, when in reality there may be an underlying cause such as SIBO or dysbiosis that has not yet been identified.

Final thoughts

Constipation is often more complex than simply needing more fibre.

In many cases, it reflects:

• slow gut motility
• microbial imbalance
• poor digestion

Addressing the root cause — rather than just managing symptoms — is key to long-term improvement.

If you would like personalised support, please contact us on 0345 129 7996 or visit our clinic page for more information.