What is Constipation?
Constipation refers to infrequent, difficult, or incomplete bowel movements. Stools are often hard, dry, and small, making them painful or straining to pass.
Doctors diagnose constipation when someone has fewer than 3 bowel movements per week. Other symptoms include abdominal pain, bloating, and a sense of incomplete evacuation after using the bathroom.
Constipation occurs when stool moves too slowly through the digestive tract. This over-absorption of water leads to hard, dry stools that are difficult to eliminate.
Causes of Constipation
Low Fiber Diet
Fiber adds bulk to stool and helps move it smoothly through the colon. Low fiber diets make stools harder and bowel movements more difficult.
Dehydration
Being dehydrated leads to over-absorption of water from stool in the colon. This causes the stool to become hard, dry and difficult to pass.
Medications
Many medications like painkillers, antidepressants, iron supplements, and antacids can cause constipation as a side effect.
Sedentary Lifestyle
Physical inactivity can slow down the muscular contractions that push stool through the colon. Exercise helps maintain regular bowel movements.
Ignoring the Urge to Go
Repeatedly ignoring the natural urge to have a bowel movement allows stool to remain in the colon longer. This leads to excessive water absorption and straining.
What is Diarrhea?
Diarrhea refers to loose, watery stools that occur more than 3 times a day. People with diarrhea typically pass frequent, loose stools that may contain mucus or undigested food particles.
Diarrhea is caused by faster movement of fecal matter through the intestines. This results in too much water remaining in stool before it can be reabsorbed by the colon.
Causes of Diarrhea
Bacterial, Viral, or Parasitic Infection
Infections from bacteria, viruses, or parasites are a common cause of diarrhea. These pathogens disrupt the intestines ability to absorb water and electrolytes.
Food Intolerances
Lactose intolerance, fructose malabsorption, and allergies to foods like gluten can trigger diarrhea in sensitive individuals. The body fails to properly digest these compounds.
Medications
Antibiotics, anti-inflammatories, heart medications, and antacids may cause diarrhea as a side effect by impacting gut motility or absorption.
Chronic Digestive Conditions
IBS, IBD, celiac disease, and other GI issues often involve diarrhea. The intestinal inflammation disrupts normal water reabsorption.
Artificial Sweeteners
Sugar substitutes like xylitol, sorbitol, and maltitol can have a laxative effect in large amounts, causing osmotic diarrhea.
Is Diarrhea a Form of Constipation?
Diarrhea and constipation represent opposite extremes on the bowel movement spectrum. Yet in some cases, they can be related.
Paradoxical Diarrhea
Paradoxical diarrhea refers to having diarrhea caused directly by constipation itself. When stool sits in the colon too long, excess water gets absorbed. Leftover liquid leaks around the dry, impacted stool, resulting in watery diarrhea.
Laxative abuse is a common cause of paradoxical diarrhea. The diarrhea ends once the constipated stool passes.
Overflow Incontinence
In severe constipation, liquid stool can leak out around a large, obstructing fecal mass. This overflow incontinence causes involuntary leakage of stool, mimicking diarrhea.
Again, the diarrhea resolves once the obstruction clears. Some refer to this phenomenon as false diarrhea.
Bowel Obstructions
Partial bowel obstructions from conditions like cancer or diverticulitis can also mimic diarrhea. Liquid drips around the obstruction, unable to pass normally.
Diarrhea caused by partial obstructions tends to be intermittent and improves after passing stool or flatus.
Post-Obstruction Diarrhea
After prolonged constipation fully resolves, some individuals experience diarrhea. This is known as post-obstruction diarrhea.
Diarrhea results from irritation and overloaded fluid secretion after the colonic obstruction clears. It typically lasts a few days at most.
Keto Diet and Constipation
The ketogenic or keto diet is a very low carb, high fat diet. It forces the body to burn fats for fuel instead of glucose.
The keto diet is often associated with constipation due to its low fiber content. Lack of fruits, beans, whole grains, and starchy vegetables promotes constipation.
High fat intake can also delay gastric emptying. Slower stomach emptying reduces bowel motility. Dehydration from carb restriction worsens constipation as well.
Tips to Minimize Keto Constipation
Here are some ways to help avoid constipation on keto:
- Drink plenty of water - aim for at least 8 glasses daily
- Include coconut oil or MCT oil - may improve bowel motility
- Eat more non-starchy veggies - spinach, kale, broccoli, etc
- Supplement with magnesium citrate - draws water into stool
- Increase physical activity - stimulates intestinal contractions
Keto Diet and Diarrhea
Diarrhea can also be a common side effect when first starting keto. This initial keto diarrhea is often referred to as the keto flu.
Dramatically reducing carbs causes major fluid shifts. The body excretes excess water and electrolytes as diarrhea.
High fat intake increases bile acid secretion which also leads to looser stools. The diarrhea is usually temporary and improves within 1-2 weeks.
Tips to Minimize Keto Diarrhea
Here are some tips to counteract diarrhea on the keto diet:
- Replenish electrolytes - get enough sodium, potassium and magnesium
- Stay hydrated - drink broth, mineral water or electrolyte drinks
- Go easy on fats at first - gradually increase fat intake
- Eat more soluble fiber - low carb veggies, chia seeds, nuts
- Take probiotic supplements - support gut microbiome balance
When to See a Doctor
In most cases, diarrhea or constipation caused by a change in diet improves on its own. But see a doctor if symptoms persist more than 2 weeks or are severe.
Also seek medical care for diarrhea with:
- Blood or mucus in stool
- Unexplained weight loss
- Fever or abdominal pain
- Signs of dehydration - dizziness, dry mouth, rapid heart rate
- No bowel movement for 3+ days
- Hard, dry stools
- Straining with bowel movements
- Bloating or abdominal pain
Chronic constipation or diarrhea can negatively impact quality of life. Your doctor can check for underlying causes and provide appropriate treatment.
When Constipation Causes Diarrhea
Although diarrhea and constipation are very different conditions, they can sometimes be related.
In certain cases, constipation itself can actually cause secondary diarrhea. Examples include:
- Paradoxical diarrhea from laxative abuse
- Overflow incontinence with severe constipation
- Intermittent diarrhea from a partial bowel obstruction
- Post-obstruction diarrhea after prolonged constipation
Keto dieters may also experience alternating constipation and diarrhea as the body adjusts to very low carb intake.
Pay attention to any connection between symptoms. Treating underlying constipation can sometimes alleviate secondary diarrhea.
Prevention is Ideal
Preventing constipation and diarrhea whenever possible is ideal for comfort and health.
To help avoid constipation:
- Eat plenty of fiber - veggies, fruits, whole grains
- Stay well hydrated
- Exercise daily
- Establish regular bathroom habits
- Avoid medications that cause constipation
For diarrhea prevention:
- Drink only purified water when traveling
- Wash hands thoroughly before eating
- Avoid high fat/greasy foods if sensitive
- Steam vegetables to improve digestibility
- Limit added sugars and artificial sweeteners
Implementing healthy bowel habits provides lasting relief compared to repeated symptomatic treatment.
When to Seek Medical Care
Make an appointment with your healthcare provider if significant diarrhea or constipation persists over 2 weeks. Also seek immediate care for:
- Blood or pus in stool
- Severe abdominal pain
- Fever over 101 F (38 C)
- Dehydration symptoms - dizziness, rapid heart rate, confusion
Chronic diarrhea or constipation can greatly reduce quality of life. Your doctor can evaluate for underlying causes and provide appropriate treatment to help restore bowel regularity.
FAQs
Can constipation actually cause diarrhea?
Yes, in some cases constipation can lead to secondary diarrhea. Examples include paradoxical diarrhea from laxatives, overflow incontinence leaking around a blockage, and post-obstruction diarrhea after prolonged constipation.
Why does the keto diet cause diarrhea?
The keto flu often involves diarrhea due to major fluid shifts as carbs are restricted. High fat intake also increases bile secretion, resulting in looser stools until the body adapts to keto.
How can you tell the difference between IBS and constipation diarrhea?
Diarrhea from IBS tends to cause abdominal cramps and be triggered by stress or certain foods. Constipation diarrhea only occurs intermittently and resolves with the passage of hard stool.
What is the best way to prevent diarrhea and constipation?
Prevention involves getting enough fiber, drinking adequate fluids, exercising, establishing regular bathroom habits, and avoiding constipating medications or foods that trigger diarrhea.
When should you see a doctor for diarrhea or constipation?
See your doctor if significant diarrhea or constipation persists more than 2 weeks. Also seek medical care for blood in stool, high fever, severe pain, dehydration, or inability to have a bowel movement for 3+ days.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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