Resolving Hypothyroidism-Related Constipation

Mary Shomon | Aug 22, 2017

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On television, they call it “regularity.” But as anyone who has experienced constipation knows, it’s about a lot more than being regular. Painful or difficult elimination, abdominal pain, bloating, and gas can all be symptoms of constipation.

The National Institutes of Health defines constipation as “a condition in which you have fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass.”

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What causes constipation?

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There are a number of causes of constipation, including:

  • Untreated or insufficiently treated hypothyroidism
  • A low-fiber diet
  • Insufficient exercise
  • Dehydration
  • Other conditions, including irritable bowel syndrome, diabetes, gastrointestinal blockages, and pelvic disorders
  • Prescription medications and supplements
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Medications and supplements that can cause constipation

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Some of the medications and supplements that can cause constipation include:

  • Surgical anesthesia
  • Narcotic pain medications
  • Iron supplements
  • Antacids with aluminum or calcium
  • Anticonvulsant medication
  • Antispasmodic medications
  • Calcium channel blockers for high blood pressure and heart conditions
  • Diuretics for high blood pressure
  • Parkinson’s disease medications
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Step 1: Optimize your thyroid treatment

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If you are a thyroid patient experiencing constipation, your first step is to optimize your treatment, making sure your TSH, free thyroxine (free T4), and free triiodothyronine (free T3) are at levels that relieve thyroid symptoms. If your thyroid levels are in the normal range, but not optimal, changing your dosage of medication, adding a T3 medication, or switching to a natural desiccated thyroid drug may relieve your constipation.

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Step 2: Increase your fiber intake from food

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Adding more fiber to your diet is one of the most basic changes you can make to help relieve constipation. Focus on eating 20 to 30 grams of fiber daily, ideally from high-fiber foods, such as raw non-starchy vegetables, fresh fruits (apples, berries, and citrus are especially high in fiber), dried fruits like prunes, seeds (like high-fiber chia seeds), beans/legumes (split peas are a fiber powerhouse), and nuts. For more ideas, visit Dr. Oz’s list of 50 fiber-rich foods.

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Step 3: Take fiber supplements

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If you have trouble getting enough fiber from foods, consider adding a fiber supplement. One of the most effective and inexpensive forms of fiber is psyllium, which comes in a powder or in easy-to-take capsules. Psyllium is also found in the brand-name supplement Metamucil.

Other fiber supplements include:

  • Inulin: Found in the supplement Fiber Choice, inulin is a prebiotic fiber that helps feed good bacteria in your colon.
  • Methylcellulose: Found in the supplements Citrucel and SmartFiber, methylcellulose powder is dissolvable in cold liquids.
  • Wheat dextrin: Found in the supplement Benefiber, wheat dextrin dissolves in cold and hot liquids, and is not thickening.
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Step 4: Drink enough water

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An important way to help relieve constipation is to drink enough water. Many experts recommend that you aim to drink half your body weight in ounces. So, if you weigh 160 pounds, you should drink 80 ounces of water per day. Start adding more water slowly, to allow your body to adjust (and prevent frequent trips to the restroom.) You can count drinks without caffeine such as herbal teas and seltzer towards your daily water total.

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Step 5: Move/exercise

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Getting enough movement each day is essential to help relieve constipation.Movement and exercise help speed up digestion, and the detoxifying effect may help with elimination. Build in movement — whether it’s formal exercise, walking, climbing stairs, cleaning, or other activity — into your routine each day. There is some evidence that regular yoga practice can help with constipation.

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Step 6: Try other supplements and over-the-counter remedies

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A number of other over-the-counter nutritional supplements can help relieve constipation, including:

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Step 7: Try osteopathic treatment

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Research has shown that osteopathic manipulation by a trained doctor of osteopathic medicine (D.O.) can be effective for constipation in some people, including children. You can learn more about the osteopathic approach to treating constipation in this article.

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Step 8: Try bowel retraining

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Bowel retraining is a behavioral program that helps teach you how to establish or re-establish control over your bowels. For more information, the International Foundation for Functional Gastrointestinal Disorders has a free downloadable PDF guide, titled Strategies for Establishing Bowel Control.

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Step 9: Talk to your doctor about over-the-counter remedies

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Over-the-counter laxatives can be helpful for occasional use, but if you have chronic constipation, you should discuss any laxative use with your doctor. Some common over-the-counter laxatives include:

  • Magnesium (Milk of Magnesia)
  • Polyethylene glycol (Miralax)
  • Stool softeners: Docusate (Colace)
  • Oral stimulants: Bisacodyl (Dulcolax), Senna (Senokot)
  • Rectal suppositories

Laxatives can be habit-forming, and long-term use can have negative side effects, including pain and cramps, diarrhea, nausea, and electrolyte imbalances.

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Step 10: Try prescription medications

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If you have chronic constipation that doesn’t respond to other approaches, your doctor may prescribe a more powerful laxative drug. These include:

  • Linaclotide (Linzess)
  • Lactulose (Cephula, Chronulac, Constulose, Duphalac, Enulose)
  • Lubiprostone (Amitiza)
  • Plecanatide (Trulance)

Like over-the-counter laxatives, the prescription laxatives can cause a number of side effects, including stomach cramps, nausea, vomiting, gas, and diarrhea.