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Relieving Chronic Constipation with Functional Nutrition & the 5R Framework

Jonathan Vellinga, MD -

Relieving Chronic Constipation with Functional Nutrition & the 5R Framework

Chronic constipation is a prevalent condition marked by the infrequency of passing stool, difficulty passing stool, or both. Estimates indicate that 10% to 15% of the population suffer from this painful condition (1). However, the definition of constipation varies, so the estimates of sufferers differ as well, with one estimate being as high as 80% of the population (2)! The actual number of sufferers is likely around 1 out of every 5 or 6 people. Symptoms can vary, but one thing can be agreed upon; chronic constipation can be highly uncomfortable and potentially dangerous if left untreated.


Temecula Center for Integrative Medicine believes in functional medicine approaches to addressing chronic constipation, including functional nutrition and the “5R” framework. The 5R framework is a methodology for repairing the digestive system that practitioners can customize to fit the patient’s needs. Functional nutrition is not a methodology. Instead, it’s a general term encompassing the holistic and customized nature of the nutrition recommendations and a nod to how food “functions” in the body. The 5R framework and functional nutrition can be applied to many health issues, not just chronic constipation. Still, both excel at addressing the underlying root cause for many destructive digestive disorders. Details about these approaches are in the second half of the article. First, chronic constipation is a complicated issue, so a review of the condition is in order.


Chronic Constipation: A Blockade of the Bowels


The definition of chronic constipation (CC) is often derived from the “Rome” criteria, which is an attempt at standardization. The Rome Foundation takes evidence-based information, deriving diagnostic criteria used by health care practitioners and researchers performing health studies. Rome identifies four subtypes of CC, which are identified through a series of examinations (1):

  • Functional constipation

  • Constipation concurrent with Irritable Bowel Syndrome (IBS)

  • Constipation as a result of opioid medications

  • Functional defecation disorders


Functional constipation is the category that may be most familiar, but the identification of four subcategories is an indication of how complex CC can be.


Rome’s definition of “functional constipation,” which is problems in the lower intestinal tract indicating a chronic condition, says that two or more of the following criteria must be met for three months (3).


For 25% or more of all bowel movement attempts:

1) Straining

2) Hard or lumpy stools

3) Feeling as if the bowel isn’t empty

4) Feeling as if there is something blocking waste from coming out

5) Using hands to push the lower abdomen or using a finger to clear stool from the rectum


Other possible criteria (that does not occur 25% or more of the time):

6) Three or fewer spontaneous bowel movements (SBMs) per 7 days

7) Rare presence of loose stools (without purposefully causing them through the use of laxatives)

8) Irritable bowel syndrome (IBS) has been excluded as a potential cause


Symptoms of CC

The inability to have regular, easy bowel movements can result in many unpleasant symptoms. The following is by no means an exhaustive list:

  • Items 1-7 listed above (straining, lumpy stools, etc.)

  • Abdominal pain, cramping, bloating

  • Frequent gas

  • Needing a long time on the toilet to achieve a bowel movement

  • Damaged tissues around the anus and in the rectum from straining or hard stools

  • Traces of blood on hard stools after straining

  • Difficulty bending over or moving the body into specific postures

  • Decreased appetite or nausea


Potential Causes of CC

A variety of factors can contribute to chronic constipation. Some of the most common causes are diet and exercise-related:

  • Chronic dehydration

  • Lack of fiber in the diet

  • Food sensitivities (low-level immune reactions to foods)

  • Imbalanced flora (bacteria/yeast/parasites) in the intestines

  • Hormone imbalances affecting digestion

  • Lack of exercise

  • Stress

  • Inadequate digestive enzymes (stomach acid, pancreatic enzymes, bile)


Chronic constipation may be secondary to some other event or disease. Secondary CC may be a result of (4):
  • Side effects or direct actions from medications

  • Re-arrangement of anatomy due to injury or surgery

  • Organic diseases (tumors or polyps) or systemic diseases (affecting the whole body, such as Celiac Disease or Irritable Bowel Syndrome)