What Is Slow Gut Transit Constipation?

Slow transit constipation is just one type of constipation. It occurs when the muscles in the colon do not work correctly, leading to constipation (1).

Symptoms can include the following (1);

• pain
• blood in stools
• bloating or distension
• straining when opening bowels

Sometimes it can be so difficult for an individual to open their bowels that they have to use their fingers to help them go or they may even suffer with overflow diarrhoea.

Diagnosis

Firstly, your GP will likely assess your symptoms to make sure they are not related to any medications that you may be on. They may even want to do blood tests to rule out certain conditions. After this, your GP will rule out your diet and lifestyle as a cause by sending you to a dietitian.

If no cause is found, you will then need to see a gastroenterologist. Further testing such as blood tests and colonoscopy will be used to rule out more causes of your constipation. If no cause is found, physiologic testing will be carried out to assess how well your gut is working (1).

What Causes Slow Gut Transit?

Research suggests that slow gut transit it could be caused by a problem with the signalling between the nerves and the muscles in the colon (2, 3).

How To Manage Slow Transit Constipation

Fibre

The use of fibre in digestive health in general is not clear cut.

A slow increase in fibre and or fibre supplement is recommended by American Gastroenterology Association (3).

However, a trial providing increases in soluble fibre of 15 -30g showed that 85% of the individuals with slow transit gut constipation did not have improved symptoms (4).

Soluble fibre is effective in reducing all IBS symptoms (5).

 Synbitoics

A relatively new study has shown the use of synbiotics can help resolve the symptoms of slow transit constipation (6).

Synbiotics are a combination of probiotics and prebiotics.

In the study, 46% of the individuals experienced full symptom relief after 12 weeks compared to only 13% in the ‘placebo group.’

Fluid

Traditionally, having a good fluid intake is pushed as being important to prevent constipation.

In actual fact (as with all things diet!) – it isn’t that straight forward.

There is no scientific evidence to prove that increasing fluid can help with constipation at all.

Instead, what we have is a few, small studies, that suggest a link between a low fluid intake and constipation.

In one study, of just 8 people, a fluid intake of less than 500mls per day, reduced how often they opened their bowels. Although the individuals didn’t open their bowels as much, they still were not technically ‘constipated’ (7).

The problem with this study is that the individuals in it did not have slow transit constipation. So it doesn’t really give us any accurate idea of how a low fluid intake may affect those that do have it.

All this study does do is suggest that fluid has a role in helping to maintain regular bowel movements.

As a healthcare professional, we are often left with poor research like this. So, what do we suggest? Well, given that having an adequate fluid intake has other benefits, I would suggest that there is more benefit in making sure individuals have enough fluid than any risk.

Fluid intake should be around 35mls/kg body weight. This is only a rough guide and if you do excessive exercise or have a medical condition such as kidney disease, your fluid intake will need to be modified. To get more accurate advice, please see a registered dietitian who can assess you on a 1-2-1 basis.

FODMAPs

FODMAPs are a fermentable carbohydrates which can cause bloating and / or loose stools in some people.

While going on a low FODMAP diet will not increase how often a person opens their bowels, it has been shown to help with other symptoms such as bloating in those with IBS (8).

As bloating is a common symptom in slow transit constipation, the low FODMAP diet may help those with slow transit constipation.

Exercise

Exercise is known to help with improving the time it takes for food to move through your gut. In one study, it was shown that doing a 30 minute walk each day significantly improved constipation (9).

 Medical Management

Needless to say, if you have any of the symptoms mentioned in this article, please see your GP.

As with many other digestive health problems, the symptoms of slow gut transit are not very specific. In other words, the symptoms may be a cause of something more sinister – so just get checked out.

In the case that you do have slow gut transit, your doctor will be able to advise you on the best medical treatments going forward. These will depend on the cause of your symptoms.

Your doctor will also advise that you make changes to your diet. So that you are not making your symptoms worse, it is advisable to see a specialist in digestive health dietitian.

Summary 

• Slow transit constipation is constipation caused by the muscles in your colon not working effectively.
• Symptoms of slow transit constipation should be reported to your GP.
• Fibre, fluid, exercise and synbiotics may all help to improve the symptoms of slow transit constipation. However, focusing on just 1 area is unlikely to provide any benefit.
• There are also a range of medications and medical procedures that can help with slow transit constipation.
• You should see a specialist dietitian to ensure your dietary changes do not worsen your symptoms.