Constipated, and can’t get to the bottom of it? You Might have Intestinal Methanogen Overgrowth

Gut Health
Written By Erica Hartwick

The “official” definition of constipation is definitely a little challenging — you’ll find online that if you are having bowel movements less than 3 times per week (!!), it constitutes as constipation.

3 bowel movements a week though.. is not enough.

Ideally, you want to have at least 1-2 bowel movements daily, and feel like with each one, that you are fully evacuating. You shouldn’t have to strain, push too hard, or spend much time on the toilet. It should be a nice brown colour (🤠)

An “ideal poop” is a 3 or 4, on the Bristol Stool Chart:

If you’re constipated & can’t seem to get to the bottom of it, and you haven’t considered IMO (intestinal methanogen overgrowth), this article is for you!

 

An Introduction to Intestinal Methanogen Overgrowth (IMO), and How it Plays a Role in Constipation

Intestinal methanogen overgrowth (formerly/also known as “methane SIBO”), is a subtype of SIBO/bacterial overgrowth (in IMO, you can actually have the overgrowth both in the small intestine, and the colon).

(If you need a refresher or introduction to SIBO, you can check out this article here)

Archea — single-cell microorganisms that are part of our microbial ecosystem — produce methane gas as a byproduct of the fermentation of carbohydrates in our gut 🦠

Methane SIBO has since been recoined “intestinal methanogen overgrowth” because it’s not actually bacteria that are overgrowing, but these archea.

When these microorganisms have the opportunity to proliferate, and produce significant amounts of methane gas as a result, we can see symptoms develop.

Methane gas has the potential to slow down transit time (how things move through our GI tract).

It acts almost like a local paralytic, impacting movement in the intestinal tract, which can ultimately lead to things like constipation, bloating, distention, gas, etc.

 

Underlying causes of Intestinal Methanogen Overgrowth


Altered Motility

When stuff isn’t moving through our guts in an effective, efficient manner — our gut can become an environment more conducive to the development of SIBO/IMO.

If the migrating motor complex (which you can learn more about here), is compromised, and contents aren’t being moved from the small intestine > to the large intestine efficiently, fibers and remnants of our foods can feed bacterial populations in the small intestine leading to an overgrowth.

Motility and the migrating motor complex can be impacted by several things:

  • Poor/dehydration

  • Lack of movement; sedentary lifestyle

  • Low thyroid function/hypothyroidism

  • Impacted vagal tone

  • Chronic stress

  • and more

Poor Digestive Function

Poor digestive function like low stomach acid production (or hypochlorhydria), poor bile flow/output, etc., can have a huge impact on microbial populations throughout our digestive system and can play a role in the development of SIBO/IMO.

Inadequate stomach acid levels may leave us susceptible to translocation of bacteria (like in the instance of our oral cavity > our gut), and compromise the rest of our digestive cascade (like bile and enzyme secretion), which may play a role in the development of SIBO/IMO in some cases.

Inadequate bile production and secretion may lead us more susceptible to developing SIBO/IMO due to its roles in microbial balance and motility.

Medication Use

Certain medications — like PPIs (proton pump inhibitors), medications that impact/slow motility (like antibiotics for example) — can impact our digestive processes, our motility, and ultimately bacterial populations. All things that can set the stage for SIBO/IMO 👋

Chronic Stress

Stress can contribute to.. a whole whack of digestive issues (AND a whole whack of issues outside of the digestive system, too). The stress response actively shuts down digestion in the moment, prioritizing vital bodily functions needed to address the stressor. Long-term, chronic stress can seriously impact our digestive function, microbial balance, motility, and more.

Ileocecal Valve Dysfunction

The ileocecal valve is a sphincter that connects our small intestine to our cecum (the first part of our large intestine). It’s located between your right hip bone and your belly button — the lower right quadrant of your abdomen!

This valve is designed to have a one-way flow, from the small intestine TO the large intestine, ensuring that remnants from digestion in the small intestine can make their way to the colon.

A faulty valve increases the potential that bacteria from the colon (where the majority of our microbiome lives) to translocate into the small intestine, leading to SIBO/IMO.


STRUCTURAL ISSUES/ABNORMALITIES

Adhesions, scar tissue, endometriosis, a history of surgery in the abdominal cavity, etc., can all increase the risk for the development of SIBO/IMO.

Similar to some of the SIBO/IMO root causes above, structural issues can impact digestive function, motility, ileocecal valve function, and microbial balance.

HYPOTHYROIDISM

Hypothyroidism and impaired thyroid function can impact motility, and ultimately lead to symptoms like constipation itself, AND leave the body more vulnerable to develop things like SIBO/IMO (which as you know, can also contribute to constipation, among other symptoms).

LIFESTYLE FACTORS

This may elaborate on a few things mentioned above, but certain lifestyle habits can certainly leave the body more susceptible to things like IMO & constipation:

  • rushing through meals and not chewing properly

  • eating while in a distracted or stressed state

  • resisting the urge to have a bowel movement

  • snacking frequently or grazing

  • sedentary lifestyle

  • chronic stress (psychological, blood sugar imbalances, inadequate sleep, etc.)

As a reminder: SIBO/IMO isn’t a root cause.

While the overgrowth may be in part responsible for the symptoms you’re experiencing (ie. constipation, bloating, abdominal pain, etc.), it’s important to investigate (and address!) the reasons why IMO occurred in the first place.

Struggling with chronic constipation and suspect IMO? You can test for this!

 

How to Test for Intestinal Methanogen Overgrowth

Certain comprehensive stool tests will test for microbes in the methanobacteriaceae family (those methane-producing archea!), and of course there are lactulose SIBO breath tests that will test for IMO (”methane” SIBO), specifically in the small intestine.

(Sample panel from the GI MAP stool test showing overgrowth of methane-producing archea, Methnobacteriaceae (family).

Panel from a SIBO breath test showing elevated levels of both hydrogen and methane production, a positive test for SIBO.

To address these overgrowths, there are strategic herbal protocols that can be implemented to bring levels of these methane producing archea down, and re-restablish balance in the microbial ecosystem in the gut.

 

SIBO/IMO Constipation Remedies: Where to get started if you’re Constipated, and Suspect you may have IMO

Wondering what you can do in the meantime before you perhaps pull trigger on seeing a practitioner and getting some labs done?

Here are a few things you can get started with:

  • Space your meals ~3-4 hours apart, and avoid grazing throughout the day. Eating more frequently, for most people, can impact our motility. Poor migrating motor function — the wave-like motion that moves stuff like undigested food and bacteria from our small intestine > to our large intestine — can be a major contributor to SIBO and IMO. And leaving 3-4 hours between meals to let our MMC do its job can be a great step in the right direction!

  • Get out for a daily 30-minute walk. Seriously. This can do wonders for motility and constipation

  • Incorporate constipation-friendly foods, like 1-2 kiwi fruit daily, beets and beet kvass, aloe vera juice, and apple pectin (cooked apples!), daily

  • Add minerals to your water (a pinch of real/celtic salt, squeeze of lemon, splash of coconut water, trace minerals, etc.)

  • Get your thyroid labs tested 🧪 As mentioned above, hypothyroid (and impaired thyroid function) can contribute to constipation, and leave the body more vulnerable to developing SIBO (IMO included). Ideally, you’ll want to seek out a full thyroid panel (it’s a blood test!). Ask your doc for: TSH, T4 (total and free), T3 (total and free), rT3, Tg, TPO, TgAB

  • Take at least 5 min every day to support your nervous system (breathe, meditate, journal, stretch, spend time outside, etc.); a nervous system stuck in a chronically stressed state isn’t going to be focused on good digestion

  • Invest in a toilet stool (just trust me) — you can grab a Squatty Potty (I’m not affiliated with the brand), but any old stool will do!

 

Getting Help with your Constipation

If you’re looking for help with getting to the bottom of your constipation, I’m an IBS & Gut Health Nutritionist who is very familiar with chronic constipation (having dealt with it myself for 15+ years!) 😅🥴💩

Here’s how I can help:

GUT RESTORE METHOD: Inside this high-touch, 5-month 1:1 program, I help clients take an investigative, root-cause approach to determine what is going on with their gut health

We use functional labs (as appropriate) to gain deeper insight into what’s going on in your gut, help inform our steps moving forward — while working on addressing root causes that may be at play for you, and building a strong health-conducive foundation to support you and your gut health long term (well beyond we wrap up our work together).

If you’d like to learn more about the Gut Restore Method, you can do so here.

 
 
 
Erica Hartwick http://www.bigcatcreative.com
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