When the digestive tract is working properly, the muscles stretch and contract to move food along. According to Dr. Brenner, when someone has a problem with their gut motility, “things don’t move through the GI tract fast enough.”

Brain-gut visceral perception is the way we feel sensations in our digestive system. Dr. Brenner tells us that when someone has a visceral perception issue, “the stuff moves down the GI tract just fine, but they feel like they are straining too much and they don’t feel like they get everything out.”

The pelvic floor is a group of muscles that play a role in having a bowel movement.

When issues with the pelvic floor cause constipation, “the stool gets down to the bottom, but the muscles that we have in the bottom that we need to relax to allow the stool to come out don’t work right,” says Dr. Brenner. Furthermore, if the pelvic floor is the cause of constipation, then laxatives will not be the proper treatment.

Another very important point that Dr. Brenner reminds us of is the connection between constipation and a history of trauma or abuse. He says that it’s essential for practitioners to become more aware of this.

The recent article that Dr. Brenner co-authored provides a detailed review of the research behind different types of over-the-counter (OTC) laxatives.

The list includes osmotic laxatives (like MiraLAX® ) which draw fluid into the intestine to make stools softer and increase the movement of the intestines. There are also stimulant laxatives (like senna) and fiber supplements (like psyllium husk).

According to Dr. Brenner, there have not been any clinical trials showing the benefits of magnesium-containing agents or stool softeners, although these products are widely used.

OTC laxatives are often the first line of treatment that Dr. Brenner recommends for constipation, but the decision to use prescription treatments will depend on symptoms.

“There is really little to no data suggesting that over-the-counter treatments can improve abdominal symptoms,” says Dr. Brenner. This means that if a patient has symptoms of IBS-C, such as pain and bloating, he will consider using a prescription because OTC treatments will likely not help with these symptoms.

There are certain foods that have been shown to be beneficial for constipation. According to Dr. Brenner, kiwi fruits, mangos, and prunes may help.

But what about foods to avoid?

Dr. Brenner says that “when we talk about constipating foods, there’s not a lot of data out there to suggest that one particular food over another one is going to increase your risk of developing constipation.”

While many people are told to drink more water and get more exercise to deal with constipation, Dr. Brenner tells us that there is no data to show that drinking more water can help. But he does mention that exercise may help get things moving.

If pelvic floor issues are the cause of constipation, seeing a pelvic floor physical therapist can be helpful. Dr. Brenner recommends to start looking into this if you’ve tried at least two evidenced-based treatments and are still having symptoms.