Finally – the real cause of chronic constipation may be revealed ...Middle East

Forget fibre – a new cause of constipation has been discovered: it may be down to the presence of two bacteria in the gut.

In this “bacterial constipation“, the harmful microbes consume gut mucus that normally eases the passage of stool through the bowels.

While the science is at an early stage, it could point the way to new treatments for constipation, said Professor Kinji Ohno, a geneticist at Nagoya University in Japan. “We are the first to have proved that bacterial constipation does exist.”

Constipation is when people have infrequent bowel motions, typically twice a week or less.

The condition is usually caused by not eating enough fibre. We are supposed to have at least 30 grams a day, from foods such as beans, peas, wholemeal bread and pasta.

But the latest research suggests there could be a different cause, at least in some. The Japanese team have found that people with chronic constipation tend to have higher numbers of two kinds of bacteria, called Akkermansia muciniphila and Bacteroides thetaiotaomicron.

This was the case both for people with chronic constipation where usual remedies had failed, as well as for those with Parkinson’s disease, a tremor disorder often accompanied by constipation.

A previous study by microbiologists at King’s College London also found that people who had more of one of the bacteria tended to have slower passage of food through their bowels, as measured by a test where they ate a muffin stained with blue dye.

These kinds of studies don’t prove that the bacteria are causing constipation – instead they could multiply more when living in a constipated gut. To investigate further, the Japanese team studied the bacteria in the lab and tested them in mice.

This showed that the two bacteria work together to break down gut mucus, which normally helps to keep the bowel lubricated and the stool hydrated.

“Mucus is a sticky gel-like substance with sugar molecules that attract and hold onto water,” said Bahee Van de Bor, a spokesperson for the British Dietetic Association. “This helps keep the lining of the gut moist and slippery.

“So when the layer thins, there’s less lubrication and moisture around the stool which can contribute it to becoming drier and harder to pass. 

The mucus proteins are protected from digestion by a chemical compound called a sulphate group. But one of the bacteria uses enzymes to remove sulphate from the mucus proteins, allowing the other one to feed on the mucin protein. “They need a helper,” said geneticist Dr Tomonari Hamaguchi.

The discovery suggests that some people with constipation could be helped by treatments that target one or other bacteria, or the enzymes they use to remove sulphate, said researcher Ohno.

Bridget Benelam, a scientist at the British Nutrition Foundation, said the bacteria may not be responsible in most people with constipation, as the researchers have so far only investigated those whose digestive problems that have failed to respond to the usual remedies.

“For a lot of people dietary changes will help, but it does seem that there is a group of people where that doesn’t work and there’s something else going on,” she said. “It’s nice to see something completely new.”

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Van de Bor said that as well as improving their diet, people with constipation should make sure they are drinking enough fluids and getting enough exercise.

Guidelines on constipation from the BDA last year said there was little evidence to support a general high-fibre diet, although they did recommend some specific fibrous foods, including prunes, rye bread and kiwifruit.

The study was published this week in the journal, Gut Microbes.

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