Frequent Constipation and Diarrhea: Warning Signs for Gut Health!

In our daily lives, we often experience discomfort due to irregular bowel movements.

Constipation, where stools are hard and difficult to pass, or diarrhea, characterized by frequent watery stools, may seem like simple symptoms, but they can be important signals that the balance of our gut health and overall body condition is being shaken.

Recently, the number of patients complaining of intestinal dysfunction has been increasing due to rising stress, changes in dietary habits, and lack of sleep.

While most people believe that having one bowel movement a day is normal, it is actually considered normal to go anywhere from three times a day to three times a week, as long as the process is smooth and without issues.

As such, the pattern and frequency of bowel movements vary from person to person; the problem arises when there is a noticeable change from your usual routine.

In this article, we will explore the primary causes of constipation and diarrhea and look into management methods for maintaining gut health.

Why Constipation Occurs

Constipation does not simply mean having a low frequency of bowel movements. If it persists, it goes beyond simple excretion issues and is accompanied by abdominal bloating, loss of appetite, and fatigue. The Korean Society of Gastroenterology defines constipation as having fewer than three bowel movements per week, or symptoms such as excessive straining, a sense of incomplete evacuation, or hard stools persisting for more than 3 months. According to statistics from the Health Insurance Review and Assessment Service, approximately 750,000 patients were treated for constipation in 2022, making it a common ailment for modern people, with an increasing trend. The main causes include decreased intestinal function due to irregular eating habits, stress, and lack of exercise.

Constipation can be broadly divided into organic constipation and functional constipation. Organic constipation refers to cases with clear anatomical or pathological causes such as colon tumors, strictures, inflammatory bowel disease, or neurological disorders. Functional constipation is defined as cases where there is an abnormality in intestinal or bowel control function but no structural problem. Furthermore, functional constipation is subdivided into slow-transit constipation and defecatory dysfunction.

Slow-Transit Constipation

This occurs when the peristaltic movement of the colon is slow, causing the time it takes for stool to pass through the intestines to be abnormally long. Major causes include lack of water and dietary fiber, decreased physical activity, and reduced intestinal muscle or nerve function.

Defecatory Dysfunction

This refers to a state where it is difficult to evacuate because the anal sphincter and pelvic floor muscles do not relax properly even though the stool has reached the rectum. Incorrect bowel habits, repeated excessive straining, and structural changes such as hemorrhoids or rectocele can be the causes.

Types and Main Symptoms of Constipation
Classification	Definition	Main Causes	Representative Symptoms	Improvement Methods
Functional Constipation	Intestinal/bowel control disorder without structural abnormalities	Lifestyle habits, decreased muscle/nerve function	Increased intervals between movements, hard stools	Diet, hydration, exercise, regulating bowel movements
Slow-Transit Constipation (Subtype of Functional)	Delayed stool movement due to decreased colon peristalsis	Lack of water, lack of fiber, decreased activity	Hard stools, frequent sense of incomplete evacuation	Water/dietary control, stimulating bowel movement, regular exercise
Defecatory Dysfunction (Subtype of Functional)	Difficulty evacuating due to anal/pelvic floor muscle relaxation failure	Poor bowel habits, pelvic floor muscle incoordination, hemorrhoids/rectocele	Excessive straining during bowel movements, incomplete evacuation	Correcting bowel posture, pelvic floor muscle training, etc.
Organic Constipation	Constipation caused by anatomical issues, inflammation, or tumors	Colon cancer, strictures, inflammatory bowel disease, neurological disorders	Varies depending on the underlying disease	Treatment of the underlying disease

While all constipation may seem the same, the causes and response methods differ significantly, making accurate evaluation based on symptoms crucial. In the case of functional constipation, if the intestinal contents are completely evacuated using medication or enemas, a vicious cycle can occur where constipation returns until the stool fills the intestines again. The ultimate goal of constipation treatment is to establish natural bowel habits through lifestyle changes.

1) Korean Society of Gastroenterology. Clinical Practice Guidelines for the Treatment of Constipation. 2019. http://www.ksgm.org/guide/8_kjg.pdf

2) Health Insurance Review and Assessment Service, 2023 Statistics on Diseases and Medical Procedures in Daily Life

Gut Health as Seen Through Diarrhea

Diarrhea occurs when water absorption in the intestines is insufficient or when intestinal movement becomes excessively fast. It is diagnosed when one has loose stools more than three times a day or when the water content of the stool is significantly higher than usual. Acute diarrhea is mostly a temporary symptom that recovers within 2 weeks, typically caused by infectious gastroenteritis from consuming water or food contaminated with Norovirus, Rotavirus, or bacteria (E. coli, Salmonella, etc.), and may be accompanied by abdominal pain, vomiting, fever, and chills. On the other hand, chronic diarrhea lasting more than 4 weeks requires suspicion of causes other than simple enteritis. This includes irritable bowel syndrome (IBS), inflammatory bowel disease (Crohn’s disease, ulcerative colitis), malabsorption such as lactose intolerance, endocrine diseases like hyperthyroidism, and the effects of medications such as antibiotics, anticancer drugs, or certain blood pressure medications. Repeated diarrhea can easily lead to a deficiency of water and electrolytes (sodium, potassium), which can result in fatigue, dehydration, muscle cramps, and in severe cases, heart rhythm abnormalities. Furthermore, as the intestinal mucosa is damaged and the balance of intestinal microorganisms is disrupted, a vicious cycle can occur where diarrhea persists, so diagnosis and treatment by a specialist are recommended.

Types and Main Symptoms of Diarrhea
Type	Main Causes	Characteristics	Improvement Methods
Acute Infectious Diarrhea	Viral or bacterial infections, etc.	Improves within 2 weeks	Water/electrolyte replenishment and hygiene management
Irritable Bowel Syndrome	Gut-brain signal dysregulation, stress	Worsens with stress, pain relieved after bowel movement	Regular meals, reducing caffeine/spicy foods
Inflammatory Bowel Disease	Abnormal immune response in the gut	Possible bloody stools, weight loss	Professional endoscopic evaluation required
Malabsorption Diarrhea	Lactose intolerance, bile acid absorption issues, etc.	Fatty stools, stools that float in water	Restricting dairy or digestive enzyme evaluation
Drug-Induced Diarrhea	Antibiotics, anticancer drugs, antidepressants, etc.	Symptoms occur after taking medication	Check the need for medication adjustment

Lifestyle Habits to Protect Gut Health

Gut health is not just about digestive function; it is closely linked to various bodily functions such as immune regulation, energy metabolism, and hormonal balance. There are more than 100 trillion microorganisms in the gut, and their balance plays a crucial role in the digestion process, nutrient absorption, and regulation of inflammatory responses. Therefore, maintaining a healthy intestinal environment is the key to managing gut health.

<Lifestyle Habits Helpful for Gut Health>

Dietary Fiber Intake

Dietary fiber maintains moisture in the intestines to soften the quality of stool and serves as food for beneficial bacteria, helping with microbial balance.

It is recommended to consume both insoluble fiber, abundant in brown rice, oats, vegetables, and legumes, and soluble fiber, found in apples, onions, and chicory.

Sufficient Water Intake

Drinking about 1.5 to 2 liters of water a day softens the stool and facilitates intestinal movement.

Establishing Regular Eating and Bowel Habits

Eating at consistent times and maintaining a rhythm for bowel movement times stabilizes the peristaltic movement of the intestines.

Stress Management

Stress affects the gut-brain axis, which can cause decreased intestinal movement or intestinal hypersensitivity. Habits such as regular exercise, sufficient sleep, and meditation are helpful.

Management Factor	Details	Expected Effect
Dietary Fiber Intake	Vegetables, whole grains, legumes, fruits	Maintains stool moisture, microbial balance
Water Intake	1.5–2L per day	Softens stool and promotes bowel movement
Regular Meals & Bowel Habits	Consistent meal and bowel movement times	Stabilizes intestinal peristalsis rhythm
Stress Management	Exercise, sleep, meditation	Stabilizes gut-brain axis, reduces abdominal pain
Probiotics/ Prebiotics	Assists in regulating gut microbial balance	Improves gut environment and reduces inflammation

Finally, if constipation or diarrhea persists or recurs, regular checkups and consultations are necessary to identify underlying diseases such as colon cancer or inflammatory bowel disease at an early stage.

In these cases, a hospital visit is necessary.

Constipation and diarrhea can mostly be improved through lifestyle management such as dietary adjustments, water intake, and improving intestinal movement. However, if the following warning signs appear, you should consider the possibility of underlying diseases such as inflammatory bowel disease, colon cancer, or endocrine abnormalities beyond simple functional problems.

Symptoms Signaling the Need for a Hospital Visit

When constipation or diarrhea persists for more than 4 weeks
When changes in stool thickness, mucus in stool, or bloody stool are seen
When accompanied by unintended weight loss
When abdominal pain persists or wakes you up at night
When dehydration symptoms (extreme thirst, decreased urine output, dizziness, etc.) appear
When symptoms worsen after taking medication
When there is a clear change in bowel patterns in individuals over 50

*Source: Korean Society of Gastroenterology (https://gastrokorea.org) / Health Insurance Review and Assessment Service (https://www.hira.or.kr/main.do)

Test Item	Purpose	Diseases Expected from Results
Colonoscopy	Check colon mucosa status, inflammation, polyps, or tumors	Organic constipation, inflammatory bowel disease, colon cancer, etc.
Stool Test (Occult Blood/Inflammatory Markers)	Check for intestinal inflammation or bleeding	Differentiating inflammatory bowel disease, colon bleeding
Blood Test (Electrolytes/Thyroid Function, etc.)	Evaluate electrolyte balance and endocrine abnormalities	Dehydration, thyroid dysfunction
Intestinal Motility/Pelvic Floor Muscle Function Test	Check for decreased intestinal movement or evacuation dysfunction	Slow-transit constipation, defecatory dysfunction

When these signals are present, performing tests such as colonoscopy, abdominal ultrasound, blood tests, stool tests, and intestinal motility tests (colonic transit time test, anorectal manometry) will help in accurate diagnosis and determining the direction of treatment.

Gut health is broadly connected to immunity, nutrient absorption, mood, and energy metabolism, beyond the simple inconvenience of bathroom issues. Do not lightly overlook the signals your body sends; if symptoms repeat or persist ambiguously, consulting a specialist to establish a nutrition, dietary, and treatment plan that suits you is the safest and fastest way.

Review: Professor Sang-in Lee, Department of Gastroenterology, Chaum

Field of Practice: Gastrointestinal motility disorders, Gastroscopy/Colonoscopy, Early diagnosis of stomach/colon cancer. Professor Sang-in Lee, currently in charge of Gastroenterology at Chaum, is striving for the early detection of cancer through various endoscopic examinations for gastrointestinal diseases and performs endoscopic mucosal resection and polypectomy. In particular, he co-participated in establishing the gastroscopy screening cycle and age recommended by the National Cancer Center, contributing significantly to the early detection and prevention of stomach cancer. Inquiries: Chaum Gastroenterology 02-3015-5005 | Outpatient Clinic, 3rd Floor, Chaum, 4-1 Cheongdam-dong, Gangnam-gu, Seoul