by Stephanie Eckelkamp
Updated 12/8/22

If you’ve been spending marathon straining sessions in the bathroom with subpar results, that’s definitely not a good thing — but it’s also not that uncommon. It’s estimated that around 16% of all adults and 33% of adults over age 60 deal with constipation. And these numbers are almost certainly higher for those with chronic Lyme disease and other chronic illnesses, according to Dr. Bill Rawls, MD, medical director of RawlsMD and Vital Plan.

The good news: You can start getting relief even before you’re completely healed. Below, we’ll break down a few key ways living with Lyme can set you up for constipation, plus approachable strategies to get relief fast and stay regular over the long haul.

How Chronic Lyme Drives Chronic Constipation

Lyme-causing microbes and coinfections trigger inflammation and other processes in the body that put your cells into a state of heightened stress, impairing cellular functioning and ramping up the body’s sympathetic (“flight-or-flight”) nervous system and dialing down the parasympathetic (“rest-and-digest”) nervous system.

This is bad on multiple levels because it significantly slows motility — the normal movement of food waste through your gastrointestinal tract and eventually out of your body. “When things slow down like this, the colon continues to pull water out of the stool, causing it to become hard and stuck,” says Dr. Rawls. Compounding the constipation problem: The intense emotional stress accompanying Lyme also triggers that same fight-or-flight response.

Sluggish motility, in turn, can contribute to bacterial overgrowth in the intestines, potentially exacerbating constipation further and damaging the intestinal lining, says Dr. Rawls. And when there’s damage, there’s the potential for pathogens and toxins from the bowels to leak into the bloodstream and migrate throughout the body, which can further ramp up inflammation and your body’s stress response. (Can you see how it’s a vicious cycle?)

Additionally, it’s incredibly common for people with Lyme disease to end up with sleep problems, anxiety, and heightened pain due, in part, to this sympathetic nervous system overactivity. The constipation connection? According to Dr. Rawls, almost all of the drugs commonly prescribed to treat these issues — narcotics, benzodiazepines, tricyclic antidepressants, gabapentin, etc. — work by slowing nerve signals in the body, which can impair GI motility and drive constipation.

Last but not least, if you’re dealing with pain or deep fatigue as a result of Lyme, you’re probably not exercising regularly — and prolonged inactivity is also shown to promote constipation.

How to Prevent and Manage Constipation During Lyme Recovery

1. Cover the Basics: Eat Your Veggies, Move Your Body, Hydrate, and Sleep.

While they’re not quick fixes, these basic healthy lifestyle practices will probably have the biggest long-term impact on your ability to stay regular throughout your Lyme recovery. Bonus: They’re crucial for supporting a healthy stress and immune response, too.

Eat more veggies: Try to eat more vegetables than any other food group, suggests Dr. Rawls. Not only do they provide vitamins, minerals, and phytochemicals, but they’re a great source of fiber, which helps increase the weight and size of stool so that it moves more easily through the GI tract. (Un-fun fact: most adults only get half the recommended intake). Dr. Rawls is also a big fan of raw, fermented veggies like kimchi, which deliver a one-two punch of fiber and probiotic bacteria. Want fruit? Opt for high-fiber berries.

Move your body: While it can be hard to work out if Lyme limits your mobility, try embracing things like a gentle yoga flow, tai chi, qigong, or simple bodyweight exercises such as sit-ups, push-ups, planks, and leg lifts. Not only could this help speed up colonic motility, per one study, but it could help alleviate constipation-causing stress, too.

Stay hydrated: Drinking enough fluids (water, herbal teas, and seltzers are all a-okay) is key for moving stool and preventing constipation. But you don’t want to overhydrate, either. Pro tip: Drink enough so that your pee is pale yellow in color.

Sleep: The highest priority on your to-do list should be aiming for eight hours of sleep per night. It’s key for all aspects of healing and mitigating the effects of stress on the body. To ease into a restful slumber, take a few deep, calming breaths before bed or do a short guided meditation for sleep (try the Calm app).

2. Take This Type of Magnesium.

For more of an in-the-moment constipation fix, pick up a bottle of Milk of Magnesia from your local drugstore, which contains magnesium hydroxide. “This has always been my go-to for constipation,” says Dr. Rawls. “It’s a natural osmotic laxative, meaning it attracts water and prevents stool from drying and hardening in the colon.”

Taking the recommended dose on the label can help flush out your system if you’re really backed up, but taking regular lower doses of Milk of Magnesia can be used as a preventative if you’re prone to constipation. Dr. Rawls recommends about ½ tablespoon before bed every night to keep stool soft without risking dependency or damaging the colon. Harsh, stimulant laxatives, on the other hand — even natural ones from herbs like senna — can be quite damaging.

Based on his clinical experience, Dr. Rawls cautions that some (but certainly not all) Lyme patients may be sensitive to taking high amounts of magnesium. So if you try a magnesium hydroxide-based product and don’t feel well, consider a synthetic osmotic laxative like Miralax.

3. Embrace Flax and Chia Seeds.

Ground flaxseed meal is a personal favorite of Dr. Rawls for maintaining regularity. “It has a mild laxative effect thanks to some fiber (approximately 3 grams per 2 tablespoons), but unlike fiber supplements like Metamucil, the fiber in flax is not broken down by gut bacteria — so it’s much less likely to cause gas and bloating,” he says. It’s also high in plant-based omega-3 essential fatty acids that are nourishing to the gut. Try adding a couple of tablespoons to your next smoothie or salad.

Another small but mighty seed: Chia. Of all the seeds, chia packs the biggest fiber punch with about 10 grams per 2 tablespoons and a nice dose of omega-3s. What makes chia truly unique, though, is when you expose these little black seeds to water, they absorb that water and develop a slippery, gelatinous texture. So, when you make chia pudding or drinks, you’ll reap the motility-stimulating benefits of both hydration and fiber.

4. Consider Gut-Nourishing Herbs.

While you want to steer clear of strong laxative herbs like senna, two milder herbs can help gently promote regularity and restore gut health:

Triphala is a combination of three fruits (amla, bibhitaki, and haritaki) that has a nourishing effect on gut cells, says Dr. Rawls. It’s been traditionally used in Ayurvedic medicine to support a healthy intestinal lining and offer very mild laxative effects to promote the passage of waste. It’s also been shown to promote the growth of good gut bacteria while suppressing the growth of unhealthy gut microbes.

Dandelion root functions as a digestive stimulant and offers mild laxative properties that may help regulate bowel movements and ease constipation. It contains a fiber called inulin, which has prebiotic properties and functions as a demulcent, meaning it forms a coating over mucous membranes and has a soothing effect.

Bottom Line

Lyme disease is hard enough already; you don’t need to be dealing with constipation on top of it. Fortunately, as you navigate your way through recovery, the simple, sustainable strategies above can help keep things moving and ease gut discomfort — and boost overall health in the process.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme. You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.