Does Celiac Disease Make You Constipated?

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While many people think of celiac disease (CD) as a condition in which the consumption of gluten triggers diarrhea, it may surprise you to know that it can also cause constipation as well. Constipation is a less common symptom of CD but one that can affect both children and adults with this autoimmune disorder.

The cause may not only include changes in the digestive tract that can occur with CD, but it may also involve gluten-free foods that can be constipating.

This article explains how celiac disease causes constipation and, conversely, how to recognize when constipation is a sign of celiac disease. It also covers ways to prevent or treat constipation if you are managing and living with CD.

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What Is Constipation?

You have constipation if you have fewer than three bowel movements per week. Occasional constipation happens to many people, but constipation is considered chronic if you're constipated for three months or longer.

There are many possible causes for constipation in adults and children, including:

  • Not eating enough fiber, such as from fruit, vegetables, and grains
  • Not drinking enough fluids
  • A lack of physical activity
  • Ignoring the urge to pass stools
  • Changes in your eating habits or daily routine
  • Anxiety or depression
  • Being underweight or overweight

On top of this, there are numerous medical conditions that can cause constipation, such as:

Side effects of certain medications can also cause constipation, including of the use antacids, antidepressants, diuretics ("water pills"), calcium supplements, and iron supplements.

How Does Celiac Disease Make You Constipated?

When a person has celiac disease, the immune system reacts abnormally to the presence of gluten by releasing immune proteins called celiac antibodies that target and attack the walls of the intestines. The targets are tiny, finger-like projections called villi that line the entire length of the small intestine.

Damage to the villi, in turn, triggers "classic" symptoms of CD such as chronic diarrhea, bloating, loss of appetite, and the inability to absorb nutrients from food (known as malabsorption).

However, for some people with CD, malabsorption can trigger constipation rather than diarrhea. This is because, with malabsorption, food is less thoroughly digested. As the under-digested food enters the small intestine, it is not broken down enough for nutrients to be absorbed. The only thing that can be absorbed is water and, in some people, too much is absorbed, leading to constipation.

On top of this, many of the food products used to replace gluten (like rice flour, potato starch, and tapioca starch) contain little to no fiber. Because fiber is essential to regular, normal bowel movements, the lack of fiber can further contribute to or worsen constipation.

Normal Constipation or Celiac Disease?

Studies suggest that constipation caused by celiac disease is generally long-lasting and unrelieved by laxatives. People with CD-associated constipation also tend to be less responsive to CD treatments.

What Are the Other Symptoms of Celiac Disease?

The symptoms of celiac disease can vary significantly from person to person. While most people regard CD as a purely gastrointestinal disease, it can also cause extraintestinal symptoms (meaning symptoms that don't involve the digestive tract).

Gastrointestinal
  • Chronic diarrhea, with pale and abnormally foul-smelling stools

  • Abdominal pain

  • Bloating and gas

  • Nausea or vomiting

  • Weight loss or failure to gain weigh

  • Stunted growth in children

  • Chronic constipation

  • Mouth ulcers

  • Lactose intolerance

Extraintestinal
  • Chronic fatigue

  • Headache and "brain fog"

  • Eye inflammation and cataracts

  • Irregular periods

  • Muscle or joint pain

  • Hair loss

  • Kidney stones

  • Osteoporosis

  • Heart and liver problems

  • Infertility

In some people, CD can also be silent, meaning that they have no symptoms even as the intestines incur increasing autoimmune damage.

Constipation in Children With Celiac

Recent research suggests that a significant number of children who suffer from functional (chronic) constipation may actually have celiac disease. An early study from the Netherlands suggested CD was more common than expected in children who had chronic constipation unrelieved by laxatives.

In another study from the State University of New York at Buffalo, researchers evaluated children who had been diagnosed with celiac disease over a 10-year period. They found that 39% had constipation at the time they were diagnosed. By contrast, only 31% had diarrhea as a symptom.

Other studies have not drawn the same conclusions. A 2018 study from Turkey reported that one in every 28 children with functional constipation actually had CD (less than 1%). These findings were echoed in a 2020 study from Colombia and a 2015 study from Iran. Given the conflicting results, further research is needed.

Constipation Relief for Celiac Disease

Treating constipation in people with CD can be difficult because it is often unrelieved by laxatives. Moreover, if laxatives are overused (including stimulant laxatives that speed gut movements or osmotic laxatives that draw water out of intestinal tissues), a person may end up having watery diarrhea.

Diet is generally the preferred, first-line method to treat and prevent constipation associated with CD.

This typically involves:

  • Slowly adding fiber to your diet, particularly soluble fiber which draws water to stools
  • Drinking plenty of water
  • Being physically active to stimulate bowel movements
  • Cutting back on constipating foods, like red meat, processed foods, dairy products, and alcohol

If these interventions fail to provide relief, speak with your healthcare provider who may have medications that can help.

Also, check with your healthcare provider before using an enema to treat CD-related constipation as it may place undue stress on already inflamed intestinal tissues.

Summary

Constipation is a less common symptom of celiac disease but one that can be just as impactful as diarrhea. Constipation with CD is largely due to the over-absorption of water and the under-absorption of nutrients in intestines damaged by inflammation. Gluten-free foods are also low in fiber, which further contributes to constipation.

Constipation in people with CD is best treated with a high-fiber diet, ample hydration, plenty of exercise, and the avoidance of constipating foods.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.