- Researchers identified two gut bacteria that trigger chronic constipation which break colon mucus
- The bacteria Akkermansia muciniphila and Bacteroides thetaiotaomicron degrade protective colon mucin
- Loss of mucin causes dry, hard stool and explains why laxatives often fail in chronic constipation
Constipation occurs when an individual has fewer than three bowel movements in a week or when they have a difficult time passing stool. However, how often an individual poops can vary as some people poop only several times a day while others only poop one to two times a week. Other factors that define constipation includes; dry and hard stool, painful bowel movements and feeling that you haven't fully emptied your bowels. There are different causes of constipation, some of which are low fibre intake, dehydration, and lack of physical activity, among others. Researchers at Nagoya University in Japan, have now identified two gut bacteria that appear to work together to trigger chronic constipation.
The researchers say that the microbes, Akkermansia muciniphila and Bacteroides thetaiotaomicron, break down the protective mucus layer of the colon. The study, published in Gut Microbes, explains why common treatments fail for people living with constipation. The microbes destroy the mucus layer which makes the stool dry and difficult to pass.
Constipation and Parkinson's Disease
The study also found a link between constipation and Parkinson's disease. People who suffer from Parkinson's disease often have constipation decades before tremors begin. These people also have higher levels of these mucus-degrading bacteria. While constipation in people with Parkinson's is blamed on nerve damage, the new study points towards gut bacteria.
People with Parkinson's disease often experience severe, treatment-resistant constipation, though it's categorised apart from CIC. Patients battle constipation for 20 or even 30 years prior to movement symptoms emerging, leaving physicians without a solid explanation.
Instead of focusing on nerve or muscle activity, the researchers examined colonic mucin. This gel-like material creates a protective layer along the large intestine walls and mixes into stool. Colonic mucin maintains stool moisture, eases its passage, and protects the intestinal lining from bacteria.
Study Findings
The team found that the two bacteria degrade this protective barrier through a sequential process. Initially, B. thetaiotaomicron secretes enzymes that remove sulfate groups from mucin. These sulfate groups typically serve as a shield, preventing the bacteria from degrading it. With those defenses gone, A. muciniphila can break down the mucin.
When mucin levels fall too low, stool dries out and hardens, causing constipation. Since the main issue involves mucus loss rather than slow gut motility, regular laxatives and motility-stimulating drugs often fail to help.
To check if blocking this process could prevent constipation, the researchers modified one of the bacteria. Tomonari Hamaguchi, lead author and lecturer from the Academic Research & Industry-Academia-Government Collaboration Office at Nagoya University, said, "We genetically modified B. thetaiotaomicron so it could no longer activate the enzyme sulfatase that removes sulfate groups from mucin.
"We put these modified bacteria into germ-free mice together with Akkermansia muciniphila, and surprisingly the mice did not develop constipation; the mucin stayed protected and intact."
When the sulfatase enzyme was disabled, the bacteria could no longer break down mucin. This means medicines that block sulfatase activity can help treat what researchers describe as bacterial constipation in people. Scientists say that instead of focusing only on gut movement, if doctors target their therapies towards protecting the colon's mucus barriers, it can help improve treatment outcomes of chronic constipation.
Why Does This Matter For Indians?
This study can be beneficial for indians because 14% of people in urban India suffer from chronic constipation. Poor lifestyle choices like low-fibre diets, dehydration, and sedentary habits, exacerbated by spicy and processed foods adds to the rising problem in the country.
The new study highlights why standard laxatives fail, especially in treatment-resistant cases linked to Parkinson's, which is increasing among the ageing population in India. The study paves the way for targeted therapies like sulfatase inhibitors, which can potentially transform care.
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