Post Viral Syndrome & Constipation

May 11

Post COVID inflammation can affect any organ, nerve or tissue. The Vagus nerve runs from head to toe and branches out to touch every part of your body. When the nerve branch that controls the intestine is inflamed, the organ cannot function properly. This article provides you with information you need to manage post COVID constipation.

Updated February 20, 2024

Post COVID syndrome (Long COVID) is caused by the cytokine storm, this is when the immune system gets overstimulated and it triggers mast cell activation and the overproduction of histamines that cause inflammation. Post COVID inflammation can affect any organ, nerve or tissue. One of the most common issues is Vagus nerve inflammation. This is the longest nerve in the body that runs from head to toe and branches out to touch every part of your body. When a branch is inflamed, the signals to the organ it controls stop, and the organ cannot function properly. With constipation, the branch of the vagus nerve that controls peristalsis in part or all of your bowel can be affected.

Depending on the resource, researchers estimate that about 30% - 50% of those infected with COVID-19 will experience continued inflammation for 4 or more weeks post infection, regardless of the severity of the acute infection (the contagious stage). A common post COVID condition is multiorgan inflammatory syndrome that can affect children (MIS-C) or adults (MIS-A).

Constipation can become a serious complication in a matter of days. Constipation lasting 2-3 days without a bowels cement is too long. It is important to pay attention to foods, drinks and medications that may be causing inflammation, and eat a low-density diet, increasing salads, fruits and easy to digest proteins vs breads, grains and heavy meats.

Try to move your body a bit with gentle exercise like stretching and deep breathing to sooth the nerves and help restart peristalsis (intestinal contractions that moves food along the digestive tract). Laxatives work by drawing water into the intestines. Gentle laxatives like Miralax or Lactulose and drinking extra water to soften the stool. Magnesium products like citrate of magnesia are more harsh but effective.

Ask your dr to check your electrolytes, including magnesium. COVID has a tendency to throw the electrolytes you body needs out of balance. Also have your vitamin levels checked - vitamins C, D, E and B-12.

An easy technique that can help is abdominal massage. Abdominal massage or stomach massage is a gentle, noninvasive treatment that may have relaxing and healing effects for some people. It's used to treat a wide variety of health concerns, especially those related to the stomach, such as digestion issues, constipation, and bloating. Below is a video demonstration on the technique (see videos below).

Acupuncture can be helpful in restoring the nerve functions responsible for peristalsis. Chiropractic can be helpful by realigning the spinal vertebrae and reliving pressure on the branch/branches of the vagus nerve that control the intestinal function.

Some herbal remedies that are known to help with constipation are slippery elm bark, aloe, marshmallow, aloe, rhubarb, senna, psyllium, and cascara buckthorn. Be sure to research herbs before you try them to look for drug interactions with medications you are taking.

Case Study

9-year-old healthy boy, 97%ile in height & weight, no preexisting medical conditions.

The subject experienced a viral infection. While siblings recovered within 24 hours, the subject had ongoing post viral syndrome symptoms after the acute phase of the virus. The vagus nerve branch that controlled his intestines was inflamed and stopped working for a year, therefore his intestines stopped working and he developed an ileus (intestinal blockage). Symptoms include nausea, vomiting, low appetite, belching that smell like someone that just passed gas, dehydration, weight loss, and the key symptom of watery diarrhea with no consistency because fluids push around the blockage while solids continue to build up in the intestinal tract.

In this case, multiple specialists missed the diagnosis, and therefore didn’t treat the child until a year had passed. By then he had dropped to the 3%ile in height and weight due to malnourishment, developed kidney stones due to chronic dehydration, lost all strength and muscle tone, and had fallen behind in school with devastating psychosocial impact.

Once the proper diagnosis was made, laxatives were used 2x/day for 7 days, and the force resulted in a ruptured colon, a life-threatening event usually requiring emergent surgical repair and antibiotics. In this case, the body spontaneously protected itself and a fistula (false passage) developed between the colon and esophagus. When the child would sit on the toilet to have a bowel movement, the formed stool would come out of his mouth. He was hospitalized for three days, and a nasal gastric (NG) tube was placed to drain all fluids from the stomach, allowing complete gut rest for three days. This allowed the fistula to collapse, and scar closed, restoring the intestinal pathway. Normal bowel function did not return over the next three months, requiring ongoing laxative treatment and further malnourishment. Acupuncture with a Chinese medical doctor was eventually utilized and gradually restore bowel function at 18 months post costal infection.

Takeaways

Don’t ignore constipation. Healthy bowel function includes 2 or more effortless bowel movements daily.

To help your body recover from post viral constipation, eat lots of fresh fruits and vegetables, and drink eight 8 oz glasses of water daily.

Avoid alcohol and caffeine.

Exercise within tolerance, massage your stomach, and if don’t have a bowel movement for two days or if your belly feels hard to the touch at bedtime, use a gentle laxative like prune juice, slippery elm (herb) or Miralax.

Ask the doctor about prescription Lactulose. It’s a plant fiber and gentler than over the counter laxatives. Common brand names for Lactulose: Kristalose, Generlac, Enulose. It is a laxative and ammonia reducer used to treat constipation and some cases of liver disease.

Natural remedies to research include slippery elm bark, magnesium, rhubarb, senna and more. Be sure to check for drive interactions before adding new supplements to your routine.

Be sure to talk to your doctor or pharmacist before taking herbal supplements or over the counter medications.

Stomach massage technique to relieve constipation and gas by stimulating peristalsis.

Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein, vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress effects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

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