Sjögren’s syndrome (SS) is a systemic autoimmune disease that affects multiple organ systems throughout the body, not just the moisture-producing glands. Many people experiencing gastrointestinal discomfort wonder if their SS diagnosis is related to constipation. Sjögren’s can be directly linked to constipation and other gastrointestinal motility issues through distinct mechanisms that extend beyond simple dryness. Understanding these underlying causes is the first step toward effective management.
Systemic Dryness and Autonomic Dysfunction
Sjögren’s syndrome is systemic, impacting the entire body, including the digestive tract which requires moisture for proper function. The gastrointestinal tract relies on secretions to lubricate the passage of food and waste. When these secretions are diminished, the contents of the large intestine become excessively dry, leading to hard stools and difficulty with bowel movements.
Sjögren’s often involves the nervous system, a manifestation known as autonomic neuropathy or dysautonomia, which is a major cause of digestive problems. The autonomic nervous system (ANS) controls involuntary functions, including peristalsis—the rhythmic muscular contractions that propel waste through the intestines. When the nerves controlling this process are damaged by autoimmune activity, contractions slow down or become uncoordinated, resulting in intestinal dysmotility and delayed gastric emptying (gastroparesis).
This nerve damage disrupts the body’s ability to move waste effectively. The slowed transit time allows the colon to absorb too much water from the already dry contents, further compacting the stool and exacerbating constipation. Gastrointestinal complaints are common in Sjögren’s patients, with up to 90% of those with primary SS reporting some form of GI issue.
Non-Sjögren’s Related Contributors to Constipation
Several factors commonly associated with living with Sjögren’s can contribute to or worsen constipation. Many medications used to manage SS symptoms, such as those for pain or inflammation, impede normal bowel function. For example, certain central pain medications, antidepressants, and antihistamines possess anticholinergic properties that inhibit the involuntary muscle contractions necessary for gut motility. Nearly 40% of Sjögren’s patients may be prescribed at least one medication with such properties, significantly increasing their risk of constipation.
Lifestyle adjustments related to the chronic condition also affect the digestive system. Patients with chronic dryness often restrict their fluid intake, which directly impacts the moisture content of the stool, making it harder to pass. Furthermore, the fatigue and joint pain experienced by many with SS can lead to reduced physical activity. A sedentary lifestyle is a factor that slows down digestion and promotes constipation.
Constipation can also be related to co-occurring medical conditions frequently seen alongside Sjögren’s syndrome. Autoimmune diseases often cluster, increasing the likelihood of developing conditions like hypothyroidism, where an underactive thyroid slows gut motility. Additionally, some individuals with SS also have celiac disease or small intestinal bacterial overgrowth (SIBO), which can further complicate bowel regularity.
Targeted Strategies for Symptom Relief
Managing constipation requires aggressive hydration, as the body’s ability to retain moisture is compromised by the disease. Sipping water consistently throughout the day helps maintain systemic moisture levels and prevents the colon from overly dehydrating the stool.
Dietary changes should focus on increasing fiber, but this must be done cautiously alongside increased fluid intake. Fiber without sufficient liquid can bulk up the stool without softening it, potentially worsening constipation. Incorporating sources of soluble fiber, such as vegetables and fruits, helps the stool retain water and makes it easier to pass.
When lifestyle changes are insufficient, medical intervention may be necessary. Osmotic laxatives (e.g., polyethylene glycol or magnesium-based products) draw water into the colon to soften the stool, benefiting SS-related dryness. Stimulant laxatives, which make intestinal muscles contract, may be used for slowed motility but should be used sparingly. For severe motility disorders related to nerve damage, a gastroenterologist may prescribe prokinetic agents to improve intestinal contractions. All significant changes to diet or medication, especially when dealing with autoimmune and motility complications, should first be discussed with a healthcare provider.