RELATED: 11 Foods to Avoid When You’re Having Digestive Problems While constipation is uncomfortable (and sometimes distressing), it’s considered a symptom rather than a disease in itself. It’s also important to know that normal bowel habits can differ from person to person — some people may pass stool three times a day; others three times a week.
Lumpy, dry, or hard stoolsStools that are hard or painful to passFeeling as though there’s a blockage in your rectum that keeps you from having bowel movementsFeeling as though you can’t completely empty your stoolNeeding help to empty your rectum, whether by pressing with your hands on your abdomen or using a finger to remove the stool (yes, it happens!)
Constipation is considered to be chronic if you’ve experienced two or more of these symptoms for the last three months, according to the Mayo Clinic. (3) Learn More About Signs and Symptoms of Constipation: Constipation Symptoms In your lower GI tract, your large intestine, or bowel — which includes your colon and rectum — absorbs water from your digested food, changing it from a liquid to a solid (stool). Constipation occurs when digested food spends too much time in your colon. It can also occur when your colon absorbs too much water, making your stool hard and dry — and difficult for your rectal muscles to push out of your body. A wide range of factors can lead to constipation. According to the NIDKK, these include: (2)
Delayed emptying of the colon caused by pelvic floor disorders and colon surgeryGastrointestinal disorders, such as irritable bowel syndromeCertain medicines and dietary supplements, including antacids that contain aluminum; calcium supplements; anticholinergics and antispasmodics (often used to treat spasms in the intestines); anticonvulsants, which are used to prevent seizures; calcium channel blockers; diuretics; iron supplements; medications used to treat Parkinson’s disease; certain pain medications and antidepressants
A shift in your daily routine can also lead to constipation. Some people find that it’s more difficult to have a bowel movement while traveling, for instance. (Small hotel rooms with bad soundproofing contribute to the problem!) Life changes matter, too, including pregnancy (which increases the chances of constipation) — as well as simply getting older. According to a report published February 2015 in Canadian Family Physician, 26 percent of women and 16 percent of men age 65 and older experience constipation on a regular basis. (4) Other lifestyle-related causes of constipation include:
Not eating enough fiberDehydration or not drinking enough liquids in generalLack of exerciseHabitually ignoring the urge to goHeavy reliance on laxatives or enemas (when used incorrectly, these make the problem worse)
The following medical conditions may also cause constipation:
GI tract problems or disorders, such as irritable bowel syndromeTumors or other obstructionsCeliac diseaseColon polypsMultiple sclerosisDiabetesHypothyroidismParkinson’s diseaseStrokeNerve damage
Although constipation can affect anyone, according to the Mayo Clinic, you’re at highest risk if you are: (3)
A womanAn older adult (over 65)Suffering from depression or another mental health issue
You’re also at higher risk for constipation if you’re pregnant (as noted above), if you’ve just given birth, or if you’ve had surgery.
A sigmoidoscopy to examine the rectum and lower colon (where your doctor will insert a flexible tube with a light on the end to take a close look at these areas)A colonoscopy to examine the colonEvaluating the speed of your anal sphincter as well as how the muscle is workingEvaluating how well food passes through your colon with a colonic transit studyTaking an X-ray of the rectum during a bowel movement (this is called a defecography)A procedure known as MRI defecography
Medication Options
If lifestyle changes aren’t helping, your doctor may suggest a fiber supplement, stool softeners, or other medication — either over-the-counter or prescription — to loosen things up again. Laxatives are one option, but since taking these regularly can make it difficult to have a bowel movement on your own, it’s best to use them with your doctor’s guidance. The NIDDK suggests these other nonprescription options: (2)
Fiber supplements, such as MetamucilOsmotic agents, such as MiralaxStool softeners, such as ColaceLubricants (like mineral oils)Stimulants, such as Correctol
But note: The NIDDK warns that you should only use stimulants if your constipation is severe or other treatments have not worked. There are also prescription medications that help treat constipation. According to the NIDDK, your doctor may choose to prescribe one of the following: (2)
Lubiprostone (prescribed to increase fluid in your digestive tract and increase frequency of bowel movements)Medicines that encourage regular bowel movements, such as linaclotide and plecanatide (these are often used to help people with chronic constipation resulting from irritable bowel syndrome or IBS)Prucalopride (this drug gives your colon an assist if you have chronic constipation with no definitive cause)
Alternative and Complementary Therapies
While there are few high-quality studies showing that alternative therapies can effectively treat constipation, a 2015 review of studies published in the journal Evidence-Based Complementary and Alternative Medicine found that acupuncture and herbal treatments like psyllium can make a difference. (7) RELATED: What Is Irritable Bowel Syndrome?
Prevention of Constipation
You’ve likely heard it before, but the NIDDK recommends exercising regularly (moving your body keeps everything moving); increasing the amount of dietary fiber you consume (choose high-fiber foods as part of your regular rotation), as well as drinking plenty of water. (2) Bonus: A February 2019 review of studies of fiber and health in The Lancet found that people who ate the most fiber experienced a 15 to 30 percent decrease in mortality from a number of causes compared with those who ate the least fiber. (8) The U.S. government’s dietary recommendations suggest 28 grams of fiber a day for women ages 19 to 30; 25.2 grams for women ages 31 to 50; and 22.4 grams for women older than 51. Men ages 19 to 30 should get 33.6 grams of dietary fiber per day; ages 31 to 50 should get 30.8; men over 51 should aim for 28 grams. (9) Pay attention to your body signals; if you need to go, go without delay. And don’t rush yourself or strain to make it happen. Put a bit of zen into your bathroom routine and relax.
Hemorrhoids (swollen, inflamed veins in the rectum or around the anus that may cause rectal pain and bleeding)Anal fissures (small tears in the skin around the anus that are often accompanied by itchiness, pain, and bleeding)Inability to push stool out because it has hardened and packed in the colon and rectum too tightlyRectal prolapse (a condition in which part of the rectum sticks out of the anus)
RELATED: What Are Hemorrhoids? Besides being a drain on well-being, constipation is also a drain on the medical system: In a study in the same journal published in April 2015, researchers found that between 2006 and 2011, the frequency of constipation-related emergency room visits increased by 41.5 percent, from 497,034 visits to 703,391 visits, while the average cost for each patient rose by 56.4 percent, from $1,474 in 2006 to $2,306 in 2011. (12) Chronic constipation may lead to other difficult issues, as well. According to an article published in March 2019 in the American Journal of Managed Care, people with constipation typically have poorer general health, mental health, and social functioning compared with those without. (13) No wonder, since the average person suffering from constipation without a cause has to try approximately four over-the-counter and two prescription medications before settling on a treatment that works. (13)
HypothyroidismColorectal cancerDiverticular diseaseDiabetesIrritable bowel syndrome (IBS)An intestinal obstructionNeurological disorders including multiple sclerosis and Parkinson’s diseaseA defect in the digestive tractPregnancy
A number of major medical centers offer advice and information about constipation on their websites, including:
Johns HopkinsMayo UCSFCleveland Clinic
