Constipation

It’s not uncommon to have trouble pooping now and then, but difficult or infrequent bowel movements—fewer than three a week—might mean you’re constipated. Here’s why, and what you can do about it.

Constipation is having fewer bowel movements than normal. This is usually a symptom of another health issue, from something as simple as not consuming enough water or fiber, to a serious blockage in your intestine, or even colon cancer. Changing your diet or taking gentle laxatives may be enough to remedy the problem, but some people need stronger medications or even surgery.

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What Is It?

Experts define constipation as having fewer than three bowel movements a week, but this can vary greatly between individuals. When you do go, you may find it difficult or painful to have a movement, the stools may be hard and dry, or you may feel like you haven't completely emptied your bowels. Constipation is incredibly common: Some four million Americans complain of frequent constipation. Upwards of two-and-a-half million people see their doctor each year about this problem.

Constipation can affect people of all ages, but older individuals, women who are pregnant or have just given birth, as well as people who are not Caucasian tend to be at a higher risk.

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Types

Constipation that's not caused by an underlying health issue or as a result of taking certain medications is called "functional constipation." There are two major types:

  1. Normal transit constipation is when you have a normal (for you) number of bowel movements, but the stool is hard and dry.
  2. Slow transit constipation usually results in fewer than normal bowel movements. It's because the waste is moving too slowly through the digestive tract.

Chronic constipation is constipation that lasts at least several weeks.

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Symptoms

Constipation is itself a symptom and one which is characterized by a change in your regular bowel frequency along with dry and hard or lumpy stools. You may also have a stomachache or cramps and feel nauseous or bloated.

Ongoing constipation can result in complications such as hemorrhoids (swollen veins in your anus as a result of pushing too hard), anal fissures (tears in the lining of your anus because of the rough stools trying to pass through), an infection, fecal impaction (when stool gets backed up), damage to your pelvic floor muscles, and rectal prolapse (when a bit of intestine pokes out from the anus).

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Causes

The immediate cause of constipation is called "slow transit time." This is when waste products from food move too slowly through your digestive tract, which gives the colon more time to absorb water from the waste. That makes your stools dry.  

Many things can cause slow transit time. One is not getting enough fiber in your diet or not drinking enough water. Traveling and other changes in your normal routine like eating or sleeping at different times can cause constipation, as can lack of exercise and not going when you have the urge to go.

Medications can also cause constipation, including:

  • Opioids like codeine and oxycodone (Oxycontin).
  • Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen.
  • Antacids which contain calcium or aluminum.
  • Iron supplements.
  • Allergy medications like antihistamines.
  • Some blood pressure drugs, like diuretics.
  • Some antidepressants and psychiatric medications.
  • Certain tranquilizers and sedatives.
  • Gabapentin and other seizure medications.

An underlying health condition could also be causing your constipation. This includes diabetes or hypothyroidism (a sluggish thyroid gland), irritable bowel syndrome (IBS), diverticular disease, and, on the more extreme end, colorectal cancer, an intestinal obstruction, a fistula or other structural abnormality, neurological disorders like stroke, Parkinson's disease or multiple sclerosis—all of which can affect the nerves in your colon and rectum—lupus, weak pelvic muscles, and eating disorders.

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Diagnosis

Doctors have a number of tools to help them diagnose the reasons for constipation. Your healthcare provider will likely ask you questions about how long you've had the symptom and about your personal and family history of bowel issues. He or she will also want to know what medications you're taking and if you've recently traveled or made any changes to your diet. 

A physical exam comes next. This consists of listening to your abdomen with a stethoscope and checking the area for pain or swelling. The doctor may also do a digital rectal exam which means inserting a finger into your anus to feel for backed-up stool or any abnormalities.

If the cause still isn't clear, doctors may perform blood and urine tests designed to detect anemia, hypothyroidism, diabetes and celiac disease, as well as stool tests to look for blood as well as infection and inflammation.

Imaging tests can find any internal problems. These include computed tomography (CT), magnetic resonance imaging (MRI), an abdominal X-ray, a sigmoidoscopy to examine the lower part of your large intestine or a colonoscopy to investigate the length of your large intestine. A defecography is an X-ray of the anal and rectal areas, while an anorectal manometry measures your rectum's sensitivity and how well the anal muscles work. 

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Treatment

Treating your constipation will depend on the cause as well as your age and other characteristics. If you have mild or moderate constipation, drinking another two to four glasses of water a day, avoiding caffeine and alcohol (which dehydrate you), taking more fiber in the form of high-fiber food or a supplement like Metamucil, and trying an over-the-counter laxatives like Dulcolax may get you regular again.

Some doctors also recommend "bowel training," which is teaching yourself how to have a bowel movement at the same time every day. You may be able to spur a bowel movement by raising your feet (with a footstool), leaning back or squatting. Enemas involve putting water or another solution into your rectum to try to flush the stool out. Magnesium may also help but talk to your healthcare provider before trying this.

If none of these measures work, talk to your doctor about a prescription medication like linaclotide (Linzess), lubiprostone (Amitiza), prucalopride (Prudac or Motegrity), plecanatide (Trulance), and lactulose (Cephulac or Kristalose).

Less commonly, constipation may require surgery to correct a structural problem like a blockage or tear or, occasionally, remove a tumor. 

If your constipation doesn't go away after three weeks even with home remedies, or if you have bleeding from your rectum, blood in your stools, fever, weight loss without trying, or pain in your lower back, see a doctor.

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Prevention

As long as you don't have a serious underlying condition, lifestyle changes can go a long way to prevent constipation. Many of these are the same strategies used to treat constipation. Make sure you consume 20 to 35 grams of fiber per day—found in fruits, vegetables, legumes, and whole-grain breads and cereals. Stay away from caffeine and processed foods and remember to get regular exercise. The U.S. Department of Health and Human Services recommends that adults do at least 150 to 300 minutes of moderate-intensity aerobic activity (i.e. fast walking or dancing) per week—which can be as little as 20 minutes per day. Muscle strengthening by using weights or doing push-ups is also important. Try to do this at least two days a week.

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