How to Tell if You Have Severe Constipation­—And What to Do About It

Constipation is never really "normal," but if you haven't pooped in over a week, it's time to see a healthcare provider.

When it's been several days since you last pooped, you might start to wonder: When does constipation go from normal to something a bit more serious?

Maybe it was because you left your water bottle at home. Or because you've had to grab fast food for breakfast every day this week. Or maybe it's the new medication your doctor put you on. Whatever the reason, when your digestive system hits the brakes—it can get uncomfortable.

Here, gastroenterologists weigh in on why and when constipation becomes severe, and what you can do to feel better ASAP.

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Pexels / Polina Zimmerman / AdobeStock

Constipation

What's normal constipation, and when does it become severe? First, the bad news: There's no such thing as "normal" constipation, Rudolph Bedford, MD, a gastroenterologist at Providence Saint John's Health Center in Santa Monica, California, told Health. "Constipation in itself is an abnormal condition which you should do whatever you need to do to avoid," Dr. Bedford said.

However, while it's not normal, it is common: About 16 out of every 100 adults have symptoms of constipation, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Technically speaking, per the NIDDK, constipation is when you have one or more of the following symptoms:

  • Fewer than three bowel movements a week
  • Stools that are hard, dry, or lumpy
  • Stools that are difficult or painful to pass
  • A feeling that not all stool has passed.

This more common constipation typically occurs when the body struggles to move food through the digestive tract, and it can be linked to a number of different things, like changes in medication, lifestyle, or nutrition habits, per the NIDDK. As food and waste get backed up in the digestive system, "this can lead to more difficult and painful bowel movements, as well as bloating and cramping," Niket Sonpal, MD, an internist and gastroenterologist in New York City, and adjunct assistant professor of clinical medicine at Touro College of Osteopathic Medicine, told Health.

According to the NIDDK, healthcare providers may recommend over-the-counter laxatives or stool softeners for treating constipation to get things moving again.

Warning Signs of Severe Constipation

It's when constipation lasts longer than just a few days that things start to get worrisome. Dr. Sonpal said that constipation becomes severe and warrants a healthcare provider's help when a person isn't able to poop for over a week, even while taking laxatives. If you've had constipation for quite a while and you also have a family history of colon or rectal cancer, you should also check in with your doctor.

If you're struggling with constipation, the NIDDK also lists the following as signs you should see a doctor right away:

  • Bleeding from your rectum
  • Blood in your stool
  • Constant pain in your abdomen
  • Inability to pass gas
  • Vomiting
  • Fever
  • Lower back pain
  • Losing weight without trying

Prevention

First: The best treatment for constipation—severe or not—is prevention. "The best way to combat severe constipation at home is to eat a fiber-filled diet and stay extremely hydrated," said Dr. Sonpal. "Moving your body daily, like a walk or run, can help your digestive system better break down foods and pass bowel movements," Dr. Sonpal said.

You might also try different positions in the bathroom, like putting an elevated platform—like a Squatty Potty—under your feet to put you in a squat, as described in a 2020 research article published in the Journal of Physical Therapy Science. This position may help reduce straining while going number two by creating a better angle for your bowels, according to previous reporting by Health.

Treatment for Severe Constipation

If you're already backed up, fiber can actually make constipation worse, according to Elana Maser, MD, assistant professor of gastroenterology at the Icahn School of Medicine at Mount Sinai and gastroenterologist at the Feinstein IBD Center at Mount Sinai Hospital in New York City. "I would avoid fiber if you're in a severe stage," Dr. Maser told Health. "Fiber requires a lot of water intake, and if you don't take in enough water, the fiber can harden and be even more difficult to pass," Dr. Maser explained.

Instead, Dr. Bedford recommended starting with a saline laxative like Fleet enemas to try to get things moving. "You have to start to get things moving from below with an enema before taking something from above," Dr. Bedford explained. Once you're able to clear some stool out of your system, you can then continue on to a laxative like magnesium citrate, MiraLAX, or lactulose to try to clear the rest of your system, Dr. Bedford said.

If you don't feel comfortable doing this process at home, if it's not helping, or if your constipation has started really taking a toll on your well-being, it's time to seek medical help.

"Severe constipation can require medical intervention if it is negatively affecting a person's daily life and cannot be resolved with at-home treatment," said Dr. Sonpal. Once you arrive at your healthcare provider's office, what they do next will depend on the severity of your case.

According to 2022 recommendations published in the American Journal of Gastroenterology, in moderately severe cases, your provider will review your medications, since medications are common causes of constipation. They may prescribe you further laxatives and schedule a colonoscopy to see if there's an underlying cause of your constipation.

In particularly severe cases, fecal impaction can occur—that's when stool has built up in your lower colon to such a degree that it's too large to pass, as described in the American Journal of Gastroenterology recommendations. In this case, a healthcare provider would use a gloved hand to try to break up and remove the stool in order to make it more manageable for the patient to pass. Fecal impaction is most common in the elderly and in patients with neurodegenerative illnesses like Parkinson's disease.

"Surgery is usually not needed for constipation unless there is a physical blockage in the colon that is not allowing stool to pass," said Dr. Sonpal.

The bottom line here: If it's been over a week since you last pooped, see a healthcare provider, said Dr. Bedford. You may not have a severe case yet, but it's better to intervene early before it gets too bad.

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