Constipation

What is constipation?

Constipation is a common digestive issue where you have difficulty passing stools or infrequent bowel movements. It is often defined as having fewer than three bowel movements per week. People experiencing constipation may have hard, dry, or lumpy stools and may feel that not all stool has passed after a bowel movement. Other symptoms can include bloating, stomach discomfort, and straining during bowel movements.

Several factors can contribute to constipation, including diet, lack of physical activity, medications, changes in routine, and medical conditions. It is typically treated by making changes to your diet, increasing fluid and fiber intake, and regular exercise. In some cases, over-the-counter laxatives or stool softeners may be used, but they should be taken only after talking to your healthcare provider. If you have long-term constipation or experience severe pain, blood in your stool, or unexplained weight loss, it is important to seek medical attention, as these could be signs of a more serious health condition.

What causes constipation?

Constipation can be caused by a variety of factors, ranging from lifestyle habits to medical conditions. Common causes include:

Dietary Factors

  • Low fiber intake: A diet low in fruits, vegetables, and whole grains can lead to hard stools.
  • Dehydration: Not drinking enough fluids makes stools dry and difficult to pass.
  • Excessive dairy consumption: Too much cheese and milk can contribute to constipation.

Lifestyle Factors

  • Lack of physical activity: Sedentary behavior can slow digestion.
  • Ignoring the urge: Delaying bowel movements can harden stools.
  • Changes in routine: Travel or schedule changes can disrupt bowel habits.

Medication Side Effects

  • Pain relievers such as opioids
  • Antacids containing calcium or aluminum
  • Certain antidepressants
  • Some blood pressure medications

Health Conditions

  • Irritable bowel syndrome (IBS)
  • Hypothyroidism
  • Diabetes
  • Neurological disorders (Parkinson’s, multiple sclerosis)
  • Pregnancy
  • Anal fissures or hemorrhoids

Other Causes

  • Aging: Slower digestion and reduced muscle tone
  • Stress and anxiety
  • Overuse of laxatives leading to dependence
  • Intestinal blockages from tumors or scar tissue

What are the symptoms of constipation?

Common symptoms include:

  • Fewer than three bowel movements per week
  • Straining during bowel movements
  • Hard, dry, lumpy stools
  • Feeling of incomplete evacuation
  • Bloating, cramping, or lower abdominal pain
  • Small, pellet-like stools
  • Sensation of blockage in the rectum
  • Need for manual assistance to pass stool
  • Loss of appetite or nausea in some cases

Seek medical attention if you experience chronic constipation for more than three weeks, severe pain, blood in your stool, unexplained weight loss, or if symptoms do not improve with dietary changes or over-the-counter treatments.

How is constipation diagnosed?

Diagnosis typically involves:

Medical History

  • Review of symptoms, diet, fluid intake, exercise, and medication use
  • Discussion of any relevant medical conditions or family history

Physical Exam

  • Abdominal examination for tenderness or masses
  • Digital rectal exam to check for obstructions or impacted stool

Laboratory and Imaging Tests

  • Blood tests to check for thyroid dysfunction, diabetes, or electrolyte imbalances
  • Stool tests for infection or inflammation
  • Abdominal X-ray or CT scan to identify blockages or stool buildup

Endoscopic Procedures

  • Colonoscopy or sigmoidoscopy to look for growths, inflammation, or bleeding

Specialized Tests

  • Colonic transit study to measure stool movement through the colon
  • Anorectal manometry to assess rectal and pelvic floor muscle function
  • Defecography to visualize the process of bowel movements

How is constipation treated?

Treatment often combines lifestyle changes, dietary adjustments, and, if needed, medications:

Lifestyle and Dietary Changes

  • Increase fiber from foods like fruits, vegetables, whole grains, and legumes or use supplements (psyllium, methylcellulose)
  • Drink at least eight glasses of water daily
  • Engage in regular physical activity (walking, swimming, cycling)
  • Establish a regular bowel routine and respond promptly to the urge

Over-the-Counter Laxatives

  • Bulk-forming laxatives (psyllium, methylcellulose)
  • Osmotic agents (polyethylene glycol, magnesium hydroxide)
  • Stimulants (senna, bisacodyl)
  • Stool softeners (docusate sodium)
  • Enemas (saline, mineral oil)

Prescription Medications

  • Prokinetic agents (prucalopride)
  • Chloride channel activators (lubiprostone)
  • Guanylate cyclase-C agonists (linaclotide, plecanatide)

Behavioral Therapy

  • Biofeedback for pelvic floor dysfunction

Surgery

  • Considered only for structural issues such as obstruction or rectal prolapse

Address Underlying Conditions

  • Treatment of hypothyroidism, diabetes, or neurological disorders if they contribute to constipation

Sources

  • American College of Gastroenterology. Constipation and Defecation Problems. Accessed Aug. 7, 2024.
  • American Gastroenterological Association. Constipation.
  • International Foundation for Gastrointestinal Disorders. Chronic Constipation. Accessed Aug. 7, 2024.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Constipation. Accessed Aug. 7, 2024.
  • NHS. Overview: Laxatives. Accessed Aug. 7, 2024.