What is constipation?
Constipation is an abnormal condition in which bowel movements occur less frequently than what is usual for you. One-fourth or more of these bowel movements are accompanied with straining. Every person has differences in their normal, regular pattern of bowel movements, but constipation can be loosely defined as having fewer than three bowel movements per week.
When you are constipated, you have bowel movements that are hard, dry and difficult or painful to pass. You may also only pass small amounts of stool in small pieces at one time. Constipation is caused by food moving too slowly through the colon, or it can occur when the colon absorbs too much water from digested food as it forms waste products (stool).
Constipation is one of the most common gastrointestinal complaints. Constipation is very common in young children and the elderly but can occur in any age group or population.
A wide variety of diseases, disorders and conditions can lead to constipation, including lifestyle changes, dehydration, malignancy (cancer), inflammation, and other abnormal processes. Constipation can be due to mild to moderate conditions, such as a poor diet, pregnancy or hemorrhoids. Serious and life-threatening causes of constipation include colon cancer and bowel obstruction.
In some cases, constipation may be brief, such as may occur when you delay having a bowel movement when the urge is felt. Constipation can also persist over a longer period of time, such as when it is caused by a diet low in fiber and fluids.
If your constipation persists, recurs or causes you concern, seek prompt medical care.
Constipation that is associated with bloody stool, major rectal bleeding, dizziness, fainting, or severe abdominal pain can be a symptom of a serious, potentially life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms.
What other symptoms might occur with constipation?
Constipation may be accompanied by other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms frequently affect the digestive tract but may also affect other body systems.
Digestive symptoms that may occur with constipation
Constipation may accompany other symptoms affecting the digestive tract including:
- Abdominal cramping or pain
- Abdominal swelling, bloating or distention
- Change in bowel habits
- Fecal incontinence
- Full bowel sensation
- Leaking of small amounts of liquid stool without having a full bowel movement
- Nausea and vomiting
- Rectal pain or burning
- Straining during bowel movement
Other symptoms that may occur with constipation
Constipation may accompany symptoms related to other body systems including:
- Stress or anxiety
Serious symptoms that might indicate a life-threatening condition
In some cases, constipation may occur with symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
- Bloody, black or tarry stool
- Change in level of consciousness or alertness, such as passing out or unresponsiveness
- High fever (higher than 101°F)
- Major rectal bleeding
- Rapid heart rate (tachycardia) or rapid breathing (tachypnea)
- Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
- Rigid, board-like abdomen
- Severe abdominal pain
- Weakness (loss of strength)
- Yellow skin and whites of the eyes (jaundice)
What causes constipation?
Normally, the colon absorbs excessive water from food during digestion. When food moves too slowly, the colon absorbs too much water, resulting in hard, dry stool and constipation.
In young children, constipation can result from being afraid or unwilling to use the restroom, or delaying a bowel movement when the urge is felt, which can also occur in adults. Other conditions that affect digestion and cause constipation include dehydration, malignancy (cancer) and inflammation.
Gastrointestinal or digestive conditions, such as irritable bowel syndrome, colon cancer, anal fistula, and ileus (bowel paralysis) or obstruction can cause constipation. Constipation often results from consumption of a low-calorie or low-fiber diet. Chronic laxative use can cause the bowel to become dependent on laxatives in order to pass stool and lead to constipation when laxatives are stopped. Constipation with no known cause is called idiopathic constipation.
Constipation can also result from conditions that occur in other body systems, such as pregnancy and certain types of spinal cord injury. In some cases, an underlying condition, such as bowel obstruction, is life-threatening.
Lifestyle and dietary causes of constipation
Constipation can be caused by lifestyle, diet or other conditions including:
- Advanced age
- Delaying bowel movements (ignoring the urge to have a bowel movement)
- Lack of physical activity
- Low-fiber diet
- Not drinking enough fluids
- Stress or anxiety
- Travel (travel-related constipation)
Gastrointestinal causes of constipation
Constipation may occur due to conditions of the digestive tract including:
- Anal fistula (abnormal connection or tunnel between the anus and the buttocks)
- Bowel (intestinal) obstruction
- Colonic inertia (abnormal nerve and muscle function in the colon)
- Dehydration from excessive vomiting or diarrhea
- Digestive tract surgery
- Diverticulosis or diverticulitis (inflammation of an abnormal pocket in the colon)
- Food intolerances or allergies, such as to milk products
- Hirschsprung’s disease (caused by a neurological birth defect that leads to severe constipation and intestinal obstruction in newborns and infants)
- Irritable bowel syndrome (IBS; digestive discomfort that does not cause intestinal damage or serious disease)
- Pelvic floor dysfunction
Other causes of constipation
Constipation can be caused by neurological, metabolic and other conditions including:
- Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
- Eating disorders
- Hypothyroidism (underactive thyroid)
- Multiple sclerosis (disease that affects the brain and spinal cord causing weakness, coordination, balance difficulties, and other problems)
- Parkinson’s disease (brain disorder that impairs movement and coordination)
- Spinal cord injury
- Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)
- Uremia (high levels of nitrogen-type waste in the blood due to impaired kidney function)
Medications that cause constipation
Constipation can also be caused by certain medications including:
- Antacids that contain calcium and aluminum
- Calcium channel blockers for high blood pressure
- Iron supplements
- Laxative abuse
- Parkinson’s disease medications
When should you see a doctor for constipation?
Everyone has unique bowel habits. Some people have a bowel movement a few times a day, and some go only a few times a week. So, it’s important to know what’s normal for you. If you notice a change that persists despite measures to correct it, make an appointment to see your doctor.
As a general guideline, you should call your doctor or seek prompt medical care for the following:
- You have been unable to move your bowels for 3 to 5 days, even using home remedies.
- You have constipation with nausea, vomiting, or stomach pain or bloating.
- You have blood in your stool.
In most cases, constipation is not an emergency. But it can be a sign of a serious underlying problem, some of which can have potentially life-threatening complications. Examples include dehydration and bowel obstruction. Call 911 or go to your nearest emergency room for constipation along with potentially serious symptoms including:
- Black, bright bloody, or tar-like stool
- Difficulty breathing or other breathing problems
- High fever over 101°F
- Rapid or irregular heart rate
- Rigid abdomen or severe abdominal pain
- Severe rectal bleeding or vomiting blood or coffee ground-like material
- Yellowing of the skin or eyes
How is the cause of constipation diagnosed?
To diagnose the cause of constipation, your doctor will ask you several questions related to your symptoms including:
- How long have you been experiencing constipation?
- Is your constipation constant or does it come and go?
- What, if anything, seems to make your constipation better or worse?
- Are you experiencing any other symptoms, such as abdominal pain or nausea?
- Do you strain to have a bowel movement?
- Do you see blood on the toilet paper or in the toilet?
- How much water do you drink throughout the day?
- How would you describe your diet? How much fiber, in the form of fresh fruits and vegetables and whole grains, do you eat each day?
- Have you started any new medications recently?
- Do you have a family history of digestive diseases, including colon cancer?
- What other medical conditions do you have?
After reviewing your medical history, your doctor will likely perform a physical exam. This may include a digital rectal exam. Your doctor may also order several tests and exams including:
- Anal sphincter testing, including tests to measure muscle strength and muscle speed
- Blood tests to check blood cell counts, electrolyte levels, and hormone levels, such as thyroid hormone
- Colonic transit study, which measures how well food moves through the colon
- Defecography testing, which uses imaging exams, such as X-ray or MRI, to visualize muscle function
- Internal examinations, including colonoscopy and sigmoidoscopy
- X-rays with contrast agents to check for intestinal blockages
It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.
How do you treat constipation?
If your constipation is not due to an underlying medical condition, treatment focuses on diet, lifestyle changes, and over-the-counter (OTC) medicines. If your doctor diagnoses a cause of constipation, treating it will be a vital part of relieving your bowel problems.
Medications for constipation
For occasional constipation, try these self-care medicines you can find at your local pharmacy:
- Fiber supplements, such as methylcellulose (Citrucel, others) or psyllium (Metamucil, others). These products add bulk or weight to your stool, which helps your body move stool and pass it.
- Lubricants, such as mineral oil, help stool pass more smoothly through your system.
- Osmotic laxatives, such as milk of magnesia or polyethylene glycol (Miralax, others), help your stool hold on to water, making it softer.
- Stimulant laxatives, such as bisacodyl (Dulcolax, others) and senna (Senokot, others), cause your intestines to contract, which moves stool.
- Stool softeners, such as docusate (Colace), pull water into the stool to make it easier to pass.
In general, you should reserve laxatives for constipation that hasn’t responded to any of the other products. You shouldn’t use a laxative for more than a week. Chronic use of laxatives can make constipation worse. Your body can become used to artificial stimulation and lose the ability to do it naturally.
If OTC medicines don’t relieve your constipation, a prescription medicine may be necessary including:
- Medicines to increase water in your intestines, including lubiprostone (Amitiza), linaclotide (Linzess), and plecanatide (Trulance)
- Peripherally acting mu-opioid receptor antagonists (PAMORAs), including naloxegol (Movantik) and methylnaltrexone (Relistor), if constipation is opioid-induced
- Serotonin 5-HT4 receptor agonists, including prucalopride (Motegrity), increases motility or movement of your colon
Lifestyle changes to treat constipation
There are three basic lifestyle changes that can aid in relieving and preventing constipation. They include:
- Getting regular physical activity. Exercising on most days of the week increases activity in your intestines. Be sure to talk with your doctor before starting an exercise routine.
- Increasing the fiber in your diet. Women should get 25 grams and men need 38 grams per day. But going too fast when you increase fiber can cause gas and bloating. So, gradually add fiber to your diet over a few weeks. Also, be sure to drink enough fluid as you increase fiber. Aim for 2 to 2.5 liters of water per day.
- Not ignoring the urge to go. When you respond to the urge, it reinforces the nerve reflex. Ignoring it can make it more difficult to go when you finally do.
Foods to relieve constipation
Getting enough fiber is a key part of relieving and preventing constipation. It’s also important not to skip meals and to avoid highly processed foods, like fast food, potato chips, and white bread. High-fiber foods include:
- Beans and legumes, including navy beans, garbanzo beans, soybeans, lentils, almonds and peanuts
- Fresh fruits, especially apples, berries, figs, pears, plums and prunes. Eat edible skins to get the most benefit.
- Fresh vegetables, especially broccoli, corn, peas, and potatoes with their skins
- Whole grain products, especially bran cereal and popcorn
Alternative treatments for constipation
Some people benefit from additional strategies to relieve constipation including:
- Bowel training involves developing a habit of moving your bowels at the same time each day. Eating a meal stimulates your colon to move. That’s why you shouldn’t skip meals when you’re constipated. It also provides a good tool to use to train your bowels. Try training your bowels to move within 15 to 45 minutes after breakfast or dinner.
- Biofeedback therapy retrains the muscles that control bowel movements. You work with a biofeedback therapist to identify these muscles and learn how to relax them to ease stool passage.
What are the potential complications of constipation?
In some cases, constipation can be caused by a serious condition of the gastrointestinal tract, such as bowel obstruction. It is important to contact your healthcare provider if you develop persistent constipation that lasts more than a few days.
Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:
- Peritonitis and shock from intestinal obstruction
- Rectal bleeding
- Rectal prolapse