What Is Constipation? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually. (1) Generally, a person is considered constipated when they have fewer than three bowel movements a week or their stool is difficult to pass. In total, about 16 percent of the population experience constipation symptoms. (2)

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 greatly from person to person — some people may pass stool several times a day; others once or twice a week. Constipation, like other symptoms, becomes an issue when it is distressing or bothersome to the patient and interfering with their day-to-day life.

Symptoms of constipation may also include the following: (2,3)

• Lumpy, dry, or hard stools
• Stools that are hard or painful to pass
• Feeling as though there’s a blockage in your rectum that keeps you from having bowel movements
• Feeling as though you can’t completely empty your stool
• Needing 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. (3)

Learn More About Signs and Symptoms of Constipation: Constipation Symptoms

The GI tract, which consists of a series of hollow organs stretching from your mouth to your anus, is responsible for digestion, nutrient absorption, and waste removal.

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. These include: (2)

• Delayed emptying of the colon caused by pelvic floor disorders and colon surgery
• Gastrointestinal disorders, such as irritable bowel syndrome
• Certain 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 in 2015, 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 fiber
• Dehydration or not drinking enough liquids in general
• Lack of exercise
• Habitually ignoring the urge to go
• Heavy 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 syndrome
• Tumors or other obstructions
• Celiac disease
• Colon polyps
• Multiple sclerosis
• Diabetes
• Hypothyroidism
• Parkinson’s disease
• Stroke
• Nerve damage

Although constipation can affect anyone, you’re at highest risk if you are: (3)

• A woman
• An 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.

Your doctor will take a medical history and do a physical exam, which in some cases may include a gentle rectal exam with a gloved and lubricated finger.

The medical history will cover details about any medications or drugs you are taking, since drug interactions are a leading cause of constipation. (1) Your doctor will also talk to you about your diet to ensure you are drinking enough water and fiber, as well as about your level of physical activity. A lack of any of these can also be a contributor to constipation.

Depending on the severity and duration of the constipation, as well as any other associated symptoms, they may also prescribe a number of routine blood tests (to look for hypothyroidism, for instance), as well as urine and stool tests. Other diagnostic tests may include a colonoscopy, a sigmoidoscopy, and in rare cases, imaging tests. (3)

But these tests typically are only done if initial lifestyle interventions — like increases in water and fiber intake and physical activity — do not first resolve the constipation.

A patient checklist of questions can also be helpful in the diagnosis, and especially to gauge the severity, duration, and appropriate options for additional tests and treatment:

1. Is it painful to poop?
2. Am I having to strain or use manual assistance to help get the poop out?
3. Is there bright red blood coming out with my stool when I poop?
4. Am I noticing any other concerning or new symptoms — for example, fatigue, hair loss, or sensitivity to cold?
5. Have I tried lifestyle changes like increased fiber, warm water with lemon, Metamucil, and increased water intake?
   

It’s perfectly normal to have the occasional short-term bout of constipation. But if it lasts for several weeks at a time, it’s considered chronic. (3) (If the problem lasts longer than three weeks, it makes sense to see your doctor.) (5) A 2018 review of medical literature found that 16 percent of people complain of chronic constipation. (6)

As upsetting and uncomfortable as constipation can be, there are a number of lifestyle changes, including diet, exercise habits, and even switching up certain supplements that can prevent constipation from happening in the first place.

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.

Other nonprescription options include: (2)

• Fiber supplements, such as psyllium (Metamucil)
• Osmotic agents, such as polyethylene glycol 3350 (Miralax)
• Stool softeners, such as docusate (Colace)
• Lubricants (like mineral oils)
• Stimulants, such as Correctol

But note: 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. Your doctor may choose to prescribe one of the following: (2)

• lubiprostone (Amitiza), which is prescribed to increase fluid in your digestive tract and increase frequency of bowel movements
• Medicines that encourage regular bowel movements, such as linaclotide (Linzess) 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 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 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), and drinking plenty of water may help prevent constipation. (2) Bonus: A 2019 review of studies 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.

Constipation is most often acute, meaning that it appears suddenly — say, when you’re traveling — and lasts for only a short time. But when it becomes chronic, pay attention, and see your doctor, because chronic constipation can cause complications, including:

• 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 tightly
• Rectal prolapse (a condition in which part of the rectum sticks out of the anus)

RELATED: What Are Hemorrhoids?

The major risk factors for chronic constipation are being female and being elderly. (10) (Elderly is usually defined as older than 65.) Other studies suggest that constipation seems to be getting more common. A 2014 study found that, from 1997 to 2010, the incidence of constipation among patients released from a hospital stay more than doubled, from 21,190 patients to 48,450. (11)

Besides being a drain on well-being, constipation is also a drain on the medical system: In a study published in 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 2019, 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)

Constipation can be a symptom of a number of conditions, including the following: (5)

• Hypothyroidism
• Colorectal cancer
• Diverticular disease
• Diabetes
• Irritable bowel syndrome (IBS)
• An intestinal obstruction
• Neurological disorders including multiple sclerosis and Parkinson’s disease
• A defect in the digestive tract
• Pregnancy

The National Institute of Diabetes and Digestive and Kidney Diseases offers a wealth of information on constipation and other digestive disorders, as does the American College of Gastroenterology.

A number of major medical centers offer advice and information about constipation on their websites, including:

• Johns Hopkins Medicine
• Mayo Clinic
• UCSF Health
• Cleveland Clinic