Constipation
Also known as: Chronic constipation, Functional constipation, Irregular bowel movements
Constipation means having bowel movements that are infrequent, hard, or difficult to pass. There is no single 'normal' frequency, but fewer than three bowel movements a week, straining, hard lumpy stools, or a feeling of incomplete emptying all count. Almost everyone experiences it occasionally, often because of a change in diet, travel, or routine, and it usually settles quickly. Chronic constipation, lasting weeks or months, is also very common, particularly in older adults, women, and people who are inactive or take certain medications. Most cases respond to more fiber, fluid, and movement, with laxatives as a backup, but a sudden change in bowel habit in an adult over 50, or constipation with bleeding or weight loss, should always be checked.
At a Glance
- Common symptoms
- Fewer than three bowel movements a week, Hard, dry, or lumpy stools, Straining or pain when passing stool
- Main treatments
- Gradually increasing dietary fiber to 25 to 30 grams a day from fruit, vegetables, whole grains, and legumes, with enough fluid, Bulk-forming (psyllium), osmotic (polyethylene glycol, lactulose, magnesium), or stimulant (senna, bisacodyl) laxatives as advised by a pharmacist or doctor, Prescription medications such as prucalopride, linaclotide, or lubiprostone for chronic constipation that does not respond to laxatives
- Category
- Digestive · Very common at all ages; among the most frequent digestive complaints seen in primary care
- See a doctor if
- Constipation lasting more than three weeks despite diet and lifestyle changes
Symptoms
Causes
- A diet low in fiber and fluid
- Lack of physical activity and ignoring the urge to go
- Medications such as opioids, iron tablets, some antidepressants, antacids containing aluminum or calcium, and blood pressure drugs
- Slow transit through the colon or problems coordinating the pelvic floor muscles
- Conditions such as hypothyroidism, diabetes, Parkinson's disease, multiple sclerosis, or irritable bowel syndrome
- Less commonly, a blockage from a narrowing, tumor, or severe hemorrhoids and fissures that make passing stool painful
Risk Factors
- Older age
- Female sex, pregnancy, and the weeks after childbirth
- Low-fiber diet and dehydration
- Sedentary lifestyle or being bedbound
- Taking several medications, especially opioids
- Anxiety, depression, or a history of eating disorders
Diagnosis
- A history of bowel habits, diet, medications, and any warning symptoms, plus a physical and often a rectal examination
- Blood tests for thyroid function, calcium, blood count, and diabetes when indicated
- Colonoscopy if there are red flags such as bleeding, weight loss, anemia, or new symptoms over age 45 to 50
- Colonic transit studies or anorectal manometry for chronic constipation that does not respond to standard treatment
- Balloon expulsion testing to check for pelvic floor dysfunction
Treatment
- Gradually increasing dietary fiber to 25 to 30 grams a day from fruit, vegetables, whole grains, and legumes, with enough fluid
- Bulk-forming (psyllium), osmotic (polyethylene glycol, lactulose, magnesium), or stimulant (senna, bisacodyl) laxatives as advised by a pharmacist or doctor
- Prescription medications such as prucalopride, linaclotide, or lubiprostone for chronic constipation that does not respond to laxatives
- Reviewing medications that cause constipation with your prescriber; never stop them on your own
- Pelvic floor physiotherapy and biofeedback when the muscles do not relax properly
- Supportive: regular physical activity, a consistent toilet routine (often after breakfast), and using a footstool to raise the knees while on the toilet
- Supportive: prunes, kiwifruit, and ground flaxseed have reasonable evidence for softening stool and improving frequency
Prevention
- Eat plenty of fiber-rich foods every day
- Drink enough fluid, especially when increasing fiber
- Stay active; even a daily walk helps bowel movement
- Go to the toilet when you feel the urge rather than holding on
- Establish a regular, unhurried toilet routine
- Ask about preventive laxatives if you are prescribed opioids
When to See a Doctor
- Constipation lasting more than three weeks despite diet and lifestyle changes
- Blood in the stool, black stools, or unexplained weight loss
- A sudden change in bowel habit, especially if you are over 50
- Severe abdominal pain, vomiting, or inability to pass gas (possible bowel obstruction, emergency)
- Constipation alternating with diarrhea, or persistent thin, pencil-like stools
Frequently Asked Questions
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