Understanding Constipation: Symptoms, Causes, and Treatment
How To Deal With Constipation
If you’ve ever experienced constipation, you know just how uncomfortable this common condition can be. While most people will experience constipation from time to time over the course of their lives, the causes of the condition vary and are often misunderstood.
Preventing constipation by making healthy lifestyle choices can go a long way towards keeping your digestive tract running smoothly.
When it comes to understanding constipation, here’s what you need to know about the symptoms, causes, and treatment of this condition.
What is Constipation?
Constipation is a common health condition that occurs when people start to have less frequent bowel movements and experience difficulty passing stools. The condition occurs when people deviate from their normal pattern to have significantly fewer bowel movements than usual.
Officially, constipation is characterized as having a bowel movement three or fewer times per week, but everyone experiences the condition differently.
What is most important when diagnosing constipation is examining their current frequency of bowel movements compared to their normal frequency in order to determine if bowel movements are occurring less often. For example, some people may have multiple bowel movements on a daily basis while other people only have bowel movements a few times per week. Both groups can experience constipation, but it will be marked by different bowel movement frequencies
According to the Cleveland Clinic, more than 2.5 million people seek medical attention every year because of constipation, making it one of the most common digestive issues in the United States.
Millions more never visit a healthcare provider for the condition and instead pursue over the counter treatment like to experience relief from their symptoms. Constipation can affect people of all ages, races, and genders, and while anyone can experience constipation at any time, some people are more likely to experience the condition than others and may find that they regularly have difficulty passing stools.
Risk factors for chronic constipation include:
- Gender. Hormonal fluctuations in women mean that females are more likely to experience constipation than men. Hormonal shifts can occur throughout the month during the menstrual cycle as well as during major life changes like pregnancy, menopause, and the post-partum period. Pregnant women are highly at risk of experiencing constipation because a growing baby can compress the intestines, which makes it difficult for stool to pass.
- Age. As we age, most people naturally become less active and experience a slower rate of metabolism. Our muscles weaken throughout our bodies, including the muscles of the digest tract, which makes it more challenging for us to pass stools. As a result, people’s chances of experiencing constipation increase with age.
- Dietary choices. The body relies on the fiber that is naturally found in a healthy, well-balanced diet to help keep food moving through the digestive system. Fiber is found naturally in foods like fruits, vegetables, whole grains, and lentils, so people who eat diets that are full of processed foods and are low in fiber are more likely to experience constipation.
- Medical conditions. Certain neurological issues, including diseases of the brain and spinal cord, and certain digestive disorders put people at a higher risk of experiencing chronic constipation.
What Are Some Common Symptoms of Constipation?
While many people understand that constipation means going to the bathroom less often than usual or not going to the bathroom at all, there are a number of other symptoms that may occur simultaneously.
Common symptoms of constipation include:
- Having fewer than three bowel movements per week
- Stools that are difficult or painful to pass
- Feelings of bloating and nausea
- Stools that are hard, dry, or lumpy
- Feelings of a stomach ache or cramps
- Feeling like you have not completely emptied your bowels after having a bowel movement.
How Does Constipation Occur?
There are many different reasons why constipation can occur, but the process by which constipation occurs is the same regardless of the cause.
After you eat a meal, the food starts to move through the digestive tract. Food starts to be broken down in the stomach and then enters the small intestine, where nutrients are absorbed from the food and into the body.
When a person has constipation, food moves slowly through the digestive tract for a variety of reasons.
Constipation occurs when the large intestine, also known as the colon, absorbs more water from the stool than it is supposed to as a result of the slow movement of waste through the digestive tract. As a result, stool becomes harder and can be difficult or painful to expel from the body.
What Causes Constipation?
Constipation is a common medical issue that can be caused by many different factors; some people may experience constipation as a result of a combination of issues. However, the causes of constipation typically fall into three different categories: medical conditions, lifestyle choices, and medications.
Medical conditions that are known to cause constipation include:
- A blockage in the intestines (bowel obstruction)
- Irritable bowel syndrome (IBS)
- Certain types of pelvic floor dysfunction
- Endocrine disorders, such as thyroid disease and diabetes
- Inability to relax the pelvic muscles and allow for a bowel movement to occur (anismus)
- Small tears in the skin around the anus (anal fissure)
- Colorectal cancer
- Narrowing of the colon (bowel stricture)
- Lazy bowel syndrome
- Structural defects in the digestive system, such as fistula
- Pelvic muscles that do not properly coordinate relaxation and contraction (dyssynergia)
- Neurological problems, such as Parkinson’s disease, spinal cord injury, stroke, multiple sclerosis, or damage to the nerves that control bodily functions (autonomic neuropathy)
- Abdominal cancer that presses on the colon
- Weakened pelvic muscles
- Intestinal obstruction
- Diverticulitis and other diverticular diseases
- Rectal cancer
- Multiple organ diseases, such as lupus or scleroderma
- Rectum bulge through the back wall of the vagina (rectocele)
As a result, you may need to seek medical attention in severe cases if you experience the following:
- Anal fissure: Tears in the lining of your anus from hardened stool trying to pass through
- Rectal prolapse: Part of the rectum sticks out through the anus.
While medical conditions are usually associated with chronic constipation, lifestyle choices can affect either chronic or acute constipation. In fact, most people experience constipation due to lifestyle choices rather than medical conditions or the use of medications.
Because our digestive systems are highly sensitive, anything can slightly disrupt your system and cause constipation.
Common lifestyle choices that are known to cause constipation include:
- Undergoing changes to your daily routine, such as eating different foods, going to bed at a different time, or changing time zones as a result of traveling
- Eating a diet that does not contain enough fiber
- Not getting enough exercise or activity throughout the day
- Eating larger than normal servings of dairy products such as milk or cheese
- Experiencing stress
- Avoiding having a bowel movement when you need to go
Many medications, including prescription medications and over the counter drugs, list constipation as a common side effect. Regardless of whether you are taking medication daily for control of a medical condition or you occasionally need to take an over the counter remedy for an illness or injury, you can experience constipation as a side effect.
Drugs that are commonly known to cause constipation include:
- Narcotic pain medications and opioid drugs such as hydrocodone, oxycodone, or codeine
- Blood pressure medications, including calcium channel blockers like diltiazem (Cardizem) and beta-blockers like atenolol (Tenormin)
- Antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs) like escitalopram (Lexapro) and tricyclic antidepressants like amitriptyline (Elavil)
- Anticonvulsant/seizure medications, such as gabapentin (Neurontin)
- Iron supplements
- Antacid medications that contain ingredients like calcium or aluminum
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
- Psychiatric medications
- Allergy medications
- Antinausea drugs, such as Zofran
What Are Some Common Complications of Chronic Constipation?
Constipation that is experienced on an occasional basis usually does not result in complications. However, people who experience constipation chronically can experience potentially serious health consequences if they do not receive medical treatment.
Potential complications of chronic constipation include:
- The development of hemorrhoids, or swollen veins, in and around the anus as a result of straining to have a bowel movement.
- Fecal impaction, a condition in which hardened stool gets stuck in the intestines and cannot be expelled.
- The development of anal fissures, or torn skin in the anus, as a result of large or hard stool attempting to pass.
- Rectal prolapse, a condition in which a portion of the intestine protrudes from the anus as a result of straining to have a bowel movement.
How Can You Treat Constipation?
Regardless of whether your constipation is caused by medical issues, lifestyle choices, or the use of certain medications, experiencing the condition can range from being uncomfortable and inconvenient to excruciatingly painful.
When you experience constipation, you want relief quickly, and there are a number of different ways to treat the condition.
The majority of people experiencing occasional constipation experience the condition as a result of their lifestyle, which means that control of the condition often rests with the individual.
One of the most effective ways to improve constipation symptoms is by making simple lifestyle changes, including:
Increasing your level of physical activity.
Constipation most commonly occurs in people who do not get much physical activity throughout the day. As any endurance athlete can tell you, working out increases the muscle activity in the digestive tract, encouraging you to go to the bathroom more frequently. Working out regularly, or even simply walking more throughout the day and incorporating gentle forms of movement, increases muscle activity in your digestive tract and helps to move stool along more quickly, helping to reduce symptoms of constipation and encourage your body to have a bowel movement.
Changing your eating habits and increasing the grams of fiber you get from whole foods.
Constipation is strongly linked to the foods that we eat, and it is estimated that only about five percent of the population in the United States actually receives enough dietary fiber as part of their daily diet. Dietary fiber, also known as roughage or bulk, is made up of the components of plants that cannot be readily digested or absorbed by the body. Because fiber is not digestible, it helps move food and waste move through the intestines and out of the body. Fiber increases the bulk and weight of your stool and makes it easier to pass. Fortunately, getting more fiber into your diet is relatively simple, as there are many common foods that are high in fiber, including whole grains, whole cereals, wheat bran, fruits, vegetables, beans, and more.
Drinking more water.
Dehydration, or not drinking enough water, is a common cause of constipation. Fortunately, that’s relatively simple to fix: drink plenty of fluids throughout the day and increase your intake of foods that have a high water content, such as fruits, vegetables, and prune juice. If you’re constipated, avoid consuming a lot of diuretics such as grapes or coffee, which can further dehydrate you.
Having better bowel habits.
If you’re wondering how you can possibly train yourself to have better bowel habits, you’re not alone. Believe it or not, bowel movements don’t just happen automatically, and there are things you can do in order to ensure that your body is able to relieve itself completely. If you are constantly rushing yourself to have a bowel movement, try simply taking the time to have a bowel movement when you feel the urge. This simple step alone can help relieve feelings of constipation and can encourage complete emptying.
If you are the parent of a child who has a fear of using the toilet or having a bowel movement, this can be challenging. However, you can encourage them to have bowel movement by giving the child plenty of time and not rushing them.
Over the Counter Treatments
Lifestyle changes can go a long way towards relieving symptoms of constipation and preventing future episodes, but sometimes, you need relief more quickly. In this case, over the counter treatments in the form of laxatives may be able to help.
A trip to your local pharmacy will quickly demonstrate that there are many different types and brands of laxatives on the market, so it is important to know the differences between these drugs and which can contain harsh ingredients that cause unpleasant side effects.
Laxatives fall into six primary categories, each of which works differently to treat constipation. The six types of laxatives include stimulant laxatives, emollient laxatives, lubricant laxatives, bulk-forming laxatives, suppository laxatives, and hyperosmotic laxatives.
Stimulant laxatives work by encouraging the muscles of the bowels to contract, which causes stool to move through the intestines more quickly. Stimulant laxatives contain active ingredients that cause the muscles in the bowels to contract, including senna, bisacodyl, and sodium picosulphate.
Stimulant laxatives are one of the fastest acting types of laxatives; they generally start working within approximately 6 to 12 hours. Stimulant laxatives are very common and can be found in both prescription drugs and over the counter medications.
Emollient laxatives are a type of laxative that work more slowly than other categories of laxatives. Commonly referred to as stool softeners, this type of laxative works by bringing water into the stool, which makes it softer. Soft, hydrated stool is more easily passed through the bowels, which means that constipation is less likely to occur and is relieved.
Emollient laxatives typically take between 12 and 72 hours to start working, so patients who are experiencing severe constipation may need to take a different type of laxative in order to find quick relief. Emollient laxatives commonly contain an active ingredient called docusate.
Lubricant laxatives do not contain any type of medication. Instead, lubricant laxatives contain ingredients that function as lubricants, such as mineral oil and other types of oil. Lubricant laxatives coat the stool in a slippery waterproof film that helps keep moisture inside the stool. As a result, the stool becomes softer and easier to pass, helping it to move more easily through the bowel.
Lubricant laxatives typically start to work in about six to eight hours, so they work quickly to relieve symptoms of constipation.
Bulk-forming laxatives act like dietary fiber that is obtained from the foods that we eat each day. Like dietary fiber, bulk-forming laxatives help to relieve the symptoms of constipation by drawing water into the bowels and stool. As more water enters the stools and bowel, the stool starts to soften and become larger, which makes it easier to pass. Stools that typically form when a person is constipated are usually small, hard, and difficult to pass, but constipation is often relieved when bulk is added to the stools.
Bulk-forming laxatives are one of the more slow acting types of laxatives, which means they are not appropriate for the treatment of severe constipation. However, they are a relatively gentle laxative because they act slowly. Bulk-forming laxatives commonly contain active ingredients that include psyllium, methylcellulose, and sterculia.
Most people will notice some effects of bulk-forming laxatives after 12 to 24 hours, while receiving full effect from this type of laxative may take 48 to 72 hours. Bulk-forming laxatives should not be used as a replacement for eating a healthy, balanced diet that contains plenty of natural dietary fiber, which can help prevent constipation.
Suppository laxatives are the most appropriate for use in situations of extreme constipation, as they are the fastest acting type of laxative, typically taking effect within as little as 15 to 30 minutes.
While most laxatives are taken orally, suppository laxatives are inserted into the rectum. Suppository laxatives deliver medication rapidly into the bowels because the active ingredients are absorbed directly from the intestines and into the bloodstream and muscles of the bowels.
The active ingredients that are most commonly included in suppository laxatives include bisacodyl and glycerol. These ingredients can help to relieve constipation by either softening the stool, making it easier to pass through the bowel, or stimulating the muscles of the bowels to contract and pass stool more quickly.
The amount of time that it takes for a hyperosmotic laxative to work depends on the active ingredient in the medication. Regardless of the active ingredient that is used, hyperosmotic laxatives work by increasing the amount of fluid that is in the bowels. The increased amount of fluid in the bowel contributes to softening the stool, which makes it easier to pass and expel from the body.
Hyperosmotic laxatives can be made from active ingredients that include:
Saline hyperosmotic laxatives use a salt water solution to treat constipation. Saline hyperosmotic laxatives are a fast acting type of laxative that typically starts to work in anywhere from 30 minutes to 3 hours. As a result, saline hyperosmotic laxatives are best suited for the short term treatment of occasional constipation.
Lactulose hyperosmotic laxatives contain an active ingredient called lactulose, which is a sugar-like compound. This type of laxative is slower acting than some other forms of hyperosmotic laxatives and typically begins to take effect in a period of 48 to 72 hours. Patients who are experiencing chronic, or long-term, constipation may benefit from taking a lactulose hyperosmotic laxative, as they are gentle and helpful in preventing the condition from occurring.
The active ingredient in polymer hyperosmotic laxatives is polyethylene glycol, which consists of large molecules that help bring water into the stool to help soften and enlarge the stool, making it easier to pass. Polymer hyperosmotic laxatives generally start to work in about six or more hours, making them well suited to the short term treatment of acute constipation.
Although over the counter laxative treatments can be an effective way to relieve the symptoms of constipation, many commercial laxatives include commonly used artificial inactive ingredients that may contain harsh chemicals or additives that can cause an adverse reaction.
Are There Any Risks Associated With Laxative Use?
Although a variety of different types of laxatives are available over the counter, over the counter medications are still associated with risk, particularly for patients who have medical conditions or sensitivities to certain ingredients.
In order to minimize your risk of experiencing side effects, make sure that you follow all of the instructions on the label of your medication.
Risks associated with laxative use include:
- Interactions with other medications
- Decreased bowel motility
- Pregnancy and breastfeeding considerations
- Dehydration and/or electrolyte imbalance
Interactions with other medications
Regardless of whether an over the counter laxative contains natural or synthetic ingredients, it is possible that the medication can interact with other over the counter and prescription medications that a patient is using simultaneously.
While natural ingredients are less likely to cause adverse effects than certain types of synthetic ingredients, it’s best to check with your doctor or pharmacist prior to using laxatives. Antibiotics and heart medications in particular are known to interact with laxatives.
Decrease in bowel motility
It’s normal to struggle with occasional constipation at various points throughout your lifetime, but patients who experience chronic constipation may use laxatives too frequently. People who use laxatives too often can experience a decrease in bowel motility, which is a type of dysfunction that affects the natural movement of the bowels.
The body can become reliant on laxatives when they are used too frequently, which ultimately can cause long term damage to the bowels. If you experience chronic constipation or start to have constipation more often, talk to a doctor about how to use laxatives appropriately.
Pregnancy and breastfeeding considerations
As a fetus grows, it may press on a woman’s bowels, preventing the passage of stool through the digestive tract and causing constipation. Although constipation is common among pregnant women, the use of laxatives is not always safe during pregnancy.
Women who are experiencing constipation during pregnancy should speak to their doctors before using laxatives, as not all types of laxatives are safe for use in pregnant women.
Women who are breastfeeding are generally able to use laxatives safely, but certain laxative ingredients can pass through breast milk to a nursing baby, potentially causing diarrhea. If you’re breastfeeding, talk to your doctor before using laxatives.
Dehydration or electrolyte imbalance
Laxatives can contribute to dehydration because they work by drawing water from different parts of the body into the bowels in order to soften the stool. As a result, people who use laxatives but do not drink enough water while taking the medication may experience dehydration or electrolyte imbalance.
In addition to helping prevent dehydration while using laxatives, drinking lots of water throughout the day can also help prevent constipation from occurring to begin with. Therefore, focusing on your hydration is extremely important.
When Should You See a Doctor About Constipation?
Although constipation can usually be safely treated at home, there may come a point where you need to seek medical attention.
If you experience constipation for a period of three weeks or more, make sure to get a check-up just to ensure that you don’t have a medical condition that could be causing the problem.
Also see your doctor if:
- You have stomach pain
- You've never been constipated before now
- You're losing weight without trying
- You've noticed blood in your stools
Occasional constipation is usually not dangerous, but letting constipation go untreated for an extended period of time can cause potentially uncomfortable health consequences like hemorrhoids, rectal prolapse, and more.
When you visit the doctor for constipation, your doctor may perform an exam in order to determine the cause of your constipation. During the exam, the doctor may insert a gloved, lubricated finger into your anus to check for a blockage or blood, which can be a sign of a more serious medical condition. You may also have tests to rule out conditions that can cause constipation.
Depending on the findings of the exam, your doctor may request that you have additional tests done. These tests may include a barium enema X-ray, sigmoidoscopy, or colonoscopy. If your doctor orders these types of diagnostic tests, they are looking for problems in your digestive tract that could be contributing to your constipation.
After your doctor has diagnosed the cause of your constipation, you will likely be presented with your treatment options. Depending on the cause of your condition, your doctor may recommend simple at-home remedies like adding more fiber to your diet and taking laxatives. If you have an underlying medical condition that is contributing to your constipation, treating the condition may help to resolve your constipation.
While undergoing treatment for constipation, make sure to stay connected to your doctor and keep them apprised of your progress. If one treatment isn’t working, you may need to switch to another. It’s possible to become dependent on laxatives and need them to have a bowel movement. If this occurs, your doctor may have to wean you off laxatives to get your digestive tract functioning properly again.
Constipation is generally triggered by medical conditions, lifestyle choices, or the use of certain medications that are known to cause constipation as a side effect. If you find yourself experiencing back pain that you think may be related to constipation, reach out to your doctor.
While anyone can experience constipation, women, older adults, and people with certain medical conditions are more likely to experience the condition on a regular basis.
Constipation can usually be treated at home with the use of over the counter laxatives, and the condition can often be prevented by making healthy lifestyle choices like incorporating more dietary fiber into your daily diet, drinking plenty of water, and increasing your activity level.