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Relieving Chronic Constipation

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Constipation: Prevention, Causes, and Treatment

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Constipation can occur due to mild to moderate conditions, such as a poor diet, dehydration, pregnancy, or hemorrhoids. Serious and life threatening causes of constipation include colon cancer and bowel obstruction. 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. Constipation is also defined as having stools that are hard or dry, stools that are difficult to pass and require increased straining, or a feeling that you have not fully evacuated your bowels even if you go more than three times a week.

When you are constipated, you may 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 happens due to food moving too slowly through the colon, or it can occur when the colon absorbs too much water from digested food as it forms stool.

This article will explain how to prevent constipation and what can cause it. It will also give treatment options for constipation.

How can I prevent constipation?

a woman is holding a hot water bottle to her stomach
vgajic/Getty Images

You may be able to prevent some instances of constipation through lifestyle and dietary changes.

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
  • increasing the fiber in your diet
  • paying attention to the urge of having a bowel movement

Foods to relieve constipation

Getting enough fiber is a key part of relieving and preventing constipation. It is 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, navy beans, garbanzo beans, soybeans, lentils, almonds, and peanuts
  • fresh fruits, apples, berries, figs, pears, plums, and prunes with edible skins to get the most benefit
  • fresh vegetables, broccoli, corn, peas, and potatoes with their skins
  • whole grain products, including bran cereal and popcorn

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 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
  • delayed bowel movements (ignoring the urge to have a bowel movement)
  • lack of physical activity
  • low fiber diet
  • not drinking enough fluids
  • pregnancy
  • 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)
  • colorectal cancer
  • 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 (due to a neurological birth defect that leads to severe constipation and intestinal obstruction in newborns and infants)
  • irritable bowel syndrome (IBS)
  • pelvic floor dysfunction

Other causes of constipation

Constipation can happen due to some neurological, metabolic, and other conditions, including:

  • depression
  • diabetes (chronic condition that affects your body’s ability to use sugar for energy)
  • eating disorders
  • hypercalcemia (high blood calcium)
  • 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
  • stroke
  • 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 happen because of certain medications, including:

  • anesthetics
  • antacids that contain calcium and aluminum
  • anticonvulsants
  • antidepressants
  • calcium channel blockers for high blood pressure
  • diuretics
  • iron supplements
  • laxative abuse
  • narcotics
  • Parkinson’s disease medications
  • tranquilizers

Learn more about what the causes of constipation are here.

When should you contact 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 is 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:

  • Your constipation has lasted longer than 14 days.
  • 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. However, 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
  • confusion, fainting, loss of consciousness, or seizures
  • difficulty breathing or other breathing problems
  • high fever
  • 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

Learn more about when to contact a doctor for constipation here.

How is the cause of constipation diagnosed?

After reviewing your medical history, your doctor will likely perform a physical exam and listen to sounds in your bowel. If your constipation does not resolve with first-line treatments or in special circumstances, 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 doctor 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) medications. 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 options that you can find at your local pharmacy:

  • fiber supplements
  • lubricants, such as mineral oil
  • osmotic laxatives, such as milk of magnesia
  • stimulant laxatives, such as bisacodyl
  • stool softeners, such as docusate (Colace)

In general, you should reserve laxatives for constipation that has not responded to any of the other products. You should not use a laxative for more than a short time or having significant abdominal pain, nausea, or vomiting. 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 medications do not relieve your constipation, a prescription drug 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), which increase motility or movement of your colon

Alternative treatments for constipation

Some people benefit from additional strategies to relieve constipation, including:

  • Bowel training: This involves developing a habit of moving your bowels at the same time each day. Eating a meal stimulates your colon to move. That is why you should not skip meals when you are constipated. It also provides a good tool to use to train your bowels. Try training your bowels to move within 15–45 minutes after breakfast or dinner.
  • Biofeedback therapy: This 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.

Learn more about treatments for constipation here.

What are the potential complications of constipation?

In some cases, constipation can be due to a serious condition of the gastrointestinal tract, such as bowel obstruction. It is important to contact your physician 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:

  • anal fissure
  • fecal impaction
  • hemorrhoid
  • peritonitis and shock from intestinal obstruction
  • rectal bleeding
  • rectal prolapse

Summary

When you are constipated, you may 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 or feel you have not fully emptied your bowels even if you pass stool more than three times a week.

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 has any of these symptoms.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Jul 26
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