Constipation

Constipation occurs when your bowel movements become less frequent and stools become difficult to pass. It happens most often due to changes in diet or routine, or due to inadequate intake of fiber. You should call a healthcare provider if you have severe pain, blood in your stool or constipation that lasts longer than three weeks.

What is constipation?

Having fewer than three bowel movements a week is, technically, the definition of constipation. But how often you poop varies widely from person to person. Some people poop several times a day while others only poop one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you — as long as you don’t stray too far from your pattern.

Regardless of your bowel pattern, one fact is certain: The longer you go before you poop, the more difficult it becomes for poop to pass. Other key features that usually define constipation include:

• Your stools are dry and hard.
• Your bowel movements are painful, and your stools are difficult to pass.
• You have a feeling that you haven’t fully emptied your bowels.

How common is constipation?

You’re not alone if you’re feeling constipated. Constipation is one of the most frequent gastrointestinal complaints in the United States. At least 2.5 million people see their healthcare provider each year due to constipation.

Symptoms and Causes

How does constipation happen?

Constipation happens because your colon (large intestine) absorbs too much water from your poop. This dries out your poop, making it hard in consistency and difficult to push out of your body.

To back up a bit, as food normally moves through your digestive tract, your intestines gradually absorb the nutrients. The partially digested food (waste) that passes from your small intestine to your large intestine becomes your poop. Your colon absorbs water from this waste, which makes it more solid. If you have constipation, food may move too slowly through your digestive tract. This gives your colon more time — too much time — to absorb water from the waste. The stool becomes dry, hard and difficult to push out.

What causes constipation?

There are many causes of constipation, including lifestyle factors, medications and medical conditions.

Lifestyle factors

Common lifestyle causes of constipation include:

• Not eating enough fiber.
• Not drinking enough water (dehydration).
• Not getting enough exercise.
• Changes in your regular routine, such as traveling or eating, or going to bed at different times.
• Consuming large amounts of milk or cheese.
• Stress.
• Resisting the urge to have a bowel movement.

Medications

Medications that can cause constipation include:

• Strong pain medicines, like narcotics containing codeine, oxycodone (Oxycontin®) and hydromorphone (Dilaudid®).
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
• Antidepressants, including selective serotonin reuptake inhibitors (like fluoxetine [Prozac®]) or tricyclic antidepressants (like amitriptyline [Elavil®]).
• Antacids containing calcium or aluminum, such as Tums®.
• Iron pills.
• Allergy medications, such as antihistamines (like diphenhydramine [Benadryl®]).
• Certain blood pressure medicines, including calcium channel blockers (like verapamil [Calan SR®], diltiazem [Cardizem®] and nifedipine [Procardia®]) and beta-blockers (like atenolol [Tenormin®]).
• Psychiatric medications, like clozapine (Clozaril®) and olanzapine (Zyprexa®).
• Antiseizure medications, such as phenytoin and gabapentin.
• Antinausea medications, like ondansetron (Zofran®).

Many drugs can cause constipation. Ask your healthcare provider or pharmacist if you have any questions or concerns.

Medical conditions

Medical and health conditions that can cause constipation include:

• Endocrine conditions, like underactive thyroid gland (hypothyroidism), diabetes, uremia and hypercalcemia.
• Colorectal cancer.
• Irritable bowel syndrome (IBS).
• Diverticulitis.
• Outlet dysfunction constipation. This is a defect in the coordination of your pelvic floor muscles. These muscles support the organs within your pelvis and lower abdomen. They’re needed to help release poop.
• Obstructed defecation syndrome. Complex or unexplained causes may be preventing you from pooping normally.
• Intestinal pseudo-obstruction. Sometimes, the motor system in your colon can become temporarily paralyzed (as in paralytic ileus or Ogilvie syndrome).
• Neurologic disorders, including spinal cord injury, multiple sclerosis, Parkinson’s disease and stroke.
• Lazy bowel syndrome. This is when your colon contracts poorly and retains poop.
• Intestinal obstruction.
• Structural defects in your digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus or malrotation).
• Multiple organ diseases, such as amyloidosis, lupus and scleroderma.
• Pregnancy.

What are the symptoms of constipation?

Constipation symptoms include:

• You have fewer than three bowel movements a week.
• Your stools are dry, hard and/or lumpy.
• Your stools are difficult or painful to pass.
• You have a stomachache or cramps.
• You feel bloated and nauseated.
• You feel that you haven’t completely emptied your bowels after a movement.

What are the risk factors for constipation?

People of all ages can have an occasional bout of constipation. But certain risk factors make people more likely to become consistently constipated (“chronic constipation”). These factors include:

• Age. People older than 65 are often less active, have a slower metabolism and have less muscle contraction strength along their digestive tract than when they were younger.
• Being assigned female at birth, especially constipation during pregnancy and after childbirth. Changes in your hormones may make you more prone to constipation. The fetus inside your uterus may squish your intestines, slowing down the passage of stool.
• Not eating enough high-fiber foods. Fiber keeps food moving through your digestive system.
• Taking certain medications.
• Having certain neurological (diseases of the brain and spinal cord) and digestive diseases.

Can constipation cause internal damage or lead to other health problems?

There are a few complications that could happen if you don’t have soft, regular bowel movements. Some complications include:

• Swollen, inflamed veins in your rectum (hemorrhoids).
• Tears in the lining of your anus from hardened stool trying to pass through (anal fissures).
• An infection in the pouches (diverticula) that sometimes form off your colon wall from stool that’s become trapped and infected (diverticulitis).
• A pile-up of too much poop in your rectum and anus (fecal impaction).
• Damage to your pelvic floor muscles from straining to move your bowels. These muscles help control your bladder, among other things. Too much straining for too long may cause urine to leak from your bladder (stress urinary incontinence).

Can constipation cause toxins to build up in my body and make me sick?

This usually isn’t the case. Although your colon holds on to stool longer when you’re constipated and you may feel uncomfortable, it’s an expandable container for your waste. It takes a severe illness in your colon for the walls to leak toxins into your body (toxic megacolon).

Diagnosis and Tests

What should I expect when I talk to my healthcare provider about my constipation?

Talking to a healthcare provider — or anyone — about your bowel movements (or lack of them) may not be the most pleasant of topics. But know that your provider is there for you. They’re a trained healthcare professional who’s discussed just about every health topic you can think of with their patients.

Your provider will begin by asking you questions about your medical history, bowel movements, lifestyle and routines.

Medical history

These questions may include:

• What are your current and past diseases/health conditions?
• Have you lost or gained any weight recently?
• Have you had any previous digestive tract surgeries?
• What medications and supplements do you take for constipation relief or other disorders?
• Does anyone in your family have constipation or diseases of the digestive tract or a history of colon cancer?
• Have you had a colonoscopy?

Bowel movement history

These questions may include:

• How often do you have a bowel movement?
• What do your stools look like?
• Have you noticed any blood or red streaks in your stool?
• Have you ever seen blood in the toilet bowl or on the toilet paper after you wipe?

Lifestyle habits and routines

• What do you eat on a typical day for each meal?
• How often do you eat fruits and vegetables?
• How much water do you drink?
• What is your exercise routine?

Your provider will also perform a physical exam, which includes a check of your vital signs (temperature, pulse, blood pressure). They’ll use a stethoscope to listen to the sounds in your abdomen. They’ll also touch your abdomen to check for pain, tenderness, swelling and lumps.

Be aware that your provider may also perform a rectal exam. This is a finger exam of the inside of your rectum. It’s a quick check for any masses or problems that can be felt by a finger.