According to the National Institute of Diabetes and Digestive and Kidney Diseases, constipation is one of the most common digestive problems in the U.S, with more than four million Americans every year complaining of frequent constipation. (NIDDKD, 2012) Frequent constipation is commonly defined as having bowel movements fewer than three times a week and with hard, dry stools.
Your colon’s job is to absorb water and salt from food as it’s passing through your digestive system. It then creates stool (waste). The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stools remain in the colon too long, they can become hard and difficult to pass.
Poor diet frequently causes constipation, since dietary fiber and adequate water intake are necessary to help keep stools soft. Fiber-rich foods are plant foods that your body is not able to digest. Fiber comes in two forms: soluble and insoluble. The soluble fiber can dissolve in water, and it creates a soft, gel-like material as it passes through the digestive system. Insoluble fiber retains most of its structure as it goes through the digestive system.
Fiber is very helpful in easing constipation, as both forms of the fiber join with the dry, hard stools—increasing their weight and size while also softening the stools, making it easier for them to pass through the rectum.
Changes in routine, stress, and other conditions that slow muscle contractions of the colon or delay your urge to “go” may also lead to constipation.
Common Constipation Causes
- low-fiber diet (particularly diets high in meat, milk, or cheese)
- lack of exercise
- delaying the impulse to have a bowel movement
- travel or other changes in routine
- certain medications, such as antacids and pain medications
Underlying Medical Problems That Can Cause Constipation
- certain diseases, such as stroke, Parkinson’s disease, diabetes, and lupus
- problems with the colon or rectum, including intestinal obstruction, irritable bowel syndrome, or diverticulosis
- overuse or misuse of laxatives (medications to loosen stools)
- hormonal problems, including an underactive thyroid gland
- anal fissures (tears) or hemorrhoids
Every person’s definition of “normal” bowel movements may be different. Some individuals go three times a day, while others go three times a week. However, you may be constipated if you experience the following symptoms:
- fewer than three bowel movements a week
- passing hard, dry stools
- straining or pain during bowel movements
- a feeling of fullness, even after having a bowel movement
- experiencing a rectal blockage
Eating a poor diet and not exercising are major risk factors for constipation. However, you may be at greater risk if you are:
- 65 or older: Older adults tend to be less physically active, may have underlying diseases, and may eat poorer diets that lead to constipation.
- confined to bed: Those who have certain medical conditions, such as spinal cord injuries, often have difficulty with bowel movements.
- a woman or a child: Women have more frequent episodes of constipation than men, and children are more often affected than adults.
- pregnant: Hormonal changes and pressure on your intestines from your growing baby can lead to constipation.
Many people affected by constipation choose to self-treat by changing their diets, increasing their exercise, or using over-the-counter laxatives. However, laxatives should not be used for more than two weeks without consulting a physician because your body can become dependent on them for colon function.
You should talk to your general or family practitioner if:
- you have had constipation for more than three weeks
- you have blood in your stool
- you are experiencing pain during bowel movements
- you are losing weight
- you have sudden changes in your bowel movements
Your doctor will ask questions about your symptoms, medical history, and any medications or underlying medical conditions. A physical examination may include a rectal exam and blood tests to check your thyroid function.
In severe cases, additional tests may be required to identify the cause of your symptoms. These may include:
- An examination of how food is moving through your colon, called a marker study or colorectal transit study. For this test, you will swallow a pill that contains tiny markers that will show up on an X-ray. Numerous abdominal X-rays will be taken over the next few days so the doctor can visualize how the food is moving through your colon and how well the intestinal muscles are working. You may also be asked to eat a diet high in fiber during the test.
- An examination of the anal sphincter muscle function, called an anorectal manometry. For this test, your doctor will insert a thin tube with a balloon-tip into your anus. When the tube is inside, the doctor will then inflate the balloon and slowly pull it out. This test allows him or her to measure your anal sphincter’s muscle strength and see if your muscles are contracting properly.
- An examination of the colon with a barium enema X-ray. For this test, you will drink a special liquid the night before the test to clean out the bowel. The actual test involves the insertion of a dye called barium into your rectum, using a lubricated tube. The barium highlights the rectum and colon area, allowing the doctor to better view them on an X-ray.
- An examination of the colon with a colonoscopy. In this test, your doctor will examine your colon using a tube that is outfitted with a camera (colonoscope). A sedative is often given, so you will feel no pain. To prepare for this test, you will be on a liquid-only diet for one to three days, and may have to take a laxative or enema the night before the test.
Changing your diet and increasing your physical activity level are the easiest and fastest ways to treat and prevent constipation. Try the following techniques as well:
- Every day, drink 1.5 to 2 quarts of fluids, such as water or juice, to hydrate the body.
- Limit consumption of alcohol and caffeinated drinks, which cause dehydration.
- Add fiber-rich foods to your diet, such as raw fruits and vegetables, prunes, or bran cereal. Your daily intake of fiber should be between 20 and 35 grams.
- Cut down on low-fiber foods, such as meat, milk, cheese, and processed foods.
- Aim for about 150 minutes of moderate exercise every week (about 20 minutes a day), such as walking, swimming, or biking.
- If you feel the urge to have a bowel movement, don’t delay. The longer you wait, the harder your stool will become.
- Add fiber supplements to your diet if needed. Just remember to drink plenty of fluids because you can aggravate constipation if you add extra fiber without also adding fluids to your diet.
- Use laxatives sparingly. Your doctor may prescribe laxatives or enemas for a short period of time to help soften your stools. Never use laxatives for more than two weeks without talking to your doctor because you can cause your body to become dependent on them for proper colon function.
Your doctor may also advise that you stop taking certain medications that may cause constipation. More severe colon or rectal problems may require manual procedures to clear the colon of impacted stool, therapy to retrain slow muscles, or surgery to remove the problem part of your colon.
Most cases of constipation are mild and are easily treated with changes in diet and exercise. However, if you are experiencing chronic constipation, or constipation along with other changes in bowel movements, it is important that you talk to your doctor.
Written by: Danielle Moores
Medically reviewed by George Krucik, MD