Constipation

What is Constipation?

Constipation is a common bowel problem that occurs when bowel movements become less frequent or difficult to pass. It can cause stools to become hard, dry, or lumpy and may make going to the bathroom uncomfortable or painful.

Having fewer than three bowel movements a week is a common sign of constipation, but frequency isn’t the only factor. Some people may have bowel movements more often but still experience constipation if their stools are hard, they need to strain, or they feel as though they haven’t completely emptied their bowels.

What Causes Constipation?

Common causes and risk factors for constipation include:

Not eating enough fibre: A diet low in fruits, vegetables, whole grains, and other fibre-rich foods can contribute to constipation
Not drinking enough fluids: Dehydration can make stools harder and more difficult to pass
Lack of physical activity: Regular movement helps stimulate normal bowel function
Changes in your normal routine: Travel, changes in eating or sleeping patterns, and other disruptions to your daily routine can affect bowel habits
Stress: Stress and changes in the gut-brain connection can affect intestinal movement and bowel function
Pregnancy: Constipation is common during pregnancy. Hormonal changes can slow digestion, while the growing uterus can put pressure on the intestines and contribute to slower movement of stool through the digestive tract
Medications and supplements: Certain medications, including some pain medications, antidepressants, iron supplements, and other drugs, can cause or worsen constipation
Older age: Constipation becomes more common with age and may be related to changes in diet, activity levels, medications, and bowel function
Neurological conditions: Conditions affecting the nerves that control the bowel can interfere with normal bowel movements
Digestive and gastrointestinal disorders: Certain disorders affecting the colon, rectum, or pelvic floor can contribute to constipation
Pelvic floor dysfunction: Problems coordinating the pelvic floor and anal muscles can make it difficult to empty the rectum properly

What are the Symptoms?

Constipation can affect people differently.

Common symptoms include:

Fewer than three bowel movements per week
Hard, dry, or lumpy stools
Stools that are difficult or painful to pass
Straining during bowel movements
A feeling that stool is still in the rectum after having a bowel movement
A feeling of blockage or difficulty getting stool out
Abdominal pain or cramping
Bloating
Excess gas
Nausea
Changes in your normal bowel habits

Having fewer than three bowel movements per week can be a sign of constipation, but frequency alone does not determine whether someone is constipated. A person can have regular bowel movements and still experience constipation if the stools are hard, difficult to pass, or require significant straining.

How is Constipation Diagnosed?

Your healthcare provider will consider your symptoms, bowel habits, medical history, medications, diet, and lifestyle when evaluating constipation. Testing may be recommended when symptoms are persistent, severe, unusual, or suggest another underlying condition.

Tests used to evaluate constipation may include:

Medical and bowel movement history: Your healthcare provider may ask about how often you have bowel movements, stool consistency, straining, incomplete evacuation, abdominal symptoms, diet, medications, and how long your symptoms have been present
Physical examination: A physical examination may be performed to look for potential causes of constipation. This may include a digital rectal examination to assess the rectum, anal sphincter, and pelvic floor muscles
Blood tests: Blood tests may be used when appropriate to look for conditions that can contribute to constipation, such as anemia, thyroid disorders, diabetes, or electrolyte abnormalities
Stool tests: Stool testing may be recommended when symptoms suggest an infection, inflammation, bleeding, or another gastrointestinal disorder
Imaging tests: Depending on your symptoms, imaging such as computed tomography (CT), magnetic resonance imaging (MRI), or abdominal X-rays may be used to look for structural abnormalities or other causes of constipation
Colonoscopy: A colonoscope is used to examine the lining of the entire colon. A colonoscopy may be recommended based on your age, symptoms, screening needs, family history, or other risk factors. Polyps or other abnormalities can be identified and, when appropriate, removed or biopsied
Colorectal transit studies: These tests evaluate how quickly stool moves through the colon. Depending on the type of test, you may swallow capsules containing markers that can be tracked with imaging over several days. Transit studies can help determine whether slow-transit constipation is contributing to symptoms
Defecography: Defecography evaluates how the rectum and pelvic floor function during a bowel movement. Contrast material may be placed in the rectum, followed by imaging while you attempt to empty your bowel. This test can identify problems such as rectocele, rectal prolapse, pelvic floor dysfunction, or difficulty evacuating stool
Anal manometry: A small, flexible tube with pressure sensors is inserted into the anus and rectum to measure pressure and muscle function. Anal manometry can assess anal sphincter strength, sensation, and coordination and may help identify pelvic floor dysfunction or problems with bowel evacuation

How is Constipation Treated?

Treatment for constipation depends on its cause, severity, duration, and whether another medical condition is contributing to the problem. Treatment may include lifestyle and dietary changes, medications, pelvic floor therapy, and, in selected cases, surgery.

Review Medications and Supplements

Some medications and supplements can cause constipation. Talk with your healthcare provider or pharmacist about any prescription medications, over-the-counter medications, and supplements you take. Do not stop a prescribed medication on your own. Your healthcare provider may be able to adjust the dose, change the medication, or recommend another approach.

Self-Care and Lifestyle Changes

Several daily habits may help improve bowel regularity:

Exercise regularly: Physical activity can help stimulate bowel movements and support healthy intestinal function
Establish a regular toilet routine: Try sitting on the toilet at a consistent time each day, particularly after meals when the body’s natural gastrocolic reflex may stimulate the urge to have a bowel movement
Use a comfortable toilet position: Raising your feet on a small footstool and leaning slightly forward may make it easier to relax the pelvic floor and pass stool
Respond to the urge to have a bowel movement: Regularly ignoring the urge to go can make constipation worse
Allow enough time: Avoid rushing or straining excessively during bowel movements
Try toilet meditation: This is a simple mindfulness practice that can help you slow down, become aware of your body, and focus on relaxing the pelvic floor during a bowel movement

Dietary Changes

Dietary changes can play an important role in managing constipation. Depending on your individual needs, your healthcare provider may recommend:

Increasing dietary fibre gradually through fruits, vegetables, whole grains, legumes, nuts, and seeds
Adding fibre-rich foods such as prunes, pears, berries, vegetables, and bran
Considering an over-the-counter fibre supplement, particularly a soluble fibre such as psyllium
Drinking enough fluids to support healthy stool consistency
Limiting highly processed foods that are low in fibre
Keeping a food and symptom tracker to identify foods or dietary patterns that may affect your bowel habits

Increasing fibre too quickly can cause gas and bloating, so it is generally best to increase it gradually and drink adequate fluids.

Medications for Constipation

If lifestyle and dietary changes are not enough, medications may be recommended.

Options can include:

Bulk-forming fibre supplements: Help increase stool bulk and may improve bowel regularity
Osmotic laxatives: Draw water into the bowel to soften stool and make it easier to pass
Stool softeners: May help soften stools in some circumstances
Stimulant laxatives: Stimulate intestinal movement and may be useful for short-term or occasional constipation
Prescription medications: Several prescription treatments are available for chronic constipation and constipation-predominant conditions when other approaches have not provided adequate relief
Enemas or suppositories: May sometimes be recommended when stool is difficult to pass or is impacted in the rectum

Talk with your healthcare provider or pharmacist about which treatment is appropriate for you. Do not use laxatives regularly or for an extended period without medical guidance, particularly if constipation is persistent or unexplained.

Pelvic Floor Therapy and Biofeedback

For people whose constipation is caused by pelvic floor dysfunction or difficulty coordinating the muscles needed for defecation, pelvic floor physiotherapy and biofeedback can be particularly helpful.

A trained pelvic floor therapist can teach you how to properly coordinate the abdominal, pelvic floor, and anal sphincter muscles so that they relax appropriately during a bowel movement. Biofeedback may help retrain these muscles and improve the ability to empty the rectum.

Surgery for Constipation

Surgery is generally reserved for severe constipation that does not respond to appropriate medical treatment, or when a structural problem is contributing to symptoms.

Surgical treatment may be considered for conditions such as:

Intestinal obstruction or narrowing (stricture)
Severe structural abnormalities of the colon or rectum
Rectal prolapse
Certain types of rectocele or pelvic floor disorders
Other structural conditions that prevent normal bowel emptying

The appropriate surgical approach depends on the underlying cause and requires evaluation by a qualified specialist.