Constipation

What is constipation 8?

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.

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).

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.

What lab tests and other medical tests may be done to find the cause of my constipation?

Your healthcare provider may not order any tests or may order many types of tests and procedures. Tests will depend on your symptoms, medical history, and overall health and what they think the cause might be. Most of the time, additional lab testing isn’t required for a diagnosis. However, your healthcare provider may choose to do more based on your symptoms.

• Lab tests: Blood tests and urine tests reveal signs of hypothyroidism, anemia and diabetes. A stool sample checks for signs of infection, inflammation and cancer.
• Imaging tests: Your provider may order a computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or lower gastrointestinal tract series to identify other problems that could be causing your constipation. But these usually aren’t ordered.
• Colonoscopy: Your provider may perform a colonoscopy or sigmoidoscopy — an internal view of your colon with a scope. During this procedure, they may take a small sample of tissue (biopsy) to test for cancer or other issues and they’ll remove any polyps.
• Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines.
• Other bowel function tests: Your provider may order tests that check how well your anus and rectum hold and release stool. These tests include a certain type of X-ray (defecography), done to rule out causes of outlet dysfunction constipation, and the insertion of a small balloon into your rectum (balloon expulsion test and anorectal manometry).

How do you relieve constipation?

You can manage most cases of mild to moderate constipation at home. Self-care starts by taking an inventory of what you eat and drink and then making changes.

Some recommendations for immediate constipation relief at home include:

• Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration. Also, avoid juice and high-sweetened beverages.
• Avoid processed meats, fried foods and refined carbs like white bread, pasta and potatoes. It’s OK to eat lean meats like poultry and low-fat dairy products.
• Add fruits, vegetables, whole grains and other high-fiber foods to your daily diet. Eat fewer high-fat foods, like meat, eggs and cheese.
• Eat prunes, bran cereal and other high-fiber fruits like oranges, pineapples, berries, mangos, avocados and papaya.
• Keep a food diary and single out foods that constipate you.
• Get moving — exercise.
• Check how you sit on the toilet. Raising your feet, leaning back or squatting may make pooping easier.
• Add an over-the-counter supplemental fiber to your diet (like Metamucil®, MiraLAX®, Citrucel® or Benefiber®). It’s best to start slowly with these.
• If needed, take a very mild over-the-counter stool softener or laxative (such as docusate). Mineral oil enemas and stimulant laxatives are other options. There are many laxative choices. Ask your pharmacist or healthcare provider for help in making a choice. Don’t use laxatives for more than two weeks without calling your provider. Overuse of laxatives can worsen your symptoms.
• Don’t read or use your phone or other devices while trying to move your bowels.
• Avoid holding the urge to use the bathroom. Eventually, it will block the signal from your colon to your brain to relax and let the poop out.

Medication/supplement review

In addition to self-care methods, your healthcare provider will review your medications and supplements (if you take any). Some of these products can cause constipation. If they do, your provider may change the dose, switch to another drug and/or ask that you stop taking the supplement. Never stop taking your medications or supplements before talking with your provider first.

Prescription constipation medicine

A few prescription drugs are available to treat constipation. These include:

• Lubiprostone (Amitiza®).
• Prucalopride (Prudac®, Motegrity®).
• Plecanatide (Trulance®).
• Lactulose (Cephulac®, Kristalose®).
• Linaclotide (Linzess®).

Your healthcare provider will pick the drug that might work best for you based on the results of your tests.

Surgery

Surgery is rarely needed to treat constipation. But your healthcare provider may recommend surgery if a structural problem in your colon is causing constipation. Examples of these problems include:

• A blockage in your colon (intestinal obstruction).
• A narrowing in a portion of your intestine (intestinal stricture).
• A tear in your anus (anal fissure).
• The collapse of part of your rectum into your vagina (rectal prolapse).

Some causes of outlet dysfunction constipation may be treated with surgery. This is best discussed after testing. You may also need surgery if a colonoscopy reveals cancer in your colon, rectum or anus.

How can I prevent constipation?

Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem:

• Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help your colon pass stool. Most of the fiber in fruits is found in the skin, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber, too. Eat bran cereal or add bran cereal to other foods, like soup and yogurt. People with constipation should eat between 18 and 30 grams of fiber every day.
• If you have diverticulitis, you might be advised to avoid fruits with seeds.
• Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, can dehydrate you. You may need to stop drinking these products until your bowel habits return to normal.
• Exercise regularly. It doesn’t need to be much, even walking helps a lot.
• Use a dietary supplement like magnesium for constipation. (Not everyone should take magnesium. Check with your healthcare provider before taking.)
• Move your bowels when you feel the urge. Don’t wait.

When should I see my healthcare provider?

Call a healthcare provider if:

• Constipation is a new problem for you.
• You see blood in your poop.
• You’re losing weight unintentionally.
• You have severe pain with bowel movements.
• Your constipation has lasted more than three weeks.
• You have symptoms of outlet dysfunction constipation.

What questions should I ask my healthcare provider?

• Why am I constipated?
• What can I take for immediate constipation relief?
• What home remedies for constipation do you recommend?
• What should I eat or drink to prevent constipation?
• How else can I prevent constipation?

A note from Cleveland Clinic

Remember, talk openly and honestly with your healthcare provider about your bowel movements and any questions or concerns you may have. Pooping is something we all should be doing. Constipation may be a temporary situation, a long-term issue or a sign of a more serious condition. Be safe. See your provider, especially if you’ve noticed a change in your bowel pattern or if your life is being ruled by your bowels.