What Is Constipation?

Constipation is defined by less frequent bowel movements and hard stools that are difficult to pass through the colon. It affects some 4 million people in the United States. Constipation is the most common gastrointestinal issue and results in 2.5 million healthcare provider visits annually.

This article will cover in detail what causes constipation, the symptoms of constipation, what to expect if you have constipation, how diagnosis for constipation works, and what treatments exist for constipation. You’ll also learn what to expect if you have constipation during pregnancy, and how to prevent constipation, as well as when to see a healthcare provider for constipation.

What Causes Constipation?

Constipation can happen due to a diet or lifestyle change, medication use, or as a symptom of a health condition. While constipation may be nothing to worry about, there are some cases where having constipation indicates a more serious health problem.

Diet

Constipation often happens due to a lack of fiber in the diet. Fiber comes from whole grains, legumes, fruits, vegetables, and nuts. Adequate water intake is also key for ensuring the fiber is passable and for preventing dehydration. Too much fiber without adequate water intake can also cause or worsen constipation.

Lifestyle

Lifestyle factors that impact constipation include changes to your regular routine, such as traveling, getting a new job or schedule at work, going to bed at different times, and any increase in stress levels. However, not getting enough physical activity, holding your bowel movement (resisting the urge to have a bowel movement for any reason), and eating excessive amounts of milk or cheese can all cause constipation, too.

Medication

Many types of medications have constipation as a side effect. Sometimes these side effects are short term and other times they are chronic. Medication types known to cause constipation include:

• Pain medications
• Antidepressants
• Antacids
• Iron supplements
• Certain blood pressure medications
• Medications for seizure disorder (anticonvulsants)
• Over-the-counter (OTC) laxatives

Underlying Health Issues

Constipation can also be caused by underlying health conditions affecting the digestive and endocrine systems, such as underactive thyroid gland (hypothyroidism) or diabetes.

Constipation is also a symptom in colon (colorectal) cancer, neurological disorders like multiple sclerosis (MS), cases of internal obstruction or intestinal blockage, or structural differences in the digestive tract.

Other Risk Factors

Other risk factors for developing constipation include:

• Excessive use of laxatives
• Irritable bowel syndrome (IBS)
• Pregnancy
• Aging

All of these factors have an impact on the overall functioning of the digestive system.

Symptoms of Constipation

You’ll know when you have constipation. Overall, your bowel movements will be more challenging. You can expect:

• Less frequent bowel movements
• Dry, hard, pebble-like stools
• Painful bowel movements, such as pushing with no relief
• Bloating, cramping, nausea, and gas
• Stools are difficult to pass through the colon
• Even after pushing, it doesn’t feel like you have fully emptied your bowels

Symptoms of constipation should be considered with context to what's “normal” when it comes to your own bowel movement frequency. For example, some people have several bowel movements a day, and others have several over the course of a week.

How Long Does Constipation Last?

Constipation can come and go. While everyone is different, if constipation has lasted for three weeks or more, call your healthcare provider to determine why you are having this problem and what may help.

Complications of Constipation

Ongoing constipation can cause health complications. The most common complication of constipation is hemorrhoids from straining to pass stool or anal fissure from a small tear around the anus. If you experience a tear, rectal bleeding can occur. If bacteria from stool enter, infection could occur. 

Less common is rectal prolapse or when the intestinal lining pushes out from the anal opening. Another possible complication is fecal impaction or prolonged constipation in which the stool is layering and compacting in the colon, making bowel movement even more challenging.

Diagnosing Constipation

Diagnosing constipation includes talking to your healthcare provider about bowel movement history and symptoms. While this isn’t everyone’s favorite topic, bear in mind your healthcare provider is there to answer all your health questions.

After asking about history, symptoms, and lifestyle, your healthcare provider will determine whether or not lab tests to rule out underlying conditions, full physical examination, including a rectal exam, and further medical assessment before treatment is necessary.

Treatment and Relief for Constipation

After you are diagnosed with constipation, you will be offered possible remedies to help, depending on what the diagnostic process revealed. 

Dietary and Lifestyle Changes

In many cases, dietary and lifestyle changes may be enough to relieve constipation. When it comes to digestive health concerns, though, you may want to consider speaking to a dietitian about specific meal plans for your health needs. For example, you may be asked to add fiber to your diet and to adjust the amount of water you drink. Consider asking a healthcare provider about your needs based on size, health, activity levels, and where you live.

Laxatives

Laxatives can provide temporary relief of uncomplicated cases of constipation. So, if necessary, your provider may suggest taking a mild OTC laxative. Milk of Magnesia is an example.

Bear in mind that excessive laxative use can increase risk of dehydration and subsequent constipation in the future, though, so laxatives should not be used to treat chronic or frequent constipation. 

Medications

Where necessary, your healthcare provider may discuss prescription medications available to treat constipation.

Medications for constipation include:

• Stool softeners like docusate sodium (Colace)
• Osmotic laxatives like polyethylene glycol (MiraLAX)
• Bulk-forming fiber supplements like psyllium (Metamucil)
• Stimulant laxatives like senna (Senokot)

Your healthcare provider may also discuss removing or changing existing medications if they are contributing to your constipation problems. 

Surgery

It’s unlikely surgery will be required or necessary for treating constipation. One exception is a structural problem within the digestive tract or colon. For example, if there is a blockage in the colon, surgery may be needed to remedy the obstruction so stools can start passing naturally again.

Constipation During Pregnancy

Although uncomfortable, constipation during pregnancy is common. The hormonal changes in the pregnant person’s body can contribute to constipation. Constipation can also be caused from the growing fetus pushing and pressing on the intestines, which slows down the stool-passing process.

Newborn and Baby Constipation

Newborn and baby constipation may result from the bowel movement process just beginning and not yet being regular. Any changes to a baby's diet, including transitioning from breast milk to formula or from formula to soft foods, can create bowel movement changes in babies. If you have concerns, consult with your pediatrician.

How to Prevent Constipation

Preventing constipation is possible with diet and lifestyle changes is possible. Prevention tips include:

• Eating a balanced diet that contains enough fiber and water
• Avoiding dehydration from lack of liquids or consuming dehydrating beverages, such as coffee, in excess
• Limiting constipation-promoting foods such as milk and cheese
• Getting daily physical movement
• Not waiting to go to the bathroom to pass stool are also helpful in preventing constipation

When to See a Healthcare Provider for Severe Constipation

While constipation is common, there are accompanying signs and symptoms that are cause for seeing your healthcare provider.

The following signs and symptoms indicates severe constipation:

• Blood in the stool or on toilet paper
• Severe stomach pains or being unable to pass gas
• Vomiting or having a fever
• Unexplained weight loss
• Lower back pain (could be due to blockage)
• Fiber and physical activity aren’t helping
  

Summary

Constipation is when you have difficulty passing stool during a bowel movement. Treatment can include making changes to diet, lifestyle, and medication list, and remedying any underlying health conditions contributing to constipation. If you have signs of complications or serious symptoms, like blood in the stool, consult with a healthcare provider.