What is constipation?
Constipation is when you have persistent trouble having a bowel movement. It’s defined as having a bowel movement fewer than three times a week. Or if it’s frequently hard to push stool out when you go to the bathroom.
Constipation happens for many reasons. It can happen from not eating enough fiber. It can also be caused by certain medications, such as opioid painkillers.
There can be medical conditions that cause constipation, such as spinal cord injuries, the muscles of the anus or pelvis not working correctly, or a condition like thyroid disease.
You can first try to treat it with a combination of diet changes and over-the-counter remedies. Many people become constipated at some time or another, and it gets better. But if it doesn’t, or it happens often, talk to your doctor.
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Most common symptoms
It’s important to know what your poop looks like. Is it usually pebble-like, lumpy, or smooth? Is it mostly liquid? It helps your doctor to know this. Keep a record of how often you are having bowel movements for the two weeks or so before your doctor’s appointment. —Dr. Adam Pont
You have fewer than three bowel movements a week on average. It may be very difficult to push out stool and you may need to strain a lot or help the stool out with your finger.
- Less than three bowel movements a week
- Trouble pushing stool out of the anus
- Trouble starting or finishing pooping
Other symptoms you may have
What causes constipation?
Like many GI disorders, there is evidence that the bacteria in the gut (the microbiome) of people with chronic constipation differs from people without constipation. Active research is ongoing to test whether manipulating the bacteria in the gut can affect and improve constipation symptoms. —Dr. Pont
There are many causes of constipation.
- Not eating enough fiber. Fiber makes your stool bulky and helps it travel through your digestive system.
- Certain medications can cause constipation including pain killers (morphine, oxycodone, and even NSAIDs like ibuprofen), antihistamines (allergy medicine), diuretics (water pills), some blood pressure medications, and some antidepressants. Also, dietary supplements that have calcium or iron in them can result in constipation.
- Abnormal bowel or muscle function. Sometimes constipation occurs when your stool is not moving fast enough through your colon. This is called slow transit constipation. Sometimes the muscles that typically help push stool out may not be working correctly. This is called functional outlet obstruction.
- Health issues that prevent physical activity. If you can’t move about easily due to a health issue, you are more likely to become constipated.
- Underlying health issues. If you have diabetes, uncontrolled high blood sugar can damage your nerves, including those in your digestive tract. In some cases that can result in slower stool movement and constipation.
- Thyroid disease. If you have abnormally low thyroid hormone levels, it can make your digestive system slow down. This can lead to constipation.
- Obstructing lesions in the colon. Narrowing of the colon caused by inflammatory bowel disease, prior surgery, endometriosis, ischemia (low blood flow), or tumors (including cancer) can cause constipation.
- Certain digestive tract conditions like inflammatory bowel disease and irritable bowel syndrome (IBS) can cause constipation.
- Other diseases that cause constipation: Neurological diseases (like spinal cord injury or Parkinson’s), anal disease, and muscle disorders.
- Sometimes, the cause is unknown. Still, it can be treated successfully.
If you have frequent constipation symptoms, see your primary care doctor. Depending on your symptoms, they may send you to a gastroenterologist—a doctor who specializes in digestive diseases.
You should go to the ER if:
- You have not had a bowel movement for several days and you have pain in your abdomen every time you eat or drink. Especially if you vomit when you eat or drink. You might have something blocking your intestines (acute bowel obstruction). This is an emergency.
- You have a lot of blood in your stool whenever you have a bowel movement. If you just have a few drops of blood, see your doctor.
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What helps constipation fast?
There is no one “normal” schedule for having bowel movements. Some people have a bowel movement every day, some every other day, some have bowel movements twice a day sometimes. All of this is within the spectrum of “normal.” If after treatment for constipation you are still only having a bowel movement every other day but it is easy to pass and you otherwise feel fine, that’s great!! —Dr. Pont
If you get constipated once in a while, you can treat it with home remedies.
- Drink more water.
- Go out for a walk or do other types of exercise. Movement may help move food through your bowels.
- Eat high-fiber foods or a fiber supplement.
- Take over-the-counter laxatives. These typically contain fiber, mineral oils, surfactants, or hydrating agents to speed up the movement of stool in your intestines.
- If you are taking a medication that can cause constipation, talk to your doctor about stopping or changing it.
If the laxatives do not make your symptoms better or you get constipation often, see your doctor. They may want you to see a gastroenterologist for more tests.
If you have functional outlet obstruction (anus and pelvic muscles not working correctly to expel stool), your doctor will send you to a special type of therapist. They’ll teach you how to use your abdominal and pelvic muscles together to have a bowel movement. This is usually called ‘habit training’ or ‘biofeedback training’.
In addition to lifestyle changes and increased fiber intake, you can try an over-the-counter (OTC) medication or your doctor may prescribe a medication:
- Bulk fiber laxatives (OTC): Psyllium (Metamucil), methylcellulose (Citrucel).
- Surfactant laxatives (OTC): docusate (Colace), mineral oil.
- Osmotic laxatives (OTC): Polyethylene glycol (Miralax), magnesium hydroxide (Milk of Magnesia).
- Stimulant laxatives (OTC): Bisacodyl (Dulcolax), senna (Senokot). Stimulant laxatives should only be used for a short period of time or on and off.
- Prescription medications may be used including linaclotide (Linzess), lubiprostone (Amitiza), plecanatide (Trulance), or prucalopride (Motegrity).
- If your constipation is caused by opioid pain medications, your doctor may prescribe naloxegol (Movantik), methylnaltrexone (Relistor), or naldemedine (Symproic).
Constipation in children
The main reason children become constipated is because they are holding in their stool on purpose (functional fecal retention). Your child may not want to go to the bathroom in a public restroom. Or they may not want to stop playing or reading. If they hold it in, the colon will absorb more water from their stool. This makes the stool hard and more difficult to push out of the body.
Schedule a follow-up appointment with your doctor in several weeks if symptoms are not improving. Your doctor may want to try more than one medication.
You may also need to make an appointment with a gastroenterologist. They may want to do outpatient procedures like a colonoscopy, a balloon expulsion test, or anorectal manometry. Balloon expulsion and anorectal manometry measure how well you can push out stool.
- Eat enough fiber (20 to 30 grams) every day, whether from fiber-rich foods or supplements.
- Drink plenty of water when thirsty.
- Exercise regularly.
- Go to the bathroom when you feel the urge (don’t hold in your stool).