What Is Constipation? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually. Generally, a person is constipated when they have fewer than three bowel movements a week or their stool is difficult to pass. In total, about 16% of the population experience constipation symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). While constipation is uncomfortable (and sometimes distressing), it’s considered a symptom rather than a disease.

It’s also important to know that everyday bowel habits can differ from person to person — some people may pass stool three times a day; others three times a week.

Signs and Symptoms of Constipation

Symptoms of constipation may also include the following: 

• Lumpy, dry, or hard stools
• Stools that are hard or painful to pass
• You feel there’s a blockage in your rectum that keeps you from having bowel movements.
• You felt as though you couldn’t empty your stool.
• Need help to empty your rectum, whether by pressing with your hands on your abdomen or using a finger to remove the stool (yes, it happens!)

Constipation is considered to be chronic if you’ve experienced two or more of these symptoms for the last three months, according to the Mayo Clinic. 

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Causes and Risk Factors of Constipation

The GI tract consists of a series of hollow organs stretching from your mouth to your anus, is responsible for digestion, nutrient absorption, and waste removal.

In your lower GI tract, your large intestine, or bowel — including your colon and rectum — absorbs water from your digested food, changing it from a liquid to a solid (stool).

Constipation occurs when digested food spends too much time in your colon.

It can also occur when your colon absorbs too much water, making your stool hard and dry — and challenging for your rectal muscles to push out of your body.

A wide range of factors can lead to constipation. According to the NIDKK, these include: 

• Delayed emptying of the colon caused by pelvic floor disorders and colon surgery
• Gastrointestinal disorders, such as irritable bowel syndrome
• Certain medicines and dietary supplements, including antacids that contain aluminium; calcium supplements; anticholinergics and antispasmodics (often used to treat spasms in the intestines); anticonvulsants, which are used to prevent seizures; calcium channel blockers; diuretics; iron supplements; medications used to treat Parkinson’s disease; certain pain medications and antidepressants

A shift in your daily routine can also lead to constipation. Some people find it more challenging to have a bowel movement. At the same time, travelling, for instance. (Small hotel rooms with bad soundproofing contribute to the problem!) Life changes matter, too, including pregnancy (which increases the chances of constipation) and simply getting older. According to a February 2015 in Canadian Family Physician, 26 % of women and 16 % of men age 65 and older experience constipation regularly. 

Other lifestyle-related causes of constipation include:

• Not eating enough fibre
• Dehydration or not drinking enough liquids in general
• Lack of exercise
• Habitually ignoring the urge to go
• Heavy reliance on laxatives or enemas (when misused, these make the problem worse)

The following medical conditions may also cause constipation:

• GI tract problems or disorders, such as irritable bowel syndrome
• Tumours or other obstructions
• Celiac disease
• Colon polyps
• Multiple sclerosis
• Diabetes
• Hypothyroidism
• Parkinson’s disease
• Stroke
• Nerve damage

Although constipation can affect anyone, according to the Mayo Clinic, you’re at the highest risk if you are: 

• A woman
• An older adult (over 65)
• Suffering from depression or another mental health issue

You’re also at higher risk for constipation if you’re pregnant (as noted above), if you’ve just given birth, or had surgery.

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How Is Constipation Diagnosed?

Your doctor will take a medical history and do a physical exam, most likely including a gentle rectal exam with a gloved finger. They will also likely prescribe several routine blood tests (to look for hypothyroidism, for instance) and urine and stool tests. According to the Mayo Clinic, other diagnostic tests may include:

• A sigmoidoscopy to examine the rectum and lower colon (where your doctor will insert a flexible tube with a light on the end to take a close look at these areas)
• A colonoscopy to examine the colon
• Evaluating the speed of your anal sphincter as well as how the muscle is working
• Evaluating how well food passes through your colon with a colonic transit study
• Taking an X-ray of the rectum during a bowel movement (this is called a defecography)
• A procedure is known as MRI defecography.

Duration of Constipation

It’s perfectly normal to have the occasional short-term bout of constipation. But if it lasts for several weeks at a time, it’s considered chronic, according to the Mayo Clinic. (If the problem lasts longer than three weeks, it makes sense to see your doctor.) A review of the medical literature published in May 2018 in the journal Medicine found that 16 % of people complain of chronic constipation. 

Treatment and Medication Options for Constipation

As upsetting and uncomfortable as constipation can be, several lifestyle changes, including diet, exercise habits, and even switching up certain supplements, can prevent constipation from happening in the first place.

Medication Options

If lifestyle changes aren’t helping, your doctor may suggest a fibre supplement, stool softeners, or other medication — either over-the-counter or prescription — to loosen things up again. Laxatives are one option, but since taking these regularly can make it challenging to have a bowel movement on your own, it’s best to use them with your doctor’s guidance.

The NIDDK suggests these other nonprescription options: 

• Fibre supplements, such as Metamucil
• Osmotic agents, such as Miralax
• Stool softeners, such as Colace
• Lubricants (like mineral oils)
• Stimulants, such as Correctol

But note: The NIDDK warns that you should only use stimulants if your constipation is severe or other treatments have not worked.

There are also prescription medications that help treat constipation. According to the NIDDK, your doctor may choose to prescribe one of the following: 

• Lubiprostone (prescribed to increase fluid in your digestive tract and increase the frequency of bowel movements)
• Medicines that encourage regular bowel movements, such as linaclotide and Plecanatide (these are often used to help people with chronic constipation resulting from irritable bowel syndrome or IBS)
• Prucalopride (this drug gives your colon an assist if you have chronic constipation with no definitive cause)

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Alternative and Complementary Therapies

While few high-quality studies show that alternative therapies can effectively treat constipation, a 2015 review of studies published in the journal Evidence-Based Complementary and Alternative Medicine found that acupuncture and herbal treatments like psyllium can make a difference.

Prevention of Constipation

You’ve likely heard it before, but the NIDDK recommends exercising regularly (moving your body keeps everything moving) and increasing the amount of dietary fibre you consume (choose high-fibre foods as part of your regular rotation), as well as drinking plenty of water. Bonus: A February 2019 review of studies of fibre and health in The Lancet found that people who ate the most fibre experienced a 15 to 30 % decrease in mortality from several causes compared with those who ate the least fibre. The U.S. government’s dietary recommendations suggest 28 grams of fibre a day for women ages 19 to 30; 25.2 grams for women ages 31 to 50; and 22.4 grams for women older than 51. Men ages 19 to 30 should get 33.6 grams of dietary fibre per day; ages 31 to 50 should get 30.8; men over 51 should aim for 28 grams.

Pay attention to your body signals; go without delay if you need to go. And don’t rush yourself or strain to make it happen. Put a bit of zen into your bathroom routine and relax.

Complications of Constipation

Constipation is most often acute, meaning that it appears suddenly — say when you’re travelling — and lasts for only a short time. But when it becomes chronic, pay attention and see your doctor because chronic constipation can cause complications, including:

• Haemorrhoids (swollen, inflamed veins in the rectum or around the anus that may cause rectal pain and bleeding)
• Anal fissures (small tears in the skin around the anus that are often accompanied by itchiness, pain, and bleeding)
• Inability to push stool out because it has hardened and packed in the colon and rectum too tightly
• Rectal prolapse (a condition in which part of the rectum sticks out of the anus)

Research and Statistics: Who Gets Constipation and the Toll It Takes

The significant risk factors for chronic constipation are being female and being elderly, according to a 2015 study published in the journal Clinical Interventions in Aging. (Elderly is usually defined as older than 65.) Other studies suggest that constipation is becoming more common. A February 2014 study published in the American Journal of Gastroenterology found that from 1997 to 2010, the incidence of constipation among patients released from hospital stays more than doubled, from 21,190 patients to 48,450. 

Besides being a drain on well-being, constipation is also a drain on the medical system: In a study in the same journal published in April 2015, researchers found that between 2006 and 2011, the frequency of constipation-related emergency room visits increased by 41.5 %, from 497,034 visits to 703,391 visits, while the average cost for each patient rose by 56.4 %, from $1,474 in 2006 to $2,306 in 2011.

Chronic constipation may lead to other complex issues, as well. According to an article published in March 2019 in the American Journal of Managed Care, people with constipation typically have poorer general health, mental health, and social functioning compared with those without. No wonder, since the average person suffering from constipation without a cause has to try approximately four over-the-counter and two prescription medications before settling on a treatment that works. 

Black Americans and Constipation

Black Americans and Constipation

Though recent demographic research on constipation is hard to come by, a widely cited study of data from a survey of more than 15,000 people found that constipation was more frequent in Black Americans than in white Americans, with 17.3 % of Black Americans reporting the condition compared with 12.2 % of white Americans. According to the authors of a study published in Quality of Life Research, constipation may be almost three times more prevalent in nonwhite individuals than white individuals. Yet, the authors point out; Black individuals are underrepresented in trials for constipation treatments.

Related Conditions and Causes of Constipation

According to the Cleveland Clinic, constipation can be a symptom of several conditions, including the following: (5)

• Hypothyroidism
• Colorectal cancer
• Diverticular disease
• Diabetes
• Irritable bowel syndrome (IBS)
• An intestinal obstruction
• Neurological disorders including multiple sclerosis and Parkinson’s disease
• A defect in the digestive tract
• Pregnancy

Resources We Love

The National Institute of Diabetes and Digestive and Kidney Diseases offers a wealth of information on constipation and other digestive disorders, as does the American College of Gastroenterology.

Several major medical centres offer advice and information about constipation on their websites, including:

• Johns Hopkins
• Mayo
• UCSF
• Clevel and Clinic

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• What Is Constipation? Symptoms, Causes, Diagnosis, Treatment, and Prevention