Constipation is the most common gastrointestinal complaint, resulting in?2.5 million?doctor visits annually. (1) Generally, a person is considered constipated when they have fewer than three bowel movements a week, or their stool is difficult to pass. In total, about 16 percent of the population experience constipation symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2)
While constipation is uncomfortable (and sometimes distressing), it’s considered a symptom rather than a disease in itself.
It’s also important to know that normal 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
- Lumpy, dry, or hard stools
- Stools that are hard or painful to pass
- Feeling as though there's a blockage in your rectum that keeps you from having bowel movements
- Feeling as though you can't completely empty your stool
- Needing 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. (3)
Causes and Risk Factors of Constipation
The GI tract, which 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 — which includes 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 difficult 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: (2)
- 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 aluminum; 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 that it’s more difficult to have a bowel movement while traveling, for instance. (Small hotel rooms with bad soundproofing contribute to the problem!) Life changes matter, too, including pregnancy (which increases the chances of constipation) — as well as simply getting older. According to a report published February 2015 in Canadian?Family Physician, 26 percent of women and 16 percent of men age 65 and older experience constipation on a regular basis.?(4)
Other lifestyle-related causes of constipation include:
- Not eating enough fiber
- Dehydration or not drinking enough liquids in general
- Lack of?exercise
- Habitually ignoring the urge to go
- Heavy reliance on laxatives or enemas (when used incorrectly, these make the problem worse)
The following medical conditions may also cause constipation:
- GI tract problems or disorders, such as irritable bowel syndrome
- Tumors or other obstructions
- Celiac disease
- Colon polyps
- Multiple sclerosis
- Parkinson’s disease
- Nerve damage
Although constipation can affect anyone, according to the Mayo Clinic, you're at highest risk if you are: (3)
- 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 if you’ve had surgery.
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 a number of routine blood tests (to look for hypothyroidism, for instance), as well as urine and stool tests. According to the Mayo Clinic, other diagnostic tests may include: (3)
- 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 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. (3) (If the problem lasts longer than three weeks, it makes sense to see your doctor.) (5) A review of the medical literature published in May 2018 in the journal Medicine found that 16 percent of people complain of chronic constipation. (6)
Treatment and Medication Options for Constipation
As upsetting and uncomfortable as constipation can be, there are a number of lifestyle changes, including diet, exercise habits, and even switching up certain supplements that can prevent constipation from happening in the first place.
If lifestyle changes aren’t helping, your doctor may suggest a fiber 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 difficult 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: (2)
- Fiber 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: (2)
- Lubiprostone (prescribed to increase fluid in your digestive tract and increase 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)
Alternative and Complementary Therapies
While there are few high-quality studies showing 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. (7)
RELATED: What Is Irritable Bowel Syndrome?
Prevention of Constipation
You’ve likely heard it before, but the NIDDK recommends exercising regularly (moving your body keeps everything moving); increasing the amount of dietary fiber you consume (choose?high-fiber foods as part of your regular rotation), as well as drinking plenty of water. (2) Bonus: A February 2019 review of studies of fiber and health in The Lancet found that people who ate the most fiber experienced a 15 to 30 percent decrease in mortality from a number of causes compared with those who ate the least fiber. (8) The U.S. government’s dietary recommendations suggest 28 grams of fiber 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 fiber per day; ages 31 to 50 should get 30.8; men over 51 should aim for 28 grams. (9)
Pay attention to your body signals; if you need to go, go without delay. 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 traveling — 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:
- Hemorrhoids (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)
RELATED: What Are Hemorrhoids?
Research and Statistics: Who Gets Constipation, and the Toll It Takes
The major risk factors for chronic constipation are being female and being elderly, according to a 2015 study published in the journal Clinical Interventions in Aging. (10) (Elderly is usually defined as older than 65.) Other studies suggest that constipation seems to be getting 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 a hospital stay more than doubled, from 21,190 patients to 48,450. (11)
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 percent, from 497,034 visits to 703,391 visits, while the average cost for each patient rose by 56.4 percent, from $1,474 in 2006 to $2,306 in 2011.?(12)
Chronic constipation may lead to other difficult 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. (13) 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.?(13)
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 percent of Black Americans reporting the condition compared with 12.2 percent of white Americans. (14) According to the authors of a study published in Quality of Life Research, constipation may be almost three times more prevalent in nonwhite individuals compared with white individuals. Yet, the authors point out, Black individuals are underrepresented in trials for constipation treatments. (15)
Related Conditions and Causes of Constipation
According to the Cleveland Clinic, constipation can be a symptom of a number of conditions, including the following: (5)
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.
A number of major medical centers offer advice and information about constipation on their websites, including:
Editorial Sources and Fact-Checking
- Constipation.?Johns Hopkins Health.
- Constipation.?National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). May 2018.
- Constipation: Symptoms and Causes.?Mayo Clinic. June 29, 2019.
- Schuster B, Kosar L, Kamrul R. Constipation in Older Adults. Canadian Family Physician. February 2015.
- Constipation.?Cleveland Clinic. November 7, 2019.
- Forooton M, Bagheri N, Darvishi M. Chronic Constipation: A Review of Literature. Medicine. May 2018.
- Wang X, Yin J. Complementary and Alternative Therapies for Chronic Constipation. Evidenced-Based Complementary and Alternative Medicine. May?2015.
- Reynolds A, Mann J, Cummings J, Winter N, et al. Carbohydrate Quality and Human Health: A Series of Systematic Reviews and Meta-Analyses. Lancet. February 2019.
- Dietary Guidelines for Americans 2015–2020. U.S. Department of Health and Human Services.
- Roque MV, Bouras E. Epidemiology and Management of Chronic Constipation in Elderly Patients. Clinical Interventions in Aging. 2015.
- Sethi S,?Mikami?S,?Leclair? J,?Park?R,?et al. Inpatient Burden of Constipation in the United States: An Analysis of National Trends in the United States From 1997 to 2010. American Journal of Gastroenterology. February 2014.
- Sommers T,?Corban C, Sengupta N, Jones M, et al. Emergency Department Burden of Constipation in the United States From 2006 to 2011. American Journal of Gastroenterology. April 2015.
- McCormick D. Managing Costs and Care for Chronic Idiopathic Constipation. American Journal of Managed Care. March 27, 2019.
- Sandler R,?Jordan M, Shelton B. Demographic and Dietary Determinants of Constipation in the U.S. Population.?American Journal of Public Health. February 1990.
- Friedenberg F, Dadabhai A, Palit A, Sankineni A. The Impact of Functional Constipation on Quality of Life of Middle Aged Black Americans: A Prospective Case-Control Study. Quality of Life Research. December 2012.