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

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)

RELATED: 11 Foods to Avoid When You’re Having Digestive Problems

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.

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
• Diabetes
• Hypothyroidism
• Parkinson’s disease
• Stroke
• 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.

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

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.

Medication Options

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.

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?

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)

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:

• Johns Hopkins
• Mayo
• UCSF
• Cleveland Clinic