Introduction and Summary
It may not be something you want to talk about, but constipation is incredibly common. In fact, it is one of the most common digestive problems in the United States, impacting about 2.5 million people. Constipation is defined as having dry or hard bowel movements, or going to the bathroom fewer than three times a week.
In this article I’ll explore:
- What Is Constipation?
- Causes of Constipation
- Symptoms of Constipation
- Risk Factors and Complications
- Diagnosing Constipation
- How Is Constipation Treated?
- How to Prevent Constipation
- When to See a Doctor
- How K Health Can Help
What Is Constipation?
Constipation typically means that you have fewer than three bowel movements a week. While it’s common to be constipated occasionally, some people experience constipation to such an extent that it interrupts their daily life by causing bloating, pain, and even bleeding.
Some people suffer from chronic constipation, which is a condition in which you have infrequent bowel movements or difficulty passing stools that persist for several weeks or longer.
Causes of Constipation
Constipation happens for many reasons. One of the most common causes is called “functional constipation”, when waste moves too slowly through the colon. The slower food travels, the more water the body is able to absorb back from the intestines, making feces harder. Chronic functional constipation results in a backup, and even impaction, of hard feces, which can be difficult to treat.
Common causes of constipation include:
- Bowel stricture: This is the narrowing of the colon.
- Bowel obstruction: This refers to a blockage in the intestines.
- Anal fissures: These are tiny tears in the skin around the anus which can bleed when irritated.
- Rectocele: This is when the rectum bulges through the back wall of the vagina.
- Nerve problems: Neurological conditions like multiple sclerosis, stroke, or Parkinson’s disease can affect the rectum and colon.
- Pelvic muscle problems: This includes weakened pelvic muscles, anismus (the inability to relax pelvic muscles to have a bowel movement), or dyssynergia (pelvic muscles don’t correctly coordinate contraction and relaxation).
- Cancer: Colon, rectal, or abdominal cancer may press on the colon, prohibiting stool movement.
- Dietary issues: Certain foods such as processed grains, red meat, fried or fast foods, and milk and dairy products can make constipation worse. Dehydration can also cause and worsen constipation.
Diseases and conditions that change the balance of hormones can also lead to constipation, such as diabetes, hypothyroidism (underactive thyroid), or hyperparathyroidism (overactive parathyroid gland).
Pregnancy can also make you constipated. In fact, according to the American Pregnancy Association, constipation affects approximately half of all women during their pregnancy at some point. It’s thought to be attributed to a combination of pregnancy hormones relaxing the intestinal muscles and the expanding uterus putting pressure on the intestines.
Symptoms of Constipation
Normal bowel movements differ from person to person. Some people pass stool just four or five times a week, while others may have bowel movements several times a day. However, you may be constipated if you have these symptoms:
- Fewer than three bowel movements a week
- Feeling like you have a blockage preventing bowel movements
- Feeling like you can’t empty your bowels completely
- Passing dry, hard stools
- Needing to press on your abdomen to help empty your rectum
- Straining or pain when making bowel movements
- Nausea or vomiting as a result of constipation
If you’ve had two or more of these constipation symptoms for the last three months, you may have chronic constipation. However, if you experience constipation along with diarrhea, you may have IBS, or irritable bowel syndrome, a chronic condition that impacts the large intestine.
Risk Factors and Complications
Certain personal and behavioral factors can put you at risk for constipation. These include the following:
- Being female
- Individuals 65 years or older
- Being sedentary
- Living with depression or an eating disorder
- Taking certain medications such as opioids, sedatives, antidepressants, or medications to lower blood pressure
While constipation can be uncomfortable, it is typically not life threatening. Chronic or severe constipation, however, can cause complications which include:
- Anal fissures: small tears in the thin tissue that lines the anus, which can bleed when irritated.
- Hemorrhoids: inflamed and swollen blood vessels in the anus caused by straining to have a bowel movement.
- Fecal impaction: when dried stool gets stuck in the anus and rectum; this frequently requires manual clearance with fingers and enemas.
- Rectal prolapse: part of the rectum slips outside the anus when you’ve strained to have a bowel movement.
To help diagnose constipation, your doctor will perform a thorough history and physical exam. Your doctor will ask about your bowel movement history, such as how often you have bowel movements, what the stool looks like, and if you’ve seen blood or red streaks in your stool, in the toilet bowl, or on toilet paper after you wipe. The physical exam may include checking your vital signs, examining your abdomen, and performing a digital rectal examination.
Additional tests may be needed to identify the cause of your constipation. These may include:
- X-rays: These can help your doctor figure out if you have a blockage in your intestines.
- Blood tests: This can help your doctor identify certain health conditions such as hormone imbalances, high calcium levels, or hypothyroidism.
- Sigmoidoscopy: This procedure involves putting a flexible, lighted tube into your anus. This lets your doctor check the lower part of your colon and rectum for ulcers, polyps, and abnormal cells.
- Anorectal manometry: Your doctor will put a flexible, narrow tube into your rectum and anus, inflate a small balloon at the tube’s tip, and then pull it through the sphincter muscle. This procedure lets your doctor see the coordination of the muscles you use to move your bowels.
- Colonoscopy: This test involves examining your colon with a long, flexible tube with a tiny video camera at its tip and is usually performed under anesthesia. This allows the doctor to look for strictures, masses, and other abnormalities that may be causing constipation. If there are any concerning findings, they may obtain a sample of tissue and send it to the laboratory for further analysis.
- Colonic transit study: This test lets your doctor see how well your colon is working. Your doctor will ask you to swallow a capsule with a radiopaque marker or wireless recording device. Then, they’ll record the capsule’s progress for 24-48 hours through x-rays.
- Defecography: This test may show problems with muscle coordination or function. Your doctor will insert a soft barium paste. Then, you’ll pass the barium like you’d pass stool. Your doctor will monitor its progress with x-rays.
- MRI defecography: This test allows your doctor to see how your muscles work. Your doctor will put contrast gel into your rectum, which you’ll pass like you pass stool.
Taken in the context of your history, and based on the results of your physical exam and any tests that are performed, your doctor will be able to make a diagnosis and suggest the appropriate treatment for your constipation.
How Is Constipation Treated?
Luckily, you can manage most mild to moderate cases of constipation on your own by changing your diet, staying hydrated, and taking over-the-counter medications.
- Changing your diet: Keep a food diary to help you figure out what foods may be causing your constipation. You should aim to eat a healthy diet with high-fiber foods including whole-grain breads and cereals (such as bran cereal), fruits (like prunes), and veggies, since fiber can increase the weight of your stool and speeds up its movement through your intestines. Just be sure to slowly increase your fiber consumption. Otherwise, you can trigger gassiness and bloating.
- Taking fiber supplements: Along with adding fiber to your diet, talk to your doctor about taking over-the-counter fiber supplements.
- Watching what you drink: Stay hydrated by drinking eight glasses of water daily. Also, avoid beverages that can dehydrate you, like those containing caffeine or alcohol.
- Adjusting how you sit on the toilet: To make bowel movements easier, raise your feet, squat, or lean back.
- Listening to your body: Don’t fight the urge to have a bowel movement and give yourself time to do so. Using a bathroom without distractions or feeling rushed can help develop healthy bowel habits.
- Breaking a sweat: When you exercise, muscle activity increases in your intestines. Speak with your doctor before starting an exercise program if you don’t exercise already.
- Taking laxatives or stool softeners: Talk to your doctor about taking a mild over-the-counter laxative or stool softener. Just be careful with laxatives. Don’t take them more than two weeks without speaking to your doctor. Laxative overuse can cause serious side effects like rectal bleeding, bloody stools, or severe pain or cramps.
Your doctor may prescribe a medication to treat constipation. The right drug for you depends on what’s causing your constipation. You may be prescribed medications that help to:
- Speed up the movement of stool: Lubiprostone (Amitiza), linaclotide (Linzess), and plecanatide (Trulance) all help to do this by drawing water into the intestines.
- Move stool through the colon: Prucalopride (Motegrity) is one common drug for this purpose.
- Reverse the impact of opioids: Naloxegol (Movantik) and methylnaltrexone (Relistor) can reverse the impact of opioids, although their actual effectiveness is controversial.
You’ll also want to review your medications and any supplements that you take with your doctor; since some of these may cause constipation. Your doctor may switch you to another drug, change the dose, or have you stop taking the medication altogether. Never change your prescribed medications without consulting your doctor first.
Surgery is rarely needed to treat constipation, but it may be necessary for certain conditions, such as severe strictures or intestinal obstructions. Closely monitoring your symptoms and getting prompt and regular medical attention is critical to finding out if you have a diagnosis that may require surgery.
How to Prevent Constipation
You can prevent constipation by following some of the same tips that are recommended to treat it. Some examples include:
- Eat a well-balanced that’s high in fiber. Fiber helps the colon pass stool. Eat plenty of fruits, vegetables, and whole-grain breads and cereals.
- Drink eight 8-ounce glasses of water a day. Avoid caffeinated beverages like coffee and soft drinks which are dehydrating. Dairy products may also cause constipation in some people.
- Get plenty of exercise: Staying active can help keep stool moving through the colon.
When to See a Doctor
Don’t worry, constipation is very rarely an emergency, and can usually be evaluated and treated at your primary care provider’s office. Do seek emergency medical care if you experience the following:
- Bloody stool
- Significant, unintentional weight loss
- Major bloating or severe abdominal pain
- Severe pain with bowel movements
- First-time constipation, especially in children
- Constipation for more than three weeks
How K Health Can Help
You don’t need to suffer through abdominal pain and bloating caused by constipation. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.