Causes, Symptoms, Treatment, and Remedies

Constipation is when bowel movements are dry, hard, sometimes painful, and occur infrequently (less than three times a week). Many potential causes of constipation exist, including medications, pregnancy, lack of physical activity, or a disease or condition.

Constipation might be relieved with home remedies, such as changes to diet and activity level. At other times, you may require the help of a healthcare provider to determine the causes and get relief.

This article explores the symptoms, causes, diagnosis, and treatment of constipation.

What Are the Symptoms of Constipation?

How often people pass stool is variable. There is a range of normal, so every person will have their own type of “regular.” What’s important is recognizing when there is a change outside of the normal and noting the symptoms and how often it is happening.

Constipation is common, especially in adults over the age of 60 years. It may happen from time to time, or it may be a frequent occurrence.

The symptoms of constipation can include:

• Abdominal discomfort, cramping, or bloating
• Difficulty passing stool
• Feeling like there is still more stool in the bowel, even after pushing
• Hard, dry, pebble-like, or or lumpy stool
• Infrequent bowel movements (less than three times a week)
• Straining during bowel movements

What Causes Constipation?

Constipation has many possible causes. This can sometimes make diagnosis and treatment difficult, especially if there is more than one reason for hard stools.

Sometimes, constipation is not a reason to worry, and it will resolve with diet, medication, or lifestyle changes. But there are also causes that need more intensive treatment because of an underlying health condition.

Lack of Fiber in Your Diet

Most people in the United States don’t get enough fiber in their diet. The Department of Agriculture recommends that adult females get 22 to 28 grams of fiber a day and adult males get 28 to 34 grams.

Increasing fiber in the diet may help prevent and relieve constipation. However, it can be challenging to get enough fiber and yet avoid symptoms such as bloating when adding more fiber. Increasing fiber slowly over time and/or working with a healthcare provider may be helpful.

Physical Inactivity

Being sedentary or not moving the body much during the day could lead to constipation in some people. A lack of activity becomes more common with age, which increases the risk of constipation.

It’s recommended that adults get at least 150 minutes of moderate-intensity physical activity each week and strength training at least twice a week.

Certain Medications

Medications and supplements could also cause constipation. The reasons for this are varied, and people respond to medicines differently, making the issue even more complicated. Some of the medications that could lead to constipation include:

Colon or Rectal Blockages

A blockage of stool is a more serious cause of constipation. This could be from a growth, such as a polyp or tumor. It could also be caused by a rectal prolapse, where a small part of the rectum comes out of the anus.

Medical Conditions

Many common medical conditions could also affect the digestive system in a way that slows it down and causes constipation. This can include:

Other Causes

Some reasons for constipation don’t fall into any of the other categories. They might cause constipation on their own or contribute to constipation that involves other causes. This can include:

• Aging
• Dehydration
• Pregnancy

Constipation in Babies and Infants

The timing of bowel movements is variable in babies, just as it is in adults. What’s more important than timing is the consistency of the stool. Signs to be aware of are dry, hard-to-pass stools that look like hard balls, as well as painful bowel movements.

In some cases, constipation in babies is caused by diet. Starting solid foods, weaning, or adding new foods could all be possible reasons for constipation. It is often transitory and improves on its own, but if there’s a cause for concern or other symptoms, such as bleeding, parents will want to talk to a healthcare provider as soon as possible.

Constipation in Pregnancy

Constipation during pregnancy is common and is usually attributed to the changes in hormones that occur during pregnancy. Pressure on the intestines from the growing fetus is another cause. Taking iron supplements can also be a contributing factor.

What Medical Treatments Help With Constipation?

The best way to deal with constipation is to address the source. However, multiple sources could exist, and it might also be difficult for some people to pinpoint the exact cause of constipation. Some treatment options can be tried to relieve constipation.

OTC Medications

Drugstores have a variety of over-the-counter (OTC) remedies for constipation. These drugs and supplements work in various ways.

Some OTC medications and supplements for constipation are:

• Fiber supplements (Citrucel, FiberCon, Metamucil) that make stool softer and easier to pass
• Mineral oil, which acts as a lubricant
• Osmotic laxatives (Milk of Magnesia, Miralax) that draw more water into the bowel
• Stimulant laxatives (Correctol, Dulcolax, Senokot) that increase contractions in the bowel
• Stool softeners that include docusate sodium (Colace, Docusate), which draws water into the stool

Prescription Medications

When constipation does not respond to lifestyle changes or OTC remedies, a healthcare provider may prescribe a medication. Some of the medications that might be used to treat constipation are:

• Amitiza (lubiprostone), an osmotic laxative
• Cholac (lactulose), an osmotic laxative
• Linzess (linaclotide) and Trulance (plecanatide), for treating constipation due to IBS and constipation of unknown origin
• Motegrity (prucalopride), which causes the bowels to increase their activity (peristalsis)
• Pizensy (lactitol), an osmotic laxative

Other Treatment Options

You may need a specialist healthcare provider to treat some causes of constipation.

If a medication causes constipation, it could help to stop that drug or to change to a different one. Always discuss medication changes with the prescribing healthcare provider to ensure appropriate treatment for your condition and as a way to prevent complications from discontinuing a medication.

Another option for constipation is acupuncture, which is placing needles into the body for healing.

For constipation due to pelvic floor dysfunction (in which the muscles that support the pelvic organs do not work properly), biofeedback (a type of therapy delivered by a specialist mental health care provider) and bowel retraining, which involves focusing on setting a regular time to have a bowel movement, may be used.

Evidence-Based Home Remedies for Constipation

Some of the evidence-based things people can do to cope with constipation are:

Other home remedies for constipation may not be backed by much research.

Herbal supplements may have some weak evidence for use in constipation. However, seeking advice from a healthcare provider before trying these supplements is important. They include:

• Rhubarb extract, which may stimulate peristalsis
• MaZiRenWan, a supplement that contains seven or more ingredients from traditional Chinese medicine

How Is Constipation Diagnosed?

A healthcare provider can help diagnose and treat constipation. The first step is to take a report from you on how often bowel movements occur, what they look like, and how it feels to have them (such as if there is pain or straining).

They will conduct a physical exam to check for signs of dehydration and abdominal changes. They may do a rectal exam.

Blood, stool, and urine tests may be performed. If there doesn’t seem to be a reason for the constipation or it is causing significant problems with quality of life or other complications, further testing might be used.

Anorectal Manometry

Anorectal manometry helps determine if the muscles in the anal sphincter are working as they should or if they are weakened in some way.

This test is fairly invasive. An enema (introducing liquid through the anus) may be given to clear out the rectum. A catheter is then placed into the rectum to measure the pressure there. The patient will then be asked to squeeze the muscles of the anus or to bear down as you would with a bowel movement. The catheter will take readings at that time.

Magnetic Resonance Imaging (MRI) Defecography

MRI defecography is an imaging study used to diagnose pelvic floor dysfunction and causes of pelvic pain and constipation. MRI uses radio waves and strong magnets to create the image.

In this study, a gel-like substance is placed in the rectum, and images are taken as you bear down and when you relax those muscles.

Colonoscopy

In a colonoscopy, a lighted tube with a camera on the end is inserted through the rectum and up through the colon. This procedure is not generally needed to diagnose constipation but may be used if there are symptoms that suggest further assessment is needed. The healthcare provider takes images and can even administer some treatments (such as removing polyps).

Possible Complications of Constipation

Constipation can clear up on its own. But it isn’t without the risk of complications, especially those caused by straining to have a bowel movement. Potential complications of constipation include:

• Anal fissures: Small, painful tears in the anal canal
• Bowel incontinence: The inability to hold in stool, which may result in soiling
• Hemorrhoids: Painful, swollen veins in or outside of the rectum
• Fecal impaction: Stool that becomes hard and cannot be passed through the rectum with a normal bowel movement
• Rectal bleeding: Always a cause for concern, even in the presence of constipation
• Rectal prolapse: When part of the rectum protrudes through the anal sphincter

When to Contact a Healthcare Provider

It isn’t always necessary to seek care for constipation because it can resolve on it’s own with lifestyle changes. However, it is something to bring up with your healthcare provider at your next visit.

A healthcare provider should investigate chronic (ongoing) constipation, especially when there are complications or the constipation is affecting your quality of life. For example, always needing to know where the bathroom is or having daily abdominal pain and bloating are reasons to talk to a healthcare provider.

People who have underlying medical conditions that could lead to constipation should also discuss it with a healthcare provider. Constipation could indicate that something is amiss with the management of that condition, and the treatment plan may need to be adjusted.

Constipation Danger Signs

When severe symptoms accompany constipation, seek medical care right away by calling 911 or going to the emergency room. These include:

• Bleeding from the rectum
• Disorientation
• Fainting, losing consciousness
• Fever
• No stool or gas is being passed from the bottom
• Severe abdominal pain
• Vomiting that won’t stop or vomiting up what looks like coffee grounds

How to Prevent Constipation

Constipation can’t always be prevented. However, when it occurs, it can help to pay attention to the signs to avoid discomfort in the future.

Steps to prevent constipation include:

• Drinking enough water and other fluids
• Eating enough fiber in the diet
• Getting regular physical activity
• Going to the bathroom at about the same time every day
• Not ignoring the urge to have a bowel movement

Summary

Constipation is common and usually not serious. However, it can cause symptoms that become problematic and affect your quality of life. The issue may be resolved with lifestyle changes and over-the-counter remedies. But if constipation becomes a regular problem, leads to complications, or is accompanied by alarming symptoms, it needs to be discussed with a healthcare provider.