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Key takeaways
Constipation, affecting around 4 million Americans, is characterized by having fewer than three bowel movements per week and can be caused by lifestyle factors, certain medications and supplements, and various health conditions.
Symptoms of constipation include having fewer than three bowel movements per week, passing hard or dry stools, experiencing painful bowel movements, and feeling incomplete evacuation.
Lifestyle changes recommended for treating constipation include increasing fluid intake, engaging in physical activity, and adding high-fiber foods to the diet, with severe cases possibly requiring laxatives or prescription medications.
If constipation persists for more than two weeks or is accompanied by symptoms such as abdominal pain, rectal bleeding, or weight loss, it is important to seek medical advice, as these could indicate more serious conditions.
Can’t poop? You’re not alone! Around 4 million Americans frequently experience constipation, defined by the Mayo Clinic as fewer than three bowel movements per week. While it’s normal to get backed up from time to time, constipation and chronic constipation (difficulty passing stools for more than three weeks), can cause an array of uncomfortable symptoms.
So what causes this condition and how long does a typical bout of constipation last? Here’s what you need to know—plus when to be concerned.
What causes constipation?
There are many causes of constipation, including lifestyle factors, medications, and even dietary supplements, says Pratima Dibba, MD, a board-certified gastroenterologist at Medical Offices of Manhattan. Some health conditions can cause it too, like Parkinson’s disease, diabetes, hypothyroidism, and celiac disease.
Symptoms of constipation include:
- Having fewer than three bowel movements per week
- Passing hard, lumpy, or dry stools
- Having stools that are painful and/or difficult to pass
- Feeling like not all of your stool has passed
Medications and supplements that cause constipation
Certain prescription and over-the-counter treatments can lead to constipation. They include the following.
- Opioid medications: Pain relievers like Percocet and Oxycontin (which are controlled substances) improve severe pain, but they also cause constipation, says Dr. Dibba. According to research, that’s because these meds inhibit gastric emptying (the time it takes for food to leave the stomach) and reduce the motility of the intestines. As a result, more fluid is absorbed from the GI tract, leading to harder stools and constipation.
- Antidepressants: Tricyclic antidepressants, like amitriptyline and nortriptyline, and the selective serotonin reuptake inhibitor Prozac can affect the normal functioning of the digestive tract, leading to constipation.
- Blood pressure medications: Calcium channel blockers like amlodipine and beta blockers like metoprolol cause constipation by relaxing smooth muscles in the intestine and affecting motility.
- Anticholinergic medications: Anticholinergics can result in constipation as they inhibit acetylcholine, a chemical that’s important for gut motility at the muscular level, explains Dr. Dibba. Examples of anticholinergics include prescription medications such as the urinary incontinence drugs oxybutynin and tolterodine.
- Iron supplements: It’s unclear why iron supplements cause constipation, but Dr. Dibble says it is theorized that iron causes an osmotic effect in the intestine, pulling water out of the stool and causing stool hardening/constipation.
RELATED: 8 medications that cause constipation
Lifestyle factors that cause constipation
According to Sony Sherpa, MD, a holistic physician with Nature’s Rise in Sacramento, California, lifestyle factors are common culprits behind constipation. They include:
- Inadequate dietary fiber intake: Dietary fiber helps promote regularity and softens stool, making it easier to pass, says Dr. Sherpa.
- Inactive lifestyle: Physical activity increases the speed that food moves through the intestines (peristalsis), helping to reduce the risk of constipation; a sedentary lifestyle slows peristalsis down, potentially leading to constipation, explains Dr. Sherpa.
- Dehydration: Not drinking enough water slows down the movement of food through the digestive system, resulting in harder stools that are more difficult to pass, says Dr. Sherpa.
- Excessive consumption of processed foods: Processed and refined foods typically lack adequate amounts of dietary fiber, which is essential for regular bowel movements, says Dr. Sherpa. Prunes are great, but if you aren’t a fan, include cereals and bread made from whole grains in your diet.
- Travel: Dr. Dibba says that several factors during travel contribute to constipation, including dietary changes, decreased hydration, limited physical activity, altered sleep cycle, and even feeling uncomfortable using unfamiliar restrooms.
- Dairy intake: Although most people with lactose intolerance present with diarrhea, some may develop constipation as a result of dairy intake, says Dr. Dibba.
- Stress: Stress, specifically in patients with an underlying irritable bowel syndrome (IBS), can trigger constipation, says Dr. Dibba. This is attributed to a neuroenteric connection (between the brain and the gut) that manifests as constipation when a person experiences stress, anxiety, or depression, she explains.
How long does constipation last?
Constipation can be acute or chronic, says Dr. Dibba. In other words, your constipation might be short-term, lasting days to weeks, or long-term, lasting from weeks to years. It can go away on its own, but that’s not always the case, she says. Going more than three days without having a bowel movement is too long because the stool becomes hard and more difficult to pass.
Symptoms that are related to a reversible cause may be short-term, while patients on certain chronic medications or with certain medical conditions may have lifelong symptoms, Dr. Dibba explains, adding that chronic constipation can be intermittent or persistent. If your constipation lasts longer than two weeks, it’s time to see your healthcare provider.
The four types of chronic constipation
Chronic constipation is common among patients of all ages. The four types of chronic constipation include:
- Normal transit constipation refers to a normal frequency of bowel movements, however with hard, lumpy, or difficult-to-pass stool.
- Slow transit constipation occurs when stool transit is delayed in the colon, otherwise known as colonic inertia, says Dr. Dibba. It’s thought to be caused by dysfunction of the colonic muscles or nerves.
- Dyssynergic defecation (DD) occurs when there is difficulty evacuating stool from the anorectal area, says Dr. Dibba. It’s thought to be secondary to pelvic floor dysfunction, which causes narrowing of the anorectal angle and an increase of pressure within the anal canal, she explains. It results in the ineffective expulsion of stool from the rectum.
- Slow transit-dyssynergic combination occurs when patients experience both slow transit and dyssynergic defecation simultaneously, says Dr. Dibba.
In addition to the four types of chronic constipation, there are certain events and occasions when constipation is more likely to occur. These include after surgery, during menstruation when a person is pregnant, or when they quit smoking.
Constipation after surgery can be attributed to opioid pain medications, lack of adequate physical activity, manipulation of the intestines during surgery, electrolyte abnormalities, underlying medical conditions, or complications of surgery. It usually resolves within a few days.
RELATED: What you need to know about constipation after surgery
Menstruation can cause constipation around ovulation and for several days after due to fluctuations in the hormone progesterone. Similarly, constipation can occur throughout all three trimesters of pregnancy due to increases in the hormone progesterone, pressure on the bowel from the developing fetus, and lifestyle factors like decreased activity, water consumption, and fiber intake.
Constipation has been reported as a side effect of tobacco withdrawal, but more research is needed to determine the exact mechanism by which this occurs.
Constipation complications
If untreated, constipation can lead to these common complications:
- Discomfort
- Excessive bloating
- Irritation
- Hemorrhoids
- Rectal bleeding
- Anal fissures (tears)
In more severe cases, the following can occur:
- Rectal prolapse is when the bottom part of the large intestine loosens from inside the body and protrudes from the rectum. This can lead to serious complications that require immediate medical attention, such as heavy bleeding and severe prolapse that can’t be pushed back into the body.
- Fecal impaction is when stool becomes so hard and dry that it cannot be passed, and remains in the body. This can cause issues including bowel perforation, ulcers, bleeding, and uncontrollable bowel movements.
Treatments for constipation
Lifestyle modifications are the first line of intervention for constipation, says Dr. Dibba. This includes drinking enough fluids each day (3.7 liters of water for men and 2.7 liters for women), physical activity (about 30 minutes per day), and adding high-fiber foods to your diet (aim for 25-35 grams per day). Dr. Sherpa advises consuming foods rich in probiotics such as yogurt, kefir, and sauerkraut, which promote healthy bacteria in the gut, aid digestion, and reduce constipation. Additionally, caffeine increases peristalsis in the large intestine, which can promote bowel movements.
If lifestyle changes don’t work, Dr. Dibba recommends trying bulk-forming laxatives, which include Metamucil (psyllium husk), Citrucel (methylcellulose), Benefiber (wheat dextrin), and Fibercon (polycarbophil). Stool softeners, such as Colace, or saline enemas may also be used.
Severe constipation can be treated with osmotic laxatives such as Miralax (polyethylene glycol), Milk of Magnesia, or Constulose (lactulose). And if those don’t work, she says prescription medications called colon secretagogues including Amitiza (lubiprostone), Linzess (linaclotide), and Trulance (plecanatide) may be prescribed by your healthcare provider.
Stimulant laxatives such as senna and Dulcolax (bisacodyl) are effective, but they are not suggested for long-term use, Dr. Dibba advises.
When to see a healthcare provider
If your symptoms do not improve with lifestyle changes such as adequate dietary fiber intake, hydration, or physical activity, consult with your healthcare provider, advises Dr. Dibba.
“You should also seek medical attention if you have associated symptoms such as abdominal pain, abdominal distention, rectal bleeding, or weight loss,” she says. These can be signs of colon cancer and other serious conditions.
Your provider can guide you regarding when it is appropriate to go to the ER for constipation-related issues such as impaction.
