Constipation: Causes, Relief, and Treatment Options

Constipation means stools that are hard, lumpy, infrequent, or difficult to pass. Many people with constipation have fewer than three bowel movements a week or strain often. It is very common and usually treatable.

Symptoms

• Hard or lumpy stools
• Fewer than three bowel movements a week
• Straining
• Feeling that you cannot fully empty your bowels
• Feeling blocked
• Needing to press on your belly or use a finger to help pass stool

Causes

• Diet and habits: low fiber, not enough fluids, inactivity, and ignoring the urge to go.
• Medicines: opioid pain medicines, iron, calcium, some antidepressants, antihistamines, and some blood pressure medicines (such as verapamil).
• Slow colon transit, when stool moves slowly through the colon.
• Pelvic floor dysfunction, when the muscles used to pass stool do not relax or work together.
• Irritable bowel syndrome with constipation (IBS-C), when belly pain and bloating come with constipation. See IBS.
• Medical conditions: diabetes, underactive thyroid, high calcium, pregnancy, Parkinson's disease, multiple sclerosis, stroke, and spinal cord injury.
• Blockage or narrowing: colon or rectal cancer, strictures, rectocele, or rectal prolapse.

When to see a gastroenterologist

See us if constipation lasts more than a few weeks or keeps returning, or right away if you have:

• Blood in the stool
• Unexplained weight loss or anemia
• Severe belly pain or vomiting
• A new change in bowel habits, especially after age 45
• A family history of colon cancer

Testing

Most people need only a history and exam. Depending on your symptoms, we may check blood tests (blood count, thyroid, calcium), recommend a colonoscopy, or test how the bowel and pelvic floor work with anorectal manometry or a motility capsule test.

Treatment options

Lifestyle and diet

• Eat 25 to 35 grams of fiber a day from vegetables, fruit, beans, and whole grains. Add fiber slowly to limit gas.
• Try prunes (or prune juice) or two green kiwifruit a day, which help many people.
• Drink enough fluids, especially when increasing fiber.
• Be physically active.
• Go when you feel the urge, and try to sit on the toilet at the same time each day, about 15 to 30 minutes after a meal. A footstool that raises your knees can make it easier.

Over-the-counter medicines

• Fiber supplements: psyllium (Metamucil) works best; methylcellulose (Citrucel) and polycarbophil are other options. Take with plenty of water.
• Osmotic laxatives: polyethylene glycol (Miralax) is safe for daily long-term use. Magnesium oxide or magnesium citrate also work but should be avoided with kidney disease.
• Stimulant laxatives: senna (Senokot) and bisacodyl (Dulcolax) make the bowel contract. They are fine for occasional or regular use as directed.
• Stool softeners: docusate (Colace) is gentle but less effective.
• Suppositories and enemas: glycerin or bisacodyl suppositories, or a mineral oil enema, for hard stool low in the rectum.

Prescription medicines

• Linaclotide (Linzess) and plecanatide (Trulance): draw water into the intestine; approved for chronic constipation and IBS-C.
• Lubiprostone (Amitiza): softens stool; approved for chronic constipation, IBS-C in women, and opioid-induced constipation.
• Prucalopride (Motegrity): helps the colon move stool along; approved for chronic constipation.
• Tenapanor (Ibsrela): approved for IBS-C.
• Opioid-induced constipation: naloxegol (Movantik), methylnaltrexone (Relistor), and naldemedine (Symproic).
• Vibrating capsule (Vibrant): a swallowed capsule approved for chronic constipation that does not respond to laxatives.

Biofeedback therapy

If testing shows pelvic floor dysfunction, biofeedback with a specialized physical therapist teaches the muscles to relax and work together. It helps most people with this problem and works better than laxatives alone.

Surgery

Surgery is rarely needed. It is considered only for severe slow-transit constipation or structural problems such as a large rectocele or rectal prolapse.

Possible complications

• Hemorrhoids from straining
• Anal fissures (small tears) from hard stools
• Fecal impaction, when hard stool gets stuck in the rectum
• Rectal prolapse from long-term straining

Make an appointment

Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.

This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.