Constipation: Common Causes, Fiber and When to See a Doctor

What it involves

NIDDK defines constipation as having fewer than three bowel movements a week, stools that are hard, dry, or lumpy, stools that are difficult or painful to pass, or a feeling that not all stool has passed. MedlinePlus adds that it is not important to have a bowel movement every day, but if your bowel habits change you should check with your provider.

Who this is for

• Adults with constipation that has lasted for weeks or keeps coming back despite more fiber and water
• Patients who started a new medicine or supplement before their bowels changed
• Patients with diabetes, thyroid problems, or other conditions that can slow digestion
• Patients who are using laxatives often and want to know whether that is safe over the long term

What to expect

• Questions about how often you go, what your stools look like, and how long this has been happening
• A review of your eating habits, activity, medicines, and supplements
• A physical exam, and blood work or other tests when the findings call for them
• A plan that starts with food, fluids, and routine, and adds medicine or a referral only if needed

Why constipation happens

NIDDK says you may be constipated for more than one reason at a time. The causes it lists include slow movement of stool through the colon, delayed emptying from pelvic floor disorders, functional gastrointestinal disorders such as irritable bowel syndrome, certain medicines and supplements, changes in daily routine, and certain health and nutrition problems. Getting too little fiber, too little fluid, or too little activity are among the everyday ones, and changes such as pregnancy, travel, or ignoring the urge to go can also play a part.

Medicines and supplements that can contribute

NIDDK names several kinds that can make constipation worse:

• Antacids that contain aluminum and calcium
• Iron supplements, narcotic pain medicines, and diuretics
• Calcium channel blockers and anticonvulsants
• Anticholinergics, antispasmodics, and some medicines for depression or Parkinson's disease

Conditions that can show up as constipation

NIDDK lists celiac disease, diabetes, hypothyroidism, diverticular disease, disorders that affect the brain and spine, and intestinal blockages among the health problems behind constipation. If your bowels slowed along with other changes, the thyroid care page and the diabetes management page describe how those conditions are followed. Constipation from iron pills is a known side effect, as the anemia and low iron guide notes. A full, tight belly often comes with constipation, and the bloating and gas guide explains the other everyday causes and what MedlinePlus suggests trying at home.

What helps at home

NIDDK says you can often treat constipation at home by eating more high-fiber foods, drinking plenty of water and other liquids, and getting regular physical activity. It says adults should get 22 to 34 grams of fiber a day depending on age and sex, and that fiber should be added a little at a time. It also describes bowel training, such as trying to have a bowel movement 15 to 45 minutes after breakfast, giving yourself enough time, and using a footstool. Do not change or stop a medicine without talking with a provider. Straining is a common trigger for hemorrhoids, and the hemorrhoids guide explains what MedlinePlus and the NIDDK say about fiber, fluids, and stool softeners.

Laxatives: short-term, with guidance

NIDDK says a health care professional may recommend a laxative for a short time and will tell you which type is best. It lists fiber supplements, osmotic agents, stool softeners, lubricants, and stimulants, and says stimulants should be used only if constipation is severe or other treatments have not worked. If you have taken laxatives for a long time and cannot go without them, NIDDK advises talking with your doctor about slowly stopping, and says your colon should start moving stool normally over time.

Signs that need a visit soon

NIDDK says to see a doctor if constipation does not go away with self-care or you have a family history of colon or rectal cancer. It says to see one right away if you also have rectal bleeding, blood in your stool, constant abdominal pain, an inability to pass gas, vomiting, fever, lower back pain, or unintended weight loss. A new change in bowel habits in an adult is also a reason to review screening, which the colorectal cancer screening guide covers.

Sources

• NIDDK — Constipation: Symptoms & Causes
• NIDDK — Constipation: Treatment
• MedlinePlus — Constipation