Constipation: Symptoms, causes, treatment and prevention

Constipation is a common gastrointestinal issue that affects millions of people worldwide. While it may seem like a trivial concern, constipation can have a significant impact on one’s quality of life and overall well-being.

From discomfort and pain to complications and reduced productivity, the effects of constipation can be far-reaching.

This article will explore the various facets of constipation, including its definition, common symptoms, underlying causes, and types. We will also explore the available diagnosis and treatment options through conventional approaches and natural remedies. 

It is important to note that while this article provides valuable information, it is not a substitute for professional medical advice.

Individuals experiencing chronic or severe constipation should consult a healthcare provider for accurate diagnosis and personalized treatment recommendations.

What does constipation mean?

Constipation is a gastrointestinal condition characterized by infrequent bowel movements or difficulty passing stool [1].

Normal bowel movements vary from person to person, but a general guideline is having at least three bowel movements per week. However, some individuals may have more frequent bowel movements, while others may have fewer without experiencing constipation.

Constipation is not just about the frequency of bowel movements; it also involves the consistency of the stool. When a person is constipated, their stool is often hard, dry, and difficult to pass. This can lead to discomfort and straining during bowel movements.

The root cause of constipation is the digestive system’s inability to move waste through the colon efficiently. The colon absorbs water from the waste material as it travels through, which helps in forming a stool. 

What are the symptoms of constipation?
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What are the symptoms of constipation?

Constipation manifests through various symptoms, which may vary in severity and duration. Recognizing these signs can help individuals identify and address constipation early on. 

Here are some common symptoms to be aware of:

1. Infrequent bowel movements

One of the primary indicators of constipation is having fewer bowel movements than usual [2]. If you typically have regular daily bowel movements but notice a significant decrease in frequency, it could be a sign of constipation.

2. Difficulty passing stool

Constipation often makes it challenging to pass stool comfortably. Individuals may experience straining or a sense of incomplete evacuation after a bowel movement.

3. Hard or lumpy stool

The consistency of the stool is a crucial factor in determining constipation. When constipated, the stool becomes dry, hard, and lumpy, making it difficult to pass smoothly.

4. Abdominal pain and discomfort

Constipation can cause abdominal pain and discomfort, ranging from mild cramping to more severe pain. The pain is typically localized around the lower abdomen and may subside after a bowel movement.

5. Bloating and distension

Excessive gas accumulation in the intestines can result in bloating and abdominal distension. This can lead to discomfort and a feeling of fullness.

6. Rectal bleeding

In some cases, constipation can lead to small amounts of rectal bleeding. This can occur due to the passage of hard stool, causing minor tears or fissures in the anal region.

7. Sensation of bowel obstruction

Severe constipation can give individuals a sensation of bowel obstruction or blockage. This feeling may cause anxiety and necessitate medical attention.

The presence of these symptoms does not always indicate constipation. Other underlying medical conditions may cause similar symptoms. 

However, if these symptoms persist or significantly affect your daily life, consult a healthcare professional for proper evaluation and diagnosis.

What causes constipation?

Constipation can have various underlying causes, ranging from lifestyle to medical conditions. Here are some common causes to be aware of:

1. Dietary factors and low-fiber intake

One of the primary causes of constipation is a diet low in fiber [3]. Fiber adds bulk to the stool, making it easier to pass through the digestive system. Insufficient intake of fruits, vegetables, whole grains, and other fiber-rich foods can contribute to constipation.

2. Inadequate fluid intake

Dehydration and inadequate fluid consumption can result in hardening of the stool. Without enough fluids, the body absorbs more water from the colon, leading to dry and hard stools that are difficult to pass.

3. Sedentary lifestyle and lack of physical activity

Lack of physical activity can slow down the natural contractions of the colon, making it harder for waste to move through the digestive system. Regular exercise helps stimulate bowel movements and promotes healthy digestion.

4. Medications

Certain medications can cause constipation as a side effect. Opioids, antacids containing calcium or aluminum, some antidepressants, and iron supplements are known to contribute to constipation.

5. Medical conditions

Constipation can be a symptom of underlying medical conditions like irritable bowel syndrome (IBS), hypothyroidism, diabetes, neurological disorders (e.g., Parkinson’s disease), and certain gastrointestinal disorders. These conditions can disrupt normal bowel function and contribute to constipation.

6. Hormonal changes

Hormonal fluctuations during pregnancy can affect bowel movements and lead to constipation. The hormonal changes can slow down the movement of food through the digestive tract.

7. Delaying the urge to defecate

Ignoring or delaying the urge to have a bowel movement can disrupt the natural rhythm of the digestive system. Over time, this can lead to constipation.

8. Stress and anxiety

Psychological factors like stress and anxiety can impact the functioning of the digestive system. They can alter the muscle contractions in the colon, leading to constipation.

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2 types of constipation

Constipation can be classified into different types based on the underlying causes and characteristics. Here are the two main types of constipation [4]:

Primary constipation

Functional constipation

This is the most common type of constipation and occurs when no underlying medical cause exists. It is often related to lifestyle factors, like a low-fiber diet, inadequate fluid intake, a sedentary lifestyle, or ignoring the urge to defecate. Functional constipation can be managed through lifestyle modifications and dietary changes.

Slow transit constipation

In this type, the movement of stool through the colon is slow, leading to infrequent bowel movements. It can be caused by abnormal muscle contractions in the colon or impaired nerve function. Slow transit constipation may require comprehensive treatment, including dietary changes, medications, and specialized therapies.

Secondary constipation

Medication-induced constipation

Certain medications, like opioids, antacids containing calcium or aluminum, and certain antidepressants, can cause constipation as a side effect. Managing secondary constipation involves addressing the medication regimen and exploring possible alternative options.

Medical condition-related constipation

Constipation can be a symptom of underlying medical conditions, like irritable bowel syndrome (IBS), hypothyroidism, diabetes, or neurological disorders. Treating the underlying condition is essential in managing constipation in these cases.

Anorectal disorders

Conditions like anal fissures, hemorrhoids, or rectal prolapse can cause constipation by obstructing or interfering with the normal passage of stool. Treating the underlying anorectal disorder is crucial in alleviating constipation.

How is constipation diagnosed?

Diagnosing constipation involves a comprehensive evaluation of an individual’s medical history, physical examination, and, in some cases, specialized tests [5]. 

Here are the main components of the diagnostic process:

1. Medical history

The healthcare provider will discuss your symptoms, bowel habits, and any factors contributing to constipation. 

They may inquire about your dietary habits, fluid intake, physical activity levels, and medications being taken. 

A thorough understanding of your medical history helps in identifying potential underlying causes.

2. Physical examination

A physical examination may be conducted to assess the abdomen for any abnormalities or signs of distension. Your healthcare provider may also perform a digital rectal examination to evaluate the rectal tone and check for obstructions.

3. Stool diary

A stool diary can provide valuable insights into bowel movements, including frequency, consistency, and associated symptoms. Record details about stool appearance, changes in diet, and medication use to help identify patterns and potential triggers.

4. Laboratory tests

In certain cases, laboratory tests may be ordered to rule out underlying medical conditions. Blood tests can assess thyroid function and electrolyte levels and evaluate for signs of inflammation or hormonal imbalances.

5. Imaging studies

Imaging tests, like abdominal X-rays or abdominal ultrasounds, may be performed to assess the presence of any obstructions, blockages, or structural abnormalities in the gastrointestinal tract.

6. Colorectal transit study

A colorectal transit study may be conducted in suspected slow transit constipation cases. This involves tracking the movement of markers through the digestive system to evaluate the transit time and identify any delays.

7. Anorectal function tests

Anorectal function tests assess the muscle tone and coordination of the anal sphincter and rectum. These tests may include anorectal manometry, balloon expulsion test, or defecography to evaluate the muscles’ functionality in bowel movements.

The diagnostic process may vary based on individual circumstances and the suspected underlying causes. Once the diagnosis is established, appropriate treatment and management strategies can be implemented to address constipation effectively.

how is constipation treated?
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How is constipation treated?

The treatment of constipation aims to relieve symptoms, improve bowel movements, and address the underlying causes. 

The specific approach to treatment may vary depending on the severity of constipation and the individual’s medical history. Here are the main treatment options for constipation:

1. Lifestyle modifications

  • Dietary changes: Increasing fiber intake is a key dietary modification for managing constipation [6]. Consuming fruits, vegetables, whole grains, legumes, and other high-fiber foods can help add bulk to the stool and promote regular bowel movements. It is important to gradually increase fiber intake and drink plenty of fluids to prevent further constipation.
  • Adequate fluid consumption: Drinking enough fluids, especially water, is essential for maintaining hydration and softening the stool. Aim for at least 8 glasses of water per day.
  • Regular exercise and physical activity: Engage in regular physical activity to help stimulate the natural contractions of the colon and promote healthy bowel movements.
  • Establish a routine: Create a regular schedule for bowel movements to help train your body to have more predictable and regular bowel habits.

2. Over-the-counter laxatives

  • Bulk-forming laxatives: These laxatives, like psyllium husk or methylcellulose, add bulk to the stool, making it easier to pass.
  • Osmotic laxatives: These laxatives, like polyethylene glycol or lactulose, help soften the stool by drawing water into the colon.
  • Stimulant laxatives: Laxatives like bisacodyl or senna, stimulate the muscles in the intestines, promoting bowel movements.
  • Stool softeners: These agents, such as docusate sodium, help soften the stool, making it easier to pass.

3. Prescription medications

  • Prescription-strength laxatives: In cases of chronic or severe constipation, healthcare providers may prescribe stronger medications, such as lubiprostone or linaclotide, to promote bowel movements.
  • Medications targeting specific causes: If constipation is caused by an underlying medical condition, like hypothyroidism, treating the underlying condition may alleviate constipation.

4. Biofeedback therapy

This therapy can be helpful for individuals with pelvic floor dysfunction or difficulties coordinating the muscles involved in bowel movements. 

It involves using sensors to provide feedback and help individuals learn how to control and coordinate the muscles for more effective bowel movements.

5. Surgery (in severe cases)

Surgical intervention may be considered in rare cases where constipation is severe and unresponsive to other treatments. This is typically a last resort and may involve procedures like colectomy or rectal prolapse repair.

Treatment for constipation is typically tailored to the individual’s needs and may involve a combination of lifestyle modifications, over-the-counter or prescription medications, and targeted therapies.

Natural remedies for constipation

In addition to conventional treatment options, several natural remedies can help alleviate constipation and promote regular bowel movements. 

These remedies can be adjuncts to lifestyle modifications and may relieve mild cases of constipation. Here are some natural remedies to consider:

Herbal remedies and supplements

  • Psyllium husk: Psyllium is a natural fiber supplement that can add bulk to the stool and promote regular bowel movements. It is available in powder or capsule form and should be taken with plenty of water.
  • Flaxseed: Flaxseed is rich in fiber and omega-3 fatty acids. Adding ground flaxseed to meals or beverages can help promote bowel regularity.
  • Aloe vera: Aloe vera juice or gel can have a soothing effect on the digestive system and may help relieve constipation. Choosing a high-quality, pure aloe vera and following the recommended dosage is important.

Probiotics for gut health

Probiotics are beneficial bacteria that can help regulate gut health and improve digestion. 

Probiotic-rich foods like yogurt, kefir, and sauerkraut or probiotic supplements may promote healthy bowel movements.

Essential oils for relief

  • Peppermint oil: Peppermint oil has antispasmodic properties that can help relax the muscles in the intestines and promote bowel movements. It can be diluted in carrier oil and applied topically or taken orally under the guidance of a healthcare professional.
  • Ginger oil: Ginger has long been used for digestive ailments. Ginger oil can help stimulate digestion and alleviate constipation. It can be used topically or inhaled using aromatherapy techniques.

Magnesium supplements

The mineral magnesium has laxative effects and can help relieve constipation. Magnesium supplements can be taken orally, but following the recommended dosage and consulting a healthcare professional is important, as excessive intake may cause adverse effects.

While natural remedies can be helpful for some individuals, they may not be suitable for everyone.

These should not replace lifestyle modifications or prescribed treatments. They can complement conventional approaches and provide additional support in managing constipation.

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How to prevent constipation?

Preventing constipation involves adopting healthy habits and adjusting to promote regular bowel movements and optimal digestive health. 

These are some effective strategies to help you prevent constipation:

1. Maintain a healthy diet and eat high-fiber foods

  • Include fiber-rich foods in your diet: Consume a variety of fruits, vegetables, whole grains, legumes, and nuts, which are excellent sources of dietary fiber. These foods add bulk to the stool and facilitate easier bowel movements.
  • Gradually increase fiber intake: Increase fiber intake to allow your body to adjust. Sudden and excessive increases in fiber consumption may lead to bloating and gas.
  • Choose whole grains: Opt for whole-grain bread, rice, and pasta instead of refined grains, as they retain more fiber and nutrients.

2. Increase hydration and fluid intake

  • Drink plenty of water: Staying hydrated helps maintain soft and moist stools, making passing easier. Aim to drink at least 8 glasses of water throughout the day.
  • Limit dehydrating beverages: Minimize the consumption of dehydrating beverages like caffeine and alcohol, as they can contribute to dehydration and exacerbate constipation.

3. Engage in regular exercise and physical activity

  • Keep a regular physical activity routine: Regular exercise helps stimulate bowel movements by promoting muscle contractions in the intestines. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
Engage in regular exercise and physical activity

4. Manage stress

  • Stress and anxiety management: Stress can affect digestion and contribute to constipation. Implement stress management techniques like deep breathing exercises, meditation, yoga, or engaging in hobbies to promote relaxation.

5. Maintain proper bathroom habits

  • Respond to the urge: Respond promptly when you feel the urge to have a bowel movement. Ignoring or delaying the urge can disrupt the natural rhythm of the digestive system.
  • Establish a routine: Establish a regular bathroom routine by setting aside dedicated daily time for bowel movements. Consistency can help train your body to have more predictable and regular bowel habits.

6. Avoid excessive use of laxatives

  • Minimize the use of laxatives: Overusing laxatives can lead to dependency and may worsen constipation over time. Reserve their use for occasional relief and consult a healthcare professional for guidance.

7. Try using probiotics

  • Probiotics for gut health: Incorporate probiotic-rich foods, like yogurt, kefir, or fermented vegetables, into your diet. Probiotics can help maintain a healthy balance of gut bacteria, promoting optimal digestion.

What is a serious complication of constipation?

Untreated or chronic constipation can lead to various complications affecting an individual’s health and well-being. 

Recognizing these potential complications is important in understanding the significance of managing constipation effectively. Here are some possible complications of constipation:

Hemorrhoids

Straining during bowel movements due to constipation can increase the risk of developing hemorrhoids [8]. Hemorrhoids are swollen blood vessels in the rectum or anus that can cause discomfort, pain, and rectal bleeding.

Anal fissures

Hard and dry stool associated with constipation can lead to anal fissures. These are small tears in the lining of the anus, causing pain, bleeding, and discomfort during bowel movements.

Rectal prolapse

Chronic straining during bowel movements can contribute to rectal prolapse. This occurs when the rectum protrudes through the anus, resulting in a visible bulge [9]. Rectal prolapse may require medical intervention for proper management.

Fecal impaction

Severe and prolonged constipation can lead to fecal impaction, where a large mass of hardened stool becomes stuck in the rectum. Fecal impaction can cause extreme discomfort, pain, and bloating and require medical intervention for removal.

Bowel obstruction

In rare cases, constipation can lead to a complete intestine blockage, resulting in bowel obstruction. Symptoms of bowel obstruction include severe abdominal pain, vomiting, and the inability to pass stool or gas. This is a medical emergency requiring immediate attention.

Rectocele

Chronic constipation and straining can weaken the pelvic floor muscles, leading to the development of a rectocele. A rectocele occurs when the rectum protrudes into the back wall of the vagina, causing discomfort and difficulty with bowel movements.

While complications from constipation can occur, they are relatively rare. However, individuals with chronic constipation or those experiencing severe symptoms should seek medical evaluation and treatment to prevent potential complications. 

What is the impact of constipation on life expectancy and overall health?

Though constipation is not directly linked to a decreased life expectancy, chronic or persistent constipation can indicate underlying health issues that may affect overall health and well-being. 

It is important to note that the relationship between constipation and life expectancy is complex and multifactorial. 

A healthy lifestyle, including a balanced diet, regular exercise, and stress management, can improve digestive function and overall health outcomes. 

Regular check-ups with healthcare professionals are important for monitoring and managing underlying constipation-related health conditions.

Detecting and addressing constipation early can help prevent complications and associated health risks.

Closing thoughts

Constipation is a common gastrointestinal issue that can significantly impact an individual’s quality of life and overall well-being. Understanding the symptoms, causes, treatment, and prevention strategies is crucial for effectively managing and preventing constipation.

Early detection, prompt treatment, and preventive strategies can help individuals relieve discomfort, prevent complications, and improve their overall quality of life.

It is important to remember that constipation varies from person to person, and treatment approaches should be tailored to individual needs. If experiencing chronic or severe constipation, seek professional medical advice for accurate diagnosis and personalized treatment recommendations.

Remember, a healthy digestive system is the key to unlocking a happier and healthier you.

FAQs

Is it OK if I haven’t pooped in 4 days?

Going without a bowel movement for four days isn’t normal and can cause discomfort and health risks. Seek guidance from a healthcare professional if this happens.

Should I eat if I haven’t pooped?

To prevent constipation, eat a balanced diet with fiber-rich foods like fruits, veggies, and whole grains. Stay hydrated and exercise regularly for healthy digestion.

What are the dangers of constipation?

Constipation can lead to health complications like hemorrhoids, anal fissures, and bowel obstruction. It’s important to treat it promptly to maintain digestive health.

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[1] https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253 
[2] https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes 
[3] https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation 
[4] https://www.medicalnewstoday.com/articles/types-of-constipation
[5] https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259
[6] https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment
[7] https://www.medicalnewstoday.com/articles/318694
[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation
[9] https://stanfordhealthcare.org/medical-conditions/primary-care/constipation/complications.html

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