Constipation symptoms, causes & treatment

Constipation happens when hard, dry stool moves slowly through the large intestine, making it difficult to have a bowel movement. Occasional constipation is common for most people and can be resolved with simple dietary or over-the-counter treatments. If constipation stems from abnormalities in the structure or function of the digestive system, it can lead to serious health concerns. This type of constipation can result in damage or closure of the intestine and may even require surgery.

Constipation symptoms

Symptoms of constipation may include:

• Fewer than three bowel movements a week
• Hard, dry or lumpy stools
• Straining or pain during a bowel movement
• Stools that are difficult to pass
• A feeling that not all stool has passed

Constipation causes and risk factors

Some common causes of constipation include:

• Age (about 50 percent of adults over 65 have constipation)
• Anxiety
• Depression
• Cathartic colon (caused by overuse of stimulant laxatives)
• Stress
• Low fiber diet
• Inadequate fluid intake
• Lack of regular exercise
• Putting off bowel movements
• Irritable bowel syndrome (IBS)
• Sex (women are two to three times more likely to have constipation than men)
• Medication side effects
• Pregnancy
• Hypothyroid disorder
• Pelvic floor or outlet dysfunction (When nerves and muscles in the pelvic area aren’t working properly, it can become difficult to sense stool in the rectum or contract the muscles used during bowel movements.)

Constipation diagnosis

Usually, constipation is not serious. Your doctor will ask you about your potential symptoms of constipation and your bowel movements, and may perform a rectal exam to check for hemorrhoids or fissures. If you’re experiencing frequent constipation, fecal impaction or other more serious symptoms, the doctor may order additional tests to study your digestive system more closely. Some of these tests might include:

• Anal sphincter electromyography (EMG): This test determines whether your anal muscle (sphincter) and nerves are working correctly.
• Anorectal manometry: This test measures the strength of the anal sphincter muscles, movement of the rectal and anal muscles and sensation in the rectum and nerve reflexes needed for bowel movements.
• Colonoscopy: Although most often given to screen for colon cancer, this test also can be used to examine the colon for issues that could be causing constipation.
• MRI or CT scan: These tests provide high quality images of all or parts of the digestive tract.
• Double-contrast barium enema: This specialized X-ray helps show the intestines and rectum. You drink liquid barium before the test to help illuminate the digestive tract.
• Double balloon endoscopy: A long tube (endoscope) is inserted down the throat to see from the esophagus to the colon.
• Capsule endoscopy: For this test, you swallow a capsule that contains a tiny camera that records video of your digestive tract. Your doctor will review the pictures to see what may be causing your constipation.

Constipation complications

The most common complications associated with constipation are discomfort and irritation that can lead to:

• Hemorrhoids
• Rectal bleeding
• Anal fissures (tears in skin around the anus)

Sometimes difficulty passing a bowel movement can cause more serious complications such as:

• Fecal impaction – Hard, dry stool is stuck in the body and unable to be expelled naturally.
• Rectal prolapse – The large intestine detaches inside the body and pushes out of the rectum, stretching the anus muscles and pelvic nerves.

Constipation treatment

There are many options for treating constipation, depending on frequency and severity. For occasional constipation, your doctor will advise changes to your diet and exercise habits or over-the-counter laxatives or supplements. If you have chronic constipation or complications, your doctor may order further testing and treatment.

Diet and exercise

Simple changes to your daily routine can do a lot to stop constipation. Your doctor may recommend drinking more water and other clear fluids, getting more exercise to stimulate the bowels and increasing your fiber intake (20 to 35 grams per day). Whole grains, fruits and vegetables contain a lot of fiber. Some of the best foods to eat for constipation include:

• Raspberries and blackberries
• Pears
• Popcorn
• Watermelon
• Oatmeal
• Almonds
• Prunes
• Leafy green vegetables such as spinach, turnip greens and kale
• Lentils
• Yogurt

Stay away from these foods if you have constipation:

• Processed grains such as white rice, white bread and pasta
• Cow’s milk and cheese
• Red meat
• Fried foods
• Eggs

Over-the-counter treatments

If diet and exercise changes don’t bring relief, your doctor may recommend over-the-counter aids to help stool pass more easily. Some of these might include:

• Fiber supplements
• Bulk-forming laxatives
• Stimulant laxatives
• Stool softeners
• Saline laxatives
• Lubricants
• Probiotics (Ask your health care provider to help you choose the best kind.)

Nonsurgical treatment

Your doctor may prescribe one or more of the treatments below if diet, exercise and over-the-counter aids don’t work or you’re experiencing more serious symptoms of constipation.

• Prescription medication
• Enema
• Disimpaction procedure performed by a health care provider to break up and remove the stool if an enema doesn’t work
• Pelvic floor physical therapy including biofeedback to retrain the pelvic floor

Surgical treatment

Surgery may be required for severe cases of constipation or if there is damage to the intestines. Surgical interventions are also available to treat irregularities in the function of the gastrointestinal system that may be causing constipation. Here are two of the more common surgical procedures available:

• Sacral nerve modulation (SNM). A nerve stimulator is implanted at the base of your spine to give off pulses to nerves in that area prompting more regular bowel movements.
• Colectomy. A surgeon removes damaged portions or all of your colon. If all of the colon is removed, stool is then collected outside the body.