Constipation is a common digestive complaint. Most bouts of constipation are short-term, or “acute.” However, some people experience long-term symptoms, known as chronic constipation.
Chronic constipation can be uncomfortable and can interfere with a person’s day-to-day functioning. While some causes of the condition are relatively benign and highly treatable, others can be more serious.
This article outlines what chronic constipation is, including its symptoms and causes. We also outline information on treating and preventing chronic constipation, and offer advice on when to see a doctor.
Everyone experiences constipation at some point. Most cases of constipation are short-term or acute. These often occur following a change in diet or exercise habits, and is treatable with over-the-counter (OTC) medications.
In rarer cases, constipation may be chronic, meaning symptoms are long-lasting. Doctors consider constipation chronic if it:
- lasts for 3 months or more
- disrupts a person’s life and daily functioning
- does not resolve following a change in diet or exercise
- only resolves with prescription medications
To receive a diagnosis of chronic constipation, a person must experience at least three of the following symptoms within a 3-month period:
- passing fewer than three stools a week
- passing stools that are hard, lumpy or pebble-like
- straining to empty the bowel
- feeling that the rectum is not completely empty after a bowel movement
- feeling as if there is a blockage in the rectum
- needing help to empty the rectum, either by pressing on the abdomen or by inserting a finger to remove a lodged stool
Secondary symptoms of chronic constipation include:
- abdominal pain
- loss of appetite
Although people with chronic constipation experience similar symptoms, the cause of constipation may vary.
The most common triggers of constipation include:
- slow movement of stool through the colon
- difficulty eating a balanced diet, with a lack of fiber from fruit and vegetables
- inadequate fluid intake leading to dehydration
- lack of exercise leading to slowed digestion
- irritable bowel syndrome
- side effects of medications
- mental health problems, including:
Less common causes
Less common causes of constipation include:
- hormonal imbalances, such as hyperthyroidism
- conditions that affect the metabolism, such as diabetes
- disorders that affect the brain and spine, such as Parkinson’s disease
- celiac disease
- inflammation linked to diverticular disease or proctitis
- an obstruction in the intestines or rectum
- family history of constipation
Certain dietary supplements and medications can also trigger constipation. These include:
- iron supplements
- calcium supplements
- calcium channel blockers
- certain antidepressants
- medications to treat Parkinson’s disease
It may not always be possible to determine what causes constipation. Chronic constipation that occurs without a known trigger is known as chronic idiopathic constipation.
Treatments for chronic constipation may vary according to its severity and its underlying cause. Some possible treatment options are below.
Diet and lifestyle changes
The first-line treatment for chronic constipation is to make any necessary diet and lifestyle changes. These may include:
Increasing fiber intake
Dietary fiber adds bulk to the stool, enabling it to pass through the intestines more quickly. A doctor may advise gradually increasing fiber intake by introducing more fruit and vegetables into the diet. Switching from refined grains to whole grains will also help boost fiber intake.
Water softens stools, allowing them to pass smoothly through the intestines and rectum.
Increasing physical activity
Regular movement increases muscle activity in the intestines, helping stools pass through the digestive system. Therefore, increasing physical activity encourages more regular bowel movements.
Going to the bathroom when the urge arises
If a person routinely ignores their body’s signals to poop, they may no longer experience the urge for a bowel movement, which can worsen constipation.
If diet and lifestyle changes are not effective, a person may wish to try OTC medications to soften the stool or increase bowel movements. Some options include:
- fiber supplements, such as psyllium, which add bulk to the stool
- stool softeners, such as Surfak, which draw water from the intestines to moisten the stool
- osmotics, such as Phillips’ Milk of Magnesia, which increase fluid in the colon
- lubricants, such as olive oil, which help the stool pass smoothly
- stimulants, such as Senokot, which cause the intestines to contract
- enemas and suppositories to provide lubrication and stimulation
If OTC laxatives and natural remedies do not alleviate a person’s constipation, a doctor may recommend a prescription medication. The drugs lubiprostone (Amitiza) and linaclotide (Linzess) are generally effective in treating chronic constipation.
Biofeedback training (BT) is a type of behavioral therapy that aims to treat constipation and other types of bowel dysfunction.
BT involves learning how to relax and tighten the pelvic muscles that support the bladder and bowel. Relaxing these muscles at the right time can increase the likelihood of a successful bowel movement.
During BT, a therapist may insert a long tube called a catheter into the rectum to measure tension in the muscles. They will then talk the person through a series of exercises to help relax and tighten the muscles.
An older study from 2006 compared the efficacy of BT and laxative use among people with pelvic floor issues. The researchers found BT was more effective.
Surgery for chronic constipation is rare. However, a person may require surgical interventions to remove a bowel blockage or part of a diseased colon.
The best way to prevent constipation is to adopt lifestyle habits that promote good digestion. Examples include:
- eating a balanced diet
- drinking plenty of fluids
- exercising regularly
- getting enough sleep
- sticking to regular sleeping and waking times
- going to the bathroom when the urge arises
The following groups are at increased risk of experiencing chronic constipation:
- people over the age of 65 years
- females, particularly those who are pregnant
- people with limited mobility
- people taking certain medications
- people with mental health conditions, such as anxiety, depression, or an eating disorder
Passing hard stools or constantly straining to poop can lead to complications, such as:
- anal fissures, which are small tears inside the anus
- hemorrhoids, which are swollen veins in the anus
- fecal impaction, an accumulation of hardened stool inside the intestine
- rectal prolapse, where an area of the rectum stretches and protrudes from the anus
Chronic constipation is rarely the result of a serious underlying condition. It usually improves with lifestyle changes and OTC treatments.
A person should speak with their doctor if the above treatments do not ease their constipation. A doctor may recommend tests to check for underlying health issues.
In very rare cases, chronic constipation may be a sign of colorectal cancer.
A person should talk with their doctor if they experience chronic constipation that affects their physical or mental health or their day-to-day life.
People should also speak with a doctor if their constipation accompanies any of the following symptoms:
Chronic constipation can be uncomfortable and disabling. However, there are treatments that can help ease constipation and its symptoms.
Dietary and lifestyle changes are typically the first-line treatment for constipation. If these are ineffective, a person may try OTC remedies to help soften stools or encourage bowel movements.
People should speak with their doctor if they experience chronic constipation that does not respond to lifestyle changes or OTC treatments. A doctor may prescribe medications to ease their symptoms. They may also recommend tests to check for any underlying health conditions.