Causes of hard-to-pass stool and what to try

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There are many possible causes of large, painful, and hard-to-pass stools.

Constipation

Constipation can cause stools that are hard to pass. The National Institute of Diabetes and Digestive and Kidney Diseases notes that constipation is a common condition, affecting about 16 out of 100 adults in the United States. Among those aged 60 years and over, it affects 33 out of 100 people.

Possible causes of constipation include:

• older age
• lack of fiber in the diet
• travel
• ignoring the need to have a bowel movement
• dehydration
• lack of physical activity
• changes in diet or eating habits

The symptoms of constipation may include:

• fewer than three bowel movements in a week
• hard, dry, or lumpy stools
• difficulty passing a stool or pain on doing so
• the feeling of an incomplete bowel movement

Fecal impaction

Fecal impaction is a condition in which the body is unable to move a large, dry, hard stool through the colon or rectum.

Causes of fecal impaction can include:

• overuse of laxatives
• some types of pain medication
• lack of physical activity over an extended period
• dietary changes
• untreated constipation

The symptoms can include:

• inability to pass a stool
• stomach or back pain
• difficulty urinating
• nausea
• vomiting
• diarrhea that leaks out
• changes in breathing or heartbeat

Fecal impaction can be dangerous without treatment, so a person should seek medical help straight away if they have symptoms of fecal impaction.

Bowel obstruction

A bowel obstruction is a severe condition in which an obstruction in the intestines blocks the normal digestion process. As a result, it can be difficult or impossible to move stools through to the rectum.

Possible causes of a bowel obstruction include:

• foreign objects in the intestines
• abnormal twists or growths of the intestines
• inflammatory bowel disease
• a tumor
• scarring after surgery or infection
• a hernia

The symptoms can include:

• severe stomach pain or cramping
• vomiting
• a swollen or full-feeling stomach
• constipation
• inability to pass gas
• loud sounds coming from the stomach

A bowel obstruction is an emergency, and a person will need medical help immediately.

Hypothyroidism

In people with hypothyroidism, the thyroid is unable to produce enough of the thyroid hormones, which affects many bodily functions.

Hypothyroidism can cause constipation. Other symptoms may include:

• fatigue
• dry skin and hair
• being unable to tolerate the cold
• depression
• unexplained weight gain

Hypothyroidism is more common in people assigned female at birth and those over the age of 60 years.

Irritable bowel syndrome (IBS)

IBS is a digestive issue that causes abdominal discomfort and frequent changes in bowel movements.

The symptoms may include:

• stomach pain
• constipation
• diarrhea
• bloating
• gas
• mucus in the stool
• headaches
• nausea
• fatigue

There is no clear cause of IBS, but triggers can include:

• stress
• certain foods or drinks
• bacterial infection or overgrowth in the gut
• mental health disorders

Encopresis

Encopresis refers to children over 4 years of age being unable to control their bowel movements. Long-term constipation can cause encopresis.

The symptoms include:

• soiling of clothing or defecating on the floor
• painful, hard-to-pass stools
• large stools that may clog the toilet
• leaking of liquid stools

Pregnancy

Constipation can be a common symptom in pregnancy, when it can be due to:

• changing hormones affecting the digestive system
• the developing baby pressing down on the intestines
• reduced physical activity
• dietary changes

People may experience:

• hard, lumpy stools
• the feeling of an incomplete bowel movement
• straining
• infrequent bowel movements

Learn more about constipation during pregnancy.

Medications

Certain medications and supplements can cause hard-to-pass stools, including:

• antacids with aluminum and calcium
• antiseizure medications
• calcium channel blockers
• diuretics
• iron supplements
• Parkinson’s disease medications
• narcotics
• medications to treat muscle spasms
• some antidepressants

Depending on the underlying cause, a person may be able to manage large, painful, and difficult-to-pass stools with home remedies and medical treatments.

Home remedies

People may be able to treat large, hard-to-pass stools by making adjustments to their daily routine, such as:

• increasing fiber intake by eating more:
  • fruits
  • vegetables
  • whole grains
  • legumes
  • nuts
• increasing water intake
• avoiding low fiber foods, such as processed and fast foods
• doing more physical activity
• allowing time to have a bowel movement at a regular time of the day
• eating meals at regular times and chewing thoroughly
• responding to any urge to go to the toilet
• avoiding straining or sitting on the toilet for too long

Learn more about natural remedies for constipation.

Medical treatments

If people do not find home remedies effective, or if they have severe or additional symptoms, they may need medical treatment.

Depending on the underlying cause, treatment may involve:

• laxatives, stool softeners, or fiber supplements
• prescription medication to encourage bowel movements
• biofeedback therapy to retrain the muscles responsible for bowel movements
• changing an existing medication if this is a potential cause
• the manual removal of stools, if necessary
• surgery to repair the colon or treat a rectal prolapse
• therapy and positive toilet training techniques for children with encopresis
• following a specific treatment plan for conditions such as IBS

A pregnant person can contact their doctor for advice on which treatments may be safe for them.

People should also contact their doctor if they have symptoms of fecal impaction. Treatments may include:

• enemas or suppositories to soften the stool
• the manual removal of the stool from the rectum
• laxatives and increased water and fiber intake for prevention

It is advisable to see a doctor if at-home treatments are not effective or a person has any of the following symptoms:

• constant stomach pain
• inability to make a bowel movement, but there is leaking of liquid stool
• being unable to control bowel movements
• oily or greasy stools that are difficult to flush
• hard, black stools
• blood in stools
• bleeding from the rectum
• being unable to pass gas
• vomiting
• fever
• unintentional weight loss
• lower back pain

People should seek immediate medical attention if they have symptoms of fecal impaction or intestinal obstruction.

People may be able to treat large, hard-to-pass stools by making dietary changes and other simple lifestyle adjustments.

In some cases, hard-to-pass stools can cause serious complications if a person does not get treatment. If a medical condition is causing uncomfortable bowel movements, treating or managing the condition may help relieve the symptoms.

Here are some frequently asked questions about large, hard-to-pass stool.

What do you do if your poop is too big to pass?

If stool is too large to pass, this might indicate a serious condition such as fecal impaction. This is when the body is unable to move large stool through the rectum or colon. It is important to seek immediate medical advice if a person is unable to pass stool, as it can lead to perforation, incontinence, and other complications.

How do you break up a large poop that won’t come out?

Taking laxatives can help soften a stool that is too large to pass. Dietary changes, such as consuming more fiber, may also help. If home remedies or OTC treatments do not help, it is important to contact a doctor to determine the underlying cause.

Large, hard-to-pass poop can be uncomfortable, but this issue may resolve with simple changes, such as increasing fiber intake, doing more physical activity, and drinking more water.

If home remedies are not effective, it is best to see a doctor for further treatment advice to prevent any complications.