Constipation occurs when bowel movements are less frequent in their occurrence and when the bowel movement itself is difficult to pass. There are various reasons why this could occur, and the constipation may be occasional (i.e., short-term) or chronic (i.e., long-term). Consequently, there are numerous methods and forms of treatments one can undertake to relieve constipation they may be feeling or adopt as a preventative measure to manage the condition if they are at a greater risk of experiencing it. Overall, healthcare professionals should be consulted when constipation is not corrected after three weeks, causing severe pain and stark physiological changes.
Constipation refers to the inability or struggle to pass stools or going to the toilet less frequently than normal. More specifically, this condition can manifest as:
- Hard, painful or difficult to pass bowel movements
- Hard, dry or lumpy stools
- Passing fewer than three stools per week
- A feeling of incomplete bowel movement since not all the stool has passed
Consequently, constipation evokes feelings of bloating, uncomfortableness, excessive straining and longer durations spent on the toilet.
Mechanisms of action
Constipation arises as a result of mechanisms and events that occur during the digestive process. Typically, food travels through the digestive tract where in the small intestine nutrients are absorbed from it for the body to use. Following this, the remaining partially digested food moves towards the large intestine (i.e., the colon) which absorbs water from the waste to create a solid matter called stool. This stool then travels towards the rectum where it is then passed out of the body through the anus.
Constipation predominantly occurs when too much water is absorbed by the colon from the stool travelling through the digestive tract, particularly in the colon (aka slow transit constipation). Because of this the stool dries out making it dry, hard and difficult to push out the rectum (aka rectal outlet dysfunction). It is thought that food may travel too slowly through the digestive tract therefore the colon has more time to absorb water from the waste which then results in constipation.
Generally, constipation can arise due to breakdowns or interruptions of the expected digestive pathway the stool travels through.1 Examples of such disruptions include:
- A slow-moving waste/stool through the colon
- Inability to effectively eliminate stools from the rectum thereby worsening the stool’s consistency by making it harder and drier
- Problems with the necessary muscles and nerves required to pass bowel movements
More specifically, the exact cause of constipation varies given that the condition is commonly viewed as a symptom of an underlying issue, rather than an actual condition in its own right. Nevertheless, below are the details of some of the causes of constipation.
Blockages in the colon or rectum
Such blockages contribute towards stopping or slowing the passage of stool movements through the digestive tract.
Causes of such blockages include:
- Anal fissures – i.e., small tears in the tissue lining the anus
- Bowel obstruction – i.e., blockages in the intestines
- Bowel stricture – i.e., narrowing in the intestines/colon
- Rectocele – i.e., weakening of the supportive tissue wall between the rectum and the vaginal wall
- Bowel cancer or other abdominal cancer
Nerve/Neurological problems in the colon and rectum
Certain neurological conditions affect the nervous system, therefore implicating the muscles in the colon and rectum that are required to help move stools through the intestines.
Difficulty with the pelvic muscles
The pelvic floor is a collection of muscles and ligaments that support the bladder, uterus and bowel in their functioning. Difficulties with the muscles involved in the elimination of bowel movements contribute to chronic constipation. Examples of these problems include:
- Anismus – i.e., inability to relax pelvic muscles
- Dyssynergia – i.e., incorrect/ineffective coordination of the relaxation and contraction of pelvic floor muscles
- Weakened pelvic muscles – typically caused by pregnancy, childbirth, prostate cancer and obesity
Endocrine (hormonal) conditions
Hormones are necessary for the regulation and normal upkeep of bodily processes. Therefore, diseases and conditions that alter the hormonal systems often result in constipation. Examples of these endocrine diseases/conditions include:
- Diabetes mellitus – i.e., deficient production of insulin
- Hypothyroidism (underactive thyroid gland) – i.e., deficient production of thyroid
- Hyperthyroidism (overactive thyroid gland) – i.e., excessive production of thyroid
- Hyperparathyroidism (overactive parathyroid gland) – i.e., excessive production of parathyroid hormone
Common lifestyle causes
- Poor diet lacking in fibre which is commonly found in fruits, vegetables and cereals
- Dehydration – i.e., not drinking enough fluids
- Not getting enough physical exercise
- Changes to regular routines (e.g., travelling or sleep) which affects the body’s natural systems
- Resisting the urge to go to the bathroom
- Stress, especially in excessive amounts
Taking certain medication
Taking certain medications can implicate the digestive system and the regularity and effectiveness of passing bowel movements. Examples of medication include:
- Antidepressants – Selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine and sertraline) or tricyclic antidepressants (e.g., amitriptyline)
- Allergy medication – Antihistamines (e.g., diphenhydramine)
- Anticonvulsant or seizure medication (e.g., gabapentin)
- Blood pressure medication – Beta-blockers (e.g., atenolol) alongside calcium channel blockers (e.g., diltiazem, nifedipine, verapamil)
- Non-steroid anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen)
- Iron medication (e.g., ferrous sulphate/fumarate)
- Psychiatric medication (e.g., olanzapine and clozapine)
- Strong pain medication – Narcotics containing codeine, oxycodone and hydromorphone
There are various symptoms of constipation, examples of this include:
- Fullness in the stomach or pelvic region
- Cramping of the bowels
- Aching feelings in the back
- General feelings of bloating and nausea
- Having to strain or feeling in pain when trying to pass a stool
- Feelings of heaviness, sickness or discomfort in the stomach and abdominal regions
- Feelings of incomplete bowel movement like a stool still remaining in the rectum
How to stop constipation
There are a multitude of ways to assist in inducing a bowel movement to help combat constipation that can be fast-acting or a more long-term measure. Below are different measures one can undertake or adopt to stop constipation if they are already experiencing it.
Lifestyle (dietary) changes
Increase fibre intake
Generally, increasing fibre intake helps to add bulk/volume to the stool and speeds its passage through the intestines towards the rectum and anus to be disposed of.2
- Take a fibre supplement
Supplements can be taken to induce bowel movements when a low-fibre diet is thought to be the cause of constipation.
Fibre supplements can be bought online or in stores and are good for helping you achieve the recommended daily intake of fibre. However, unlike fibre-rich foods, these supplements lack the vitamins, minerals and other nutrients associated with dietary fibre.3 Furthermore, due to their additional side effects, one should take it in small amounts and speak to a healthcare professional for further advice.
- Eat more fibre-rich foods (add to regular diet)
Fibre-rich foods help to induce bowel movements when a low-fibre diet is thought to be the cause of constipation.
There are numerous foods that are naturally rich in fibre, such as vegetables, fruit, whole grain bread and cereals. Eating more of these when constipated or simply going beyond that to integrate them into your everyday diet will prove beneficial.
Additionally, avoid foods that could potentially worsen constipation, such as chips, meat, prepared/processed foods and fast foods.
Drinking a glass of water and staying hydrated helps to induce bowel movements when dehydration is thought to be the cause of constipation.
Regular and proper hydration is critical for regular bowel movements.4 It is thought that a recommended 6-8 glasses of liquid should be consumed a day, however, the exact amount each person will require depends on their individual body and build.
There are several laxatives for relieving constipation that operate all slightly differently to assist in passing a bowel movement.5 Here are some laxatives that are available over the counter:
- Fibre supplements – Additional fibre helps to bulk up the stool thereby making it softer and easier to pass
- Laxative stimulants – Works by squeezing the intestines to force a bowel movement with effects typically taking 6-12 hours to manifest
- Laxative osmotic – Increases the secretion of intestinal fluids to help the stool pass through the colon and out of the body
- Enemas – Softens the stool by using liquid to push a stool out of the rectum
- Lubricants – Helps coat the intestinal walls to enable stools to pass more easily through the colon and out of the body
- Stool softener – Helps moisten the stool by drawing water from the intestines to prevent the stool from drying out thereby making it easier to pass
- Suppositories – Inserted directly into the rectum to soften the stool and encourage bowel movements
Certain prescription-only medications may be necessary when over-the-counter medication does not prove to be helpful or if one is suffering from irritable bowel syndrome (IBS). However, it should be noted that a prescribing professional (e.g., a doctor) must sign off or recommend this. Examples of such medication include:
- Medication that draws water into the intestines to prevent the stool from drying out and hardening, as well as helps speed up the movement of the stool. Commonly prescribed drugs include linaclotide, plecanatide and lubiprostone
- Peripherally acting mu-opioid receptor antagonists (PAMORAs) reverse the effects of opioids in the intestine to help keep the stool moving through the digestive tract.6 Commonly prescribed drugs include naloxegol and methylnaltrexone
- Serotonin t-hydroxytryptamine 4 (5-HT4) receptors, notably prucalopride, helps move the stool through the colon towards the rectum and anus for passing7
Go to the toilet when the urge strikes and get in a squatting position
Whenever you have the urge to pass a bowel do not ignore it and allow yourself plenty of time in the bathroom ideally without any interruptions or distractions.
You could also bring a small footstool with you to place your feet on to place yourself in a squatting position whilst trying to poop to help prevent straining.
Have a massage
Massages help relieve constipation by releasing gas and waste products stored in the body. There are various massages that are particularly beneficial to relieving constipation8 , and these include:
- Abdominal massages
- Colon massages (or deep abdominal/internal organ massage)
- Foot massages
- Back massages
- Perineal massages
Natural remedies (e.g., supplements and herbs)
Supplements, particularly probiotics as well as herbs and teas (e.g., clover, fennel and senna) are helpful in treating and preventing constipation.
In instances of chronic constipation where there is thought to be a blockage, rectocele or stricture causing the constipation, surgery could provide a last-resort treatment when other measures have failed. Surgery involves surgically removing a part of the colon to help tackle the root cause of chronic constipation.
How to manage/prevent constipation
There are a multitude of ways to assist in inducing a bowel movement to help regulate digestion and manage or even prevent instances of constipation. Below are different measures one can undertake or adopt to stop constipation if they are at risk of experiencing it.
Essentially, eating a well-balanced diet containing plenty of fibre, drinking plenty of fluids and avoiding dehydrating liquids (e.g., alcohol, tea and coffee) are key dietary changes that are beneficial for digestive health.3
Include fibre-rich foods in your everyday diet, such as fruits, vegetables, whole-grain bread and cereals. Meanwhile, at least 6-8 glasses of liquid should be consumed daily to ensure hydration.
Improve toilet routine
Establishing a rough schedule for going to the toilet and relieving your bowels can help ensure regularity and consistency in bowel movements. Aim to go to the toilet at a regular time and place each day. Do not attempt to resist or delay the urge to go whenever it may strike. Finally, use a stool to help you squat over the toilet to help prevent straining.
Increase physical activity
Exercise most days of the week where possible. This does not necessarily have to be intense exercise but can also include light exercise (e.g., going on a daily walk, swimming, doing yoga or taking a bike ride) to help maintain circulation in the body and promote healthy bowels.9
Training your pelvic muscles
Biofeedback therapy involves working alongside a therapist to help retrain the colon muscles to produce more regular bowel movements.10 More specifically, relaxing the pelvic floor muscles helps to pass stools more easily when on the toilet.
Keeping stress to a minimum helps promote healthy and sustainable overall bodily function.
There are numerous complications to chronic (i.e., long-term) constipation including:
- Anal fissures – Small tears in the tissue lining the anus caused by large or hard stools
- Haemorrhoids – Swollen veins in and around the anus caused by straining on the toilet
- Faecal impaction – Accumulated hardened stool stuck in the last segment of the large intestine (rectum)
- Rectal prolapse – Occurs when part of the intestine (notably a small bit of the rectum) protrudes out of the anus as a result of straining on the toilet
- Diverticulitis – An infection caused by trapped and infected stools which result in small, bulging patches in the digestive tract
- Damaged pelvic floor muscles – Caused by straining on the toilet which could result in stress urinary incontinence (i.e., urine leaking from the bladder) since damage to these muscles diminishes control one has over their bladder
When to seek medical attention
Constipation can be occasional or chronic, however, if you are experiencing any of the following symptoms then you should seek medical attention immediately:
- Dark-coloured stools
- Blood in the stool
- Severe abdominal pain
Moreover, medical attention should also be sought if you experience:
- No improvement or worsening in symptoms even after trying treatment measures (i.e., lasting three weeks)
- Worsening or continued pain when attempting bowel movements
- Diarrhoea that alternates with constipation
- Losing a lot of weight without trying
Finally, a healthcare professional should be consulted if you have any pre-existing health conditions (e.g., autoimmune conditions) and if you wish to change or alter your prescription medications.
Constipation occurs when bowel movements are less frequent in their occurrence and when the bowel movement itself is difficult to pass. Constipation can be occasional (i.e., short-term) or chronic (i.e., long-term), and it may be the result of numerous things or simply a symptom of a more serious underlying condition. Nevertheless, there are numerous methods and forms of treatments one can undertake to relieve constipation they may be feeling as well as preventative measures to manage the condition if they are at a greater risk of experiencing it. Overall, a healthcare professional should be consulted in instances where constipation is not corrected after three weeks, causing severe pain and stark physiological changes.
- Talley NJ. Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord. 2004 Jan 1 [cited 2022 Dec 22];4 Suppl 2:S3–10. Avalibale from: https://europepmc.org/article/med/15184814
- Yang J, Wang HP, Zhou L, Xu CF. Effect of dietary fiber on constipation: A meta analysis. World J Gastroenterol [Internet]. 2012 Dec 28 [cited 2022 Dec 22];18(48):7378–83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544045/
- Lambeau KV, McRorie JW. Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy. J Am Assoc Nurse Pract [Internet]. 2017 Apr [cited 2022 Dec 22];29(4):216–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/
- Boilesen SN, Tahan S, Dias FC, Melli LCFL, Morais MB de. Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence? J Pediatr (Rio J) [Internet]. 2017 Aug [cited 2022 Dec 22];93:320–7. Available from: http://www.scielo.br/j/jped/a/Yx5vpWhGqcdgfyGT6yhGSnB/abstract/?lang=en
- Liu LWC. Chronic constipation: Current treatment options. Can J Gastroenterol [Internet]. 2011 Oct [cited 2022 Dec 22];25(Suppl B):22B-28B. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206558/
- Sridharan K, Sivaramakrishnan G. Drugs for treating opioid-induced constipation: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. J Pain Symptom Manage. 2018 Feb [cited 2022 Dec 22];55(2):468-479.e1. Available from: https://pubmed.ncbi.nlm.nih.gov/28919541/
- Vazquez Roque MI, Camilleri M. 5-HT4 receptor agonist treatment of chronic constipation. Drugs of the Future [Internet]. 2011 [cited 2022 Dec 22];36(6):447–54. Available from: http://www.scopus.com/inward/record.url?scp=84952985517&partnerID=8YFLogxK
- Tang Y, Shi K, He F, Li M, Wen Y, Wang X, et al. Short and long-term efficacy of massage for functional constipation. Medicine (Baltimore) [Internet]. 2020 Jun 19 [cited 2022 Dec 22];99(25):e20698. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310914/
- De Schryver AM, Keulemans YC, Peters HP, Akkermans LM, Smout AJ, De Vries WR, et al. Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scand J Gastroenterol. 2005 Apr [cited 2022 Dec 22];40(4):422–9. Available from: https://pubmed.ncbi.nlm.nih.gov/16028436/
- Rao SSC. Biofeedback therapy for constipation in adults. Best Pract Res Clin Gastroenterol [Internet]. 2011 Feb [cited 2022 Dec 22];25(1):159–66. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073852/