Constipation refers to a change in bowel habits resulting in stools that are often hard, difficult to pass or less frequent, and is often accompanied by bloating. Constipation is a common problem affecting all populations from infants to the elderly and affects older adults and women more often (women have a longer, more convoluted colon to allow for increased absorption during pregnancy, which increases risk for constipation). Common causes of constipation include high-fat low-fiber diet, medications, hormonal changes, or systemic problems like diabetes and hypothyroidism.

SYMPTOMS

Symptoms of constipation include:

  • Bloating
  • Feeling toxic and sluggish
  • Increased gas production

If you’re constipated and are also having diarrhea, your diarrhea may be caused by stool overflow. Stagnant stool may be fermented by bacteria and become loose and leak out around hard, dry stool sitting in the rectum. In more severely constipated individuals, a buildup of stool can overwhelm the sphincter mechanism causing stool to leak out. Stagnating stool in the colon can also result in toxins being absorbed through the intestinal lining into the bloodstream. Hardened feces that accumulate along the lining of the colon can also lead to overgrowth of harmful bacteria and interfere with absorption of water and nutrients.

CAUSES

Since constipation is a symptom, not a disease, it’s important to uncover the root cause of your constipation, as proper functioning bowels are a determining factor in good health. Some of the most common causes of constipation include:

  • Anatomical considerations like the longer female colon or pelvic floor disorders
  • Anismus
  • Bacterial imbalance (dysbiosis, SIBO, yeast overgrowth)
  • Cancer
  • Crohn’s disease
  • Depression
  • Diet (low fiber or high in processed foods and animal products)
  • Diverticulosis
  • Gluten intolerance or celiac disease
  • Holding stool
  • Hormonal changes
  • Irritable bowel syndrome (IBS)
  • Neurological conditions like Parkinson’s disease
  • Pelvic floor disorders
  • Pregnancy
  • Rectal prolapse, intussusception, and rectocele
  • Sedentary lifestyle
  • Slow transit, colonic inertia, dysmotility
  • Stress

Observe Your Stool

Your stool can be a useful predictor in unveiling the cause(s) of your constipation. Size, shape, consistency, ease of passage, and odor of your bowel movements are all important clues. Here are some helpful signs to look for:

  • Small pebbly stool might mean diverticulosis
  • Toothpaste-thin stool could be a sign of colon cancer but also occurs commonly with diverticulosis
  • Layered concretions that look like they’ve been deposited at different times could suggest motility problems
  • Painful passage with bleeding could be a fissure
  • A foul smell could mean a parasite or bacterial overgrowth, both conditions that typically cause loose stools but that can also have the opposite effect

DIAGNOSIS

There are many different criteria for diagnosing constipation. Most are based on stool consistency, whether evacuation is complete, and the number of stools—less than 3 per week being the standard textbook definition. In general, constipated individuals experience hard, difficult to pass, and less frequent bowel movements. But you can have a bowel movement every day and still be constipated. Some people move their bowels regularly but always feel full and uncomfortable. While there’s an official guideline for diagnosis, how you feel after a bowel movement is often the most important factor.

TREATMENT

Here are the most effective lifestyle solutions for constipation:

  • Eat a fiber-rich diet, including at least six serving of vegetables daily, and take a fiber supplement like a tablespoon of ground psyllium husk daily
  • Drink more water and avoid caffeine-containing liquids, which can be dehydrating (shoot for at least 2 liters of water daily)
  • Decrease or stop the use of constipating/bloating medications, such as anti-depressants, painkillers, blood pressure medications, vitamins with iron, and antacids
  • Practice good bathroom habits: Go when you have the urge to go; sit on the toilet at approximately the same time every morning to encourage a Pavlovian-type response if you have erratic bowels; get in and out quickly to avoid sluggish bowel emptying
  • Create the right environment in your bathroom: Creating the right ambience is essential for having good bowel movements. Temperature, lighting, accessibility, and privacy —all are important
  • Change your position: Squatting is the most natural stance for having a bowel movement. A squatting position helps to straighten the anorectal angle and keeps the knees pressed up against the abdomen, increasing intra-abdominal pressure, which helps to push the stool out. Place your feet on a small stool or bench in front of the toilet to help draw your knees up and simulate a squatting position.
  • Work with a biofeedback practitioner to help relax your anal sphincter
  • Learn to make connections between your lifestyle choices and your bowel movements. 

Medications

Laxatives are often used to treat constipation. Although laxatives (not including bulk forming laxatives like psyllium husk) may resolve your constipation symptoms, they do not treat the root cause of your constipation and can create dependency if used long-term. Senna containing laxatives in particular are to be avoided because of the possibility of dependency.

Not eating enough plant fiber, not drinking enough water, being too sedentary, and medication side effects are some of the commonest causes of constipation.

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