Top Health Science 
Constipation is one of the most common digestive complaints worldwide, affecting up to 20% of the population. It’s more prevalent among women and tends to occur more frequently with age. While occasional constipation is often harmless, chronic constipation can significantly impact quality of life and may signal a more serious underlying condition.
This post covers everything you need to know about constipation — what it is, why it happens, how to treat it, and when to see a doctor.
What is Constipation?
Medically, constipation is defined as having fewer than three bowel movements per week, passing hard or lumpy stools, experiencing straining during bowel movements, or feeling a sense of incomplete evacuation.
To be diagnosed with chronic constipation, symptoms must be present for at least 3 months and have started at least 6 months prior to diagnosis. It’s important to differentiate constipation from conditions like irritable bowel syndrome (IBS), where abdominal pain is a prominent feature.
Common Symptoms
- Infrequent bowel movements (less than 3 times per week)
- Hard, dry, or lumpy stools
- Straining or pain during bowel movements
- A sensation of incomplete evacuation
- A feeling of rectal blockage
- Needing manual assistance (e.g., using fingers) to pass stool
Causes of Constipation
Constipation can be classified into two major categories:
✅ Primary (Functional) Constipation
This occurs without any identifiable medical cause and is often related to dysfunction in the colon or pelvic floor.
- Slow Transit Constipation: The colon moves waste too slowly, often due to decreased peristalsis.
- Dyssynergic Defecation: Pelvic floor muscles fail to coordinate properly during bowel movements.
- Normal Transit Constipation: The colon functions normally, but patients perceive difficulty due to other factors like lifestyle or psychological stress.
✅ Secondary Constipation
This is caused by underlying conditions or external factors, such as:
- Endocrine/Metabolic: Hypothyroidism, diabetes
- Neurological: Parkinson’s disease, dementia, spinal cord injury
- Gastrointestinal: Colon cancer, rectal prolapse, anal stricture
- Medications: Opioids, antidepressants, antacids with aluminum or calcium, iron supplements
- Psychological: Depression, eating disorders
Pathophysiology: How Constipation Happens
Normal defecation involves coordinated muscle activity from the colon, rectum, and anal sphincters. Disruption in this coordination, slow bowel transit, or impaired rectal sensation can all contribute to constipation.
Key dysfunctions include:
- Anal dyssynergia: Involuntary tightening of anal sphincters during attempts to defecate
- Colonic inertia: Significantly reduced muscle contractions in the colon
Diagnosis: How Is Constipation Evaluated?
If you’re experiencing persistent symptoms, healthcare providers may perform a combination of the following:
1. Medical History and Physical Exam
- Symptom duration and severity
- Alarm signs: weight loss, rectal bleeding, anemia
- Neurological and pelvic floor assessments
2. Digital Rectal Exam
- To detect rectal masses, fecal impaction, anal tone abnormalities
3. Bowel Movement Diary
- Helps track frequency, stool form (Bristol stool chart), and lifestyle factors
4. Colonic Transit Study
- Using radiopaque markers to evaluate the time it takes food to travel through the colon
5. Defecography
- An imaging study performed during defecation to assess rectal function and anatomical issues
6. Anorectal Manometry
- Measures pressure and sensation in the rectum and anal canal
7. Colonoscopy
- Recommended for patients over 50 or with alarm symptoms to rule out cancer or inflammatory bowel disease
Treatment Options
1. Lifestyle and Behavioral Changes
- Never ignore the urge to go
- Set a regular toilet time, especially after meals
- Avoid sitting on the toilet for more than 10 minutes
- Use a footstool to elevate legs for optimal rectal angle
- Increase daily physical activity
2. Dietary Adjustments
✅ Fiber
- Aim for 20–30g per day
- Good sources: whole grains, beans, vegetables, fruits with skin
✅ Water
- Drink at least 2 liters of water daily
⚠️ Limit
- Red meats, processed foods, caffeine, alcohol
- Tannins from unripe fruits (e.g., persimmons, unripe bananas) may worsen constipation
Medications for Constipation
1. Bulk-forming laxatives
- Psyllium (Metamucil), methylcellulose
- Safe for long-term use
2. Osmotic laxatives
- Lactulose, polyethylene glycol (Miralax)
- Draw water into the colon to soften stool
3. Stimulant laxatives
- Bisacodyl, senna
- Use cautiously; can cause dependence
4. Magnesium salts
- Effective but avoid in kidney disease
5. Newer agents
- Prucalopride: increases intestinal motility via serotonin receptor stimulation
Non-Drug Therapies
Biofeedback Therapy
- Helps patients with pelvic floor dysfunction learn proper muscle coordination for defecation
When to See a Doctor
Seek medical advice if you experience:
- Unintended weight loss
- Rectal bleeding or bloody stools
- Persistent abdominal pain
- Anemia or fatigue
- Constipation beginning after age 50
- Family history of colorectal cancer
Constipation is a common but manageable condition. In many cases, it can be resolved with simple lifestyle and dietary changes. However, chronic or severe cases may require medical intervention, including diagnostic testing or pharmacologic therapy. Early evaluation and treatment can greatly improve outcomes and quality of life.
Maintaining a healthy gut through regular exercise, hydration, fiber intake, and proper bowel habits is the best long-term strategy for preventing constipation.
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