Constipation is a common problem defined as infrequent, difficult or incomplete bowel movements.
At the Michigan Bowel Control Program, part of the University of Michigan Health Division of Gastroenterology, our multidisciplinary team has been trained in a variety of disciplines including gastroenterology, urogynecology, colorectal surgery, physical therapy, psychiatry, nursing and nutrition counseling. In addition, our doctors and nurses offer over 100 years of combined experience in treating chronic bowel conditions and can provide the necessary expertise to properly interpret the results of sophisticated gastrointestinal tests and provide you with an individualized treatment plan that’s right for you.
Normal bowel movement frequency may range from three bowel movements per day to three bowel movements per week. If you have less than three bowel movements a week, it’s considered to be constipation. However, constipation can have other defining features, such as:
- The passage of hard, pellet-like stools
- A decrease in typical bowel movement frequency (not necessarily less than three bowel movements a week)
- The need to strain when having a bowel movement
- A sense of incomplete evacuation of the rectum with a bowel movement
- Loss of voluntary ability to defecate and pass stool
- Loss of awareness and urge to have a bowel movement
- The need to use enemas, suppositories, oral laxatives or other means to maintain regularity of bowel movements
Causes of Constipation
There are many reasons for the development of constipation, which include dietary and lifestyle habits, medications and behavioral issues.
For some, constipation may be a symptom associated with a medical condition, such as spinal cord injury or disorder, multiple sclerosis, stroke, hypothyroidism, kidney failure or depression.
There also can be more than one underlying cause for constipation. Some of the most common causes include:
People who eat a high fiber diet are less likely to become constipated. A diet low in fiber or a diet high in fats is commonly associated with constipation. Fiber–both soluble and insoluble–is the part of fruits, vegetables and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that may be difficult to pass. Americans eat an average of 5–14 grams of fiber daily, which is short of the 25–35grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed. A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy. These fast foods or prepared foods are typically low in fiber and high in fat. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and consequently low in fiber. Fiber intake from food and fiber supplements should be assessed and customized to the individual. The type of or quantity of fiber can be utilized to influence bowel function and management. Intake of fiber from food or supplement should be titrated carefully to assess tolerance or intolerance, or possible problems with the use of fiber.
Research has not yet demonstrated that low fluid intake causes constipation or that an increase in orally ingested fluids alone effectively treats constipation. Nonetheless, many individuals report relief of their constipation with an increase intake of oral fluids. Orally ingested liquids are believed to add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. However, caution must be exercised as beverages containing caffeine, such as coffee and soft drinks, are likely to worsen one’s symptoms by promoting dehydration. Alcohol is another beverage that causes dehydration and may worsen constipation in the long run. It is important to drink fluids that hydrate the body, especially in the heat or when consuming large quantities of caffeine-containing or alcoholic beverages.
A decrease in physical activity can lead to constipation. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise. Lack of physical activity is thought to be one of the reasons constipation is more common in older people or in people with disabilities. Moreover, increased physical activity is more likely to stimulate bowel motility and improve the symptoms of constipation.
Many medications can cause constipation, including prescription and non-prescription drugs. The list below includes commonly prescribed drugs and common over-the-counter drugs that may promote constipation. Be aware that there are many other drugs not listed below that may cause constipation. If you notice the development of constipation with the use of a medication, this should be brought to the attention of your physician.
During pregnancy, people may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging also may affect bowel regularity possibly due to slowing metabolism, decreased intestinal motor activity or decreased muscle tone and strength. Finally, people may become constipated when traveling because their normal diet and daily routine are disrupted.
People who ignore the urge to have a bowel movement may eventually stop feeling the need to have one, which can lead to constipation. Some people delay having a bowel movement because they do not find it convenient to use toilets outside the home. Others ignore the urge because of emotional stress or because they are simply too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play. People also may have the lack of urge to have a bowel movement related to neurologic and muscle impairments, which can result in significant constipation and fecal loading.
IBS is a common chronic disorder causing alteration in one’s bowel habits as well as abdominal discomfort, although pain is usually relieved with bowel movement. Bowel habit alterations can include constipation, diarrhea, and a mixed pattern in which the bowels alternate between that of diarrhea and constipation. IBS is believed to occur due to disruption in the proper function of the connection between the brain and the bowels. This may include alterations in normal bowel motility, bowel secretion or bow pain sensation. IBS is therefore referred to as a functional bowel disorder. There are specific therapies for IBS that also may help the associated symptom of constipation including cognitive therapies administered by behavioral therapists with specialized training for bowel disorders.
There are a number of disorders that can physically compress, squeeze or narrow the intestines. There are other disorders that affect the nerves and muscles of the sphincter and the pelvic floor which leads to discoordinated movement and can result in afunctional obstruction. This may result in a physical barrier to the easy passage of the stool through the bowels. Such conditions may present with constipation.
A number of systemic diseases and conditions also may cause constipation. These include neurologic disorders, myopathies and metabolic and endocrine disorders. These disorders can slow the movement of stool through the colon, rectum or anus and/or can cause discoordinated defecation.
Testing for Chronic Constipation
While mild constipation is often diagnosed with a medical history and physical exam and treated with diet and exercise, those with chronic constipation generally need more extensive testing and treatment. For those with chronic constipation, it’s important for your medical team to rule out other conditions that have constipation as a symptom, such as a blockage in your intestine or colon, or irritable bowel syndrome. You may be required to have one or more tests, such as:
- Colonoscopy: Exam of the colon and rectum
- Sigmoidoscopy: Exam of the lower part of colon and rectum
- Colorectal transit study: Exam to study movement of stool through the colon
- Anorectal function test: Exam evaluating sensation of the rectum and function of the anal sphincter
- Defecography: A dynamic X-ray that evaluates the evacuation of stool from the rectum
Once testing is complete, our team of medical professionals–including those from gastroenterology, urogynecology, physical medicine and rehabilitation, colorectal surgery, physical therapy, psychiatry, nursing and nutrition counseling disciplines–work together to interpret your tests, diagnose your condition and create an individualized treatment plan.
Chronic Constipation Remedies and Treatments
There are a variety of treatments to provide constipation relief, whether the constipation is mild or severe, including:
- Diet and lifestyle adjustments: Adding fiber to your diet, drinking plenty of water, exercising and not waiting to empty your bowels can improve your constipation. Our team will discuss an adjustment plan for you if needed.
- Laxatives and prescription medications: A variety of laxatives are available. If a laxative is recommended, we will explain the different types and suggest one that is best for you. If laxatives don’t provide relief, a prescription medication may be recommended.
- Physical therapy: This treatment is used to retrain the muscles of the pelvic floor when they are not working properly. This may include the use of biofeedback, which is a treatment using visual cues to help one better understand muscle function of the pelvic floor and rectum.
- Surgery: If other treatments don’t help with chronic constipation, surgery to remove part of the colon may be necessary. Surgery may also be needed if chronic constipation causes severe rectal prolapse (where straining causes part of intestinal lining to protrude from the anus).
You should see your primary care provider if the above-mentioned lifestyle, dietary or behavioral changes do not relieve the constipation. You should see a physician right away if there are associated symptoms of blood in the stool, rectal bleeding, abdominal pain, painful bowel movements, unexplained weight loss, associated nausea or vomiting or constipation lasting more than three weeks.
If you are 45 or older, you should have a routine colonoscopy. Your physician may pursue additional testing such as lab work, radiographic studies of the bowels or manometric studies of the bowels or rectum.
For more information, read our FAQ about constipation.
To see related medical services we offer, visit the Digestive and Liver Health overview page.
Make an Appointment
To schedule an appointment to discuss chronic constipation or any other gastrointestinal problem, call us at 888-229-7408.
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