You may not be comfortable talking about your bathroom habits, but struggling with bowel movements that aren't regular is probably even more uncomfortable.
The reality is that you're not suffering alone.
"Constipation is an extremely common problem," says Dr. Neeharika Kalakota, a gastroenterologist at Houston Methodist. "I see patients for constipation in my clinic every single day."
As Dr. Kalakota puts it, anyone with bowels is likely to experience constipation at some point in their life.
But for something so common, most of us know very little about this issue — including when there's a simple fix and when a doctor visit is warranted.
What does constipation feel like?
For starters, it helps to know what constipation isn't.
"Having anywhere between three bowel movements a day to three bowel movements a week is within the realm of normal," explains Dr. Kalakota.
This means that if you feel fine between trips to the bathroom and your stool has a normal consistency, having bowel movements every other day isn't a reason to panic. Nor is missing one now and then.
The signs of constipation include:
- Having fewer than three bowel movements per week
- Passing extremely hard stools
- Straining to pass stools
- Experiencing pain while passing stools
- Feeling unable to fully empty your bowels
- Bloating
- Abdominal pain
"The important thing to remember here is that constipation isn't just defined as having too few bowel movements, it concerns the consistency of your stool as well," adds Dr. Kalakota. "So, if you're going every day, but you're having extremely hard stools, that's still considered constipation."
Taking action when you notice these symptoms is important since chronic constipation can lead to painful issues like hemorrhoids. In rare cases, constipation can even be a sign of a serious health condition.
What causes constipation?
The most common reason for constipation also happens to have the simplest explanation.
"Whether or not your bowel movements are regular is very dependent on your fiber and water intake," Dr. Kalakota explains. "Fiber and water work together to promote proper form and consistency of your stool, helping it pass through the bowels without issue."
Lacking one or the other can result in stool that's hard or doesn't move easily, leading to constipation.
"This is by far the most common scenario for the occasional bout of constipation," says Dr. Kalakota. "If you notice that your poop is like tiny, hard pellets, but you didn't drink any water all day at work, that explains it."
Less common reasons for constipation include:
- Slow-transit constipation – occurs when the bowels don't move fast enough
- Drug-induced constipation – a number of medications can cause constipation
- Idiopathic constipation – a diagnosis in which the underlying cause is unknown
- Underlying health conditions – while rare, constipation can sometimes be a sign of severe diverticulosis, colon stricture or colon cancer
What's the easiest way to get constipation relief?
Because constipation is frequently caused by your diet or water intake, Dr. Kalakota recommends starting your search for relief there.
"Increase your water intake to 64 ounces a day at the very minimum, barring any health conditions that would prevent you from drinking that much, of course," says Dr. Kalakota. "You will also need to make it a point to get more fiber through your diet."
The recommended fiber intake for men and women is about 35 and 25 grams per day, respectively. Most Americans get only 15 grams of fiber per day, Dr. Kalakota notes.
Foods rich in fiber include:
- Whole grains
- Fresh fruits and veggies
- Oatmeal
- Chia seeds
- Flax seeds
Walking and exercise are often other good fixes for constipation, since activity gets the bowels moving.
"If constipation persists despite these interventions, you might start to consider over-the-counter constipation medications," says Dr. Kalakota.
At that point, it's probably time to see your doctor about it, too.
When should you see a doctor for constipation?
While usually nothing to worry about, there are times when even the occasional constipation is a reason to consult your doctor, including if:
- It's a very sudden change for you
- There's blood in your stool
- You're also experiencing abdominal pain, nausea or vomiting
- You have a family history of colon cancer
"These are things that make constipation more worrisome, and it's important to rule out a serious underlying health condition," says Dr. Kalakota.
Your doctor can also help you manage constipation that isn't occasional.
"Constipation is considered chronic when it lasts longer than four weeks," Dr. Kalakota says. "Chronic constipation is still often caused by lack of fiber or water, but if you're taking the steps above and still having issues, talk to your doctor."
He or she can help reinforce the lifestyle changes that encourage regular bowel movements, as well as determine whether your constipation might be caused by a medication you're taking or slow-motility issues. (Related: Home Remedies for Constipation)
How is chronic constipation treated?
"When constipation is chronic, we recommend initiating diet, hydration and exercise interventions — a lot of water, a lot of fiber, a lot of walking — and, in the meantime, we pair all of this with a laxative," explains Dr. Kalakota.
Laxatives are medications that help relieve constipation. Dr. Kalakota recommends starting with polyethylene glycol, a mild laxative that sits inside of your colon and adds water to the stool, making it easier for you to expel. Since it's not absorbed by your body, side effects are uncommon.
The other laxative options work as stimulants that activate your bowels. These can send you to the bathroom faster but also sometimes cause side effects, like cramping.
"Eventually, once the lifestyle interventions take root, most people find that they don't need to take a laxative every day, and can take them only on an as-needed basis," Dr. Kalakota adds.
In some cases, though, chronic constipation has a more complicated cause, like a medication you're taking or an underlying motility issue in your colon.
"Your doctor can review your medications and determine if any swaps can be made," says Dr. Kalakota. "But this is where working with your doctor is an important part of effectively managing constipation, so you're not taking a laxative more than you actually need to be."
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