Constipation: Causes, Complications, Treatment and Remedies

Concerned about constipation?? This is not something people like to talk about on a regular basis, but unfortunately, it happens.

What is constipation? Constipation is generally defined by fewer than normal bowel movements (BMs) and hard stools.

What exactly is considered a “normal” time frame between bowel movements?

Everyone has their own idea of this because everyone has their own pattern and frequency. So, what may be constipation for one person may not be for another. For example, one person may have three BMs a day while another may have three BMs a week. If you have not changed your diet and your personal pattern changes (when you change from your "routine") to fewer than your normal number of BMs, you might consider constipation as the cause. With constipation, stool stays in the colon for too long for one reason or another.

Causes of Constipation

There are lots of things that give rise to constipation, including too much of certain foods (see below), irritable bowel syndrome (below), eating disorders, inadequate fiber intake, underlying diseases (Crohn’s, IBS, diverticulitis, lupus, surgery, hypothyroidism, cancer/tumors or other blockages), physiological changing of aging, neurological problems (for example Parkinson's, MS or gastroparesis as in the case of poorly controlled diabetes), depression, stress or anxiety, poor hydration, decreased activity, delaying the urge to go, microbial changes, overuse of laxatives, and certain medications (see below). Sometimes it is so painful to defecate (poop) when constipated that a person holds their bowels. And, of course, there is Freud, who felt that “anal retentiveness,” caused by over-strict parents or a parent’s restrictive toilet training methods, results in a person's obsessive attention to neatness and detail and need for control. Constipation may hit hard in these folks.

​Signs and Symptoms of Constipation

Hard stools, small or “chunky” stools, straining to defecate (poop), a longer time than normal between having a BM, bloating, incomplete emptying, and holding stools for long periods of time are long. So, what is causing your constipation? Are you drinking enough fluids? Have you started on new medicines or changed your diet?

Bristol Stool Chart - Identifying IBS, Diarrhea and Constipation

Medications That May Cause Constipation

•   Antacids

•   Calcium

•   Pain pills (opioids and sometimes over-the-counter pain medicines, like NSAIDS)

•   Calcium channel blockers (blood pressure)

•   Some antidepressants

•   Anti-Parkinsonian medication

•   Some antidepressants

•   Iron

•   Several incontinence medications

•   Antihistamines

•   The popular diabetes/weight loss drugs – Ozempic, Mounjaro, and Wegovy

Foods That May Cause Constipation:

• Bananas (Unripe)

• Gluten (wheat, barley, rye, and especially wheat flour found in many baked goods and pastas)

• White rice

• Red meat

• White bread

• Alcohol

• Chocolate

• Dairy products

• Potato chips

diet and exercise

Complications of Constipation

• Stool Impaction

• Bowel perforation (May lead to sepsis. Can be fatal)

• Hemorrhoids (from straining)

• Bowel obstruction

• Rectal prolapse

• Urinary retention

• Bleeding hemorrhoids

• Weakened bladder (from straining pelvic floor muscles)

  Some of these problems are worsened by sitting on the toilet for long periods, straining to pass stools. You don't want to hang out there.

General Approaches to Constipation

• Hydration – Drink plenty of fluids.

• Fiber- Natural sources – fruits, vegetables, legumes, and whole grains, of course, prunes.

• Exercise stimulates muscles and builds tone in the digestive tract to help move food along the gastrointestinal tract.

• Dietary change - Avoid constipating foods and increase fiber

• Consider medication changes – Discuss medication changes with a healthcare provider.

• Biofeedback

Constipation: Causes, Complications, Treatment and Remedies

Treatment and Remedies for Constipation

​Over-the-Counter

Laxatives:

• Osmotic laxatives (common: MiraLAX) draw water into the bowel and 

      Decrease the density of stool, making it softer

• Peristaltic stimulants (common: Bisacodyl/Dulcolax) stimulate muscles in thecolonon which help move stool along

•   Bulk-forming laxatives: Psyllium (common: Metamucil, Citrucel)

•   Enemas: These can help introduce fluid into the colon, which softens the stool. Some actually stimulate the colon muscles to help move the stool on. Note: It is important to understand that overuse of laxatives can cause harm. Too much, too often, can lead to harm to the muscle and nerves of the colon. In addition, these can lead to electrolyte and mineral disturbances as well as dehydration(some draw fluid into the colon from the body). You don't want to use these too often.​

Natural Approaches to Constipation​

• Senna

• Warm Epsom salt bath

• Fish oil

• Magnesium

• Lemon in warm water

• Dried fruits, fresh kiwi, or cherries, which have lots of fiber

• Probiotics may help. ConsumerLab (you can get a trial for this site) cites some evidence regarding the benefit of using Lactobacillus casei strain Shirota for chronic constipation.

  (In some fermented foods and yogurts, Kefir - Read Labels!)

• Oral Aloe Vera (caution)

Prescriptions for Constipation

Most of the time, constipation is just...well...just constipation. However, you should speak to a healthcare provider if you have any of the following: Frequent bouts of constipation (recurring episodes for beyond three weeks), presence of blood in your stool, significant abdominal pain/cramping, severe bloating, excessive unintentional weight loss, nausea and/or vomiting (with unrelenting constipation) or you suspect your medication might cause it. The healthcare provider will take a history, do an exam, possibly labs, imaging, and scopes if necessary. Once the root of the cause is discovered, it will be treated accordingly (from dietary changes to pain control to fluids to surgery).

Constipation: Causes, Complications, Treatment and Remedies is a jumping off point for those who want to try to manage their symptoms. If you have ANY questions or concerns, please contact your healthcare provider.