Nearly everyone becomes constipated at one time or another. Older people are more likely than younger people to become constipated, but most of the time it’s not serious.

Constipation is a symptom, not a disease. You may be constipated if you are having fewer bowel movements than usual, it takes a long time to pass stools, and the stools are hard.

Some people worry too much about having a bowel movement every day. There is no right number of daily or weekly bowel movements. Being regular is different for each person. For some, it can mean bowel movements twice a day. For others, having movements three times a week is normal.

What is constipation?

Having fewer than three bowel movements a week is, technically, the definition of constipation. However, how often you “go” varies widely from person to person. Some people have bowel movements several times a day while others have them only one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you – as long as you don’t stray too far from your pattern.

Regardless of your bowel pattern, one fact is certain: the longer you go before you “go,” the more difficult it becomes for stool/poop to pass. Other key features that usually define constipation include:

• Your stools are dry and hard.
• Your bowel movement is painful and stools are difficult to pass.
• You have a feeling that you have not fully emptied your bowels.

How does constipation happen?

Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body.

To back up a bit, as food normally moves through the digestive tract, nutrients are absorbed. The partially digested food (waste) that remains moves from the small intestine to the large intestine, also called the colon. The colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. This gives the colon more time – too much time – to absorb water from the waste. The stool becomes dry, hard, and difficult to push out.

Common causes of constipation are:

• Not enough fiber in the diet
• Lack of physical activity (especially in the elderly)
• Medications
• Milk
• Irritable bowel syndrome
• Changes in life or routine such as pregnancy, aging and travel
• Abuse of laxatives
• Ignoring the urge to have a bowel movement
• Dehydration
• Specific diseases or conditions, such as stroke (most common)
• Problems with the colon and rectum
• Problems with intestinal function (chronic idiopathic constipation)

Not enough fiber in the diet. People who eat a high-fiber diet are less likely to become constipated. The most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats. 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 are difficult to pass.

Lack of physical activity. A lack of physical activity can lead to constipation, although health care professional do not know precisely why. 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 common in older people. 

Medications. Some medications can cause constipation, including:

• Pain medications (especially narcotics)
• Blood pressure medications (calcium channel blockers)
• Anti-Parkinson drugs
• Antidepressants
• Iron supplements
• Diuretics

Changes in life or routine. During pregnancy, women may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling, because their normal diet and daily routine are disrupted.

Abuse of laxatives. The common belief that people must have a daily bowel movement has led to self-medicating with over-the-counter laxative products. Although people may feel relief when they use laxatives, typically they must increase the dose over time because the body grows reliant on laxatives to have a bowel movement. As a result, laxatives may become habit-forming. 

Ignoring the urge to have a bowel movement. 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 want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play. 

Dehydration. Research shows that although increased fluid intake does not necessarily help relieve constipation, many people report some relief from their constipation if they drink fluids such as water and juice and avoid dehydration. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day. However, liquids that contain caffeine, such as coffee and cola drinks will worsen one’s symptoms by causing dehydration. Alcohol is another beverage that causes dehydration. It is important to drink fluids that hydrate the body, especially when consuming caffeine-containing drinks or alcoholic beverages. 

Specific diseases. Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum or anus. Conditions that can cause constipation include:

• Neurological disorders
• Parkinson’s disease
• Stroke
• Spinal cord injuries
• Metabolic and endocrine conditions
• Diabetes
• Poor glycemic control

Can constipation cause internal damage or lead to other health problems?

There are a few complications that could happen if you don’t have soft, regular bowel movements. Some complications include:

• Swollen, inflamed veins in your rectum (a condition called hemorrhoids).

• Tears in the lining of your anus from hardened stool trying to pass through (called anal fissures).
• An infection in pouches that sometimes form off the colon wall from stool that has become trapped and infected (a condition called diverticulitis)

• A pile-up of too much stool/poop in the rectum and anus (a condition called fecal impaction).

• Damage to your pelvic floor muscles from straining to move your bowels. These muscles help control your bladder. Too much straining for too long a period of time may cause urine to leak from the bladder (a condition called stress urinary incontinence).

Treatments

To get regular and stay regular, try these approaches:

• Drink plenty of fluids and stay hydrated. To check your hydration levels, take a look at the color of your urine. If you are fully hydrated, your urine will be pale yellow or even colorless.

• Eat fiber, fiber and more fiber. Fiber is important for regular bowel function, so make sure that you eat plenty of whole grains, fruits and vegetables. It’s a good idea to increase your fiber intake gradually and remember to drink plenty of water after eating high-fiber foods. (After all, you don’t want to trade constipation for gas.)

• An apple a day keeps the doctor away—and keeps things moving in your colon. Apples are a great source of fiber, and they help support normal bowel function.
• Try to establish a routine for bowel elimination. In other words, try to go at the same time every day. You wouldn’t leave the house in the morning without brushing your teeth, so make a toilet date, and take the same care with your colon. If you don’t need to go, though, don’t force it.
• Respond to the urge for a bowel movement. When you do need to go, go.
• Except in rare cases, avoid chemical-based laxatives such as Ex-Lax or Correctol. Excessive laxative use is likely to make your bowel “lazy” and dependent on the laxatives to work. You may also end up in a vicious cycle, alternating between constipation and diarrhea.
• Don’t skip meals. Eating stimulates the reflex that causes food (and waste) to move through your digestive system.
• Sit, don’t strain, when you are trying to go to the bathroom. Not only can forcing out hard, dry stool lead to hemorrhoids and a protrusion of rectal tissue, but it can also put you at risk for developing uterine prolapse.
• Try propping your feet up on a stool with your knees bent while you sit on the toilet. This should straighten the angle of your bowel and help you pass stool more quickly without straining.