Constipation symptoms, causes & treatment

Occasional constipation is common for most people and can often be treated with simple dietary changes or over-the-counter products. Constipation is caused by hard, dry stool that moves through the digestive system very slowly, making it difficult to have a bowel movement.

Some people have more complex issues such as irregularities in the structure or function of their digestive system, which can cause chronic constipation. In these cases, ongoing constipation can damage or even close off the intestine, requiring surgery or more intensive treatment.

Constipation symptoms

Constipation symptoms may include:

• Feeling that not all stool has passed
• Fewer than three bowel movements a week
• Hard, dry or lumpy stools
• Stools that are difficult to pass
• Straining or pain during a bowel movement

Constipation causes and risk factors

Constipation is caused when stool moves too slowly through the digestive tract or cannot be eliminated effectively. Some causes of constipation include:

• Medication side effects
• Hypothyroid disorder
• Stress
• Gender (women are two to three times more likely to have constipation than men)
• Lack of regular exercise
• Age (about 50 percent of adults over 65 have constipation)
• Depression
• Anxiety
• Low fiber diet
• Pelvic floor or outlet dysfunction (when nerves and muscles in the pelvic area aren’t working properly, making it difficult to have a bowel movement)
• Cathartic colon (caused by overuse of stimulant laxatives)
• Putting off bowel movements
• Irritable bowel syndrome (IBS)
• Inadequate fluid intake
• Pregnancy

Constipation diagnosis

Most cases of constipation are not serious. Your doctor will ask you about your bowel habits and may check for fissures or hemorrhoids. If you have a history of frequent constipation symptoms, fecal impaction or other more serious symptoms, you may need additional testing to look at your digestive system more closely. Some of these tests might include:

• MRI or CT scan. These tests provide high quality images of all or parts of the digestive tract.
• Double balloon endoscopy. A long tube (endoscope) is inserted down the throat to see from the esophagus to the colon
• Colonoscopy. Although most often given to screen for colon cancer, this test also may be used to examine the colon for issues that could be causing constipation.
• Capsule endoscopy. For this test, you swallow a capsule that contains a tiny camera that records video of your digestive track. Your doctor will review the results to see what might be causing your constipation.
• Barium enema. This specialized X-ray helps show the intestines and rectum. You drink liquid barium before the test to help illuminate the digestive tract.
• Ano-rectal manometry. This test measures the strength of the anal sphincter muscles, movement of the rectal and anal muscles and sensation in the rectum and nerve reflexes needed for bowel movements.
• Anal sphincter electromyography (EMG). This test determines whether your anal muscle (sphincter) and nerves are working correctly.

Constipation complications

In some cases, constipation can lead to:

• Anal fissures (tears in skin around the anus)
• Hemorrhoids
• Rectal bleeding

Severe constipation can cause more serious complications including:

• Rectal prolapse – The large intestine detaches inside the body and pushes out of the rectum, stretching the anus muscles and pelvic nerves, often causing damage.
• Fecal impaction – Dry, lumpy stool gets stuck inside the colon and won’t come out.

Constipation treatment

Treatment options for constipation symptoms can vary depending on frequency and severity. For most people, the doctor will advise changes to your diet and exercise habits or over-the-counter aids. If you have chronic constipation or complications, your doctor will likely advise further testing and treatment.

Nonsurgical treatment

Your doctor may prescribe these treatments if you’re experiencing more serious or frequent constipation:

• Enema
• Disimpaction procedure performed by a health care provider to break up and remove stuck stool if an enema doesn’t work
• Pelvic floor physical therapy including biofeedback to retrain the pelvic floor
• Prescription medication

Surgical treatment

In the most severe cases of constipation, surgery may be required to repair damage or structural problems inside the gastrointestinal system. Two of these procedures include:

• Colectomy. A surgeon removes all or a portion of your colon if it has been damaged from constipation. If the entire colon is removed, stool is then collected outside the body.
• Sacral nerve modulation (SNM). A device is implanted at the base of your spine to stimulate the nerves in that area to promote more frequent bowel movements.