Constipation is a condition in which you may have

• fewer than three bowel movements a week
• stools that are hard, dry, or lumpy
• stools that are difficult or painful to pass
• a feeling that not all stool has passed

However, people can have different bowel movement patterns, and only you know what’s normal for you.

Constipation is not a disease, but may be a symptom of another medical problem. Constipation may last for a short or long time.

Constipation is common among all ages and populations in the United States. About 16 out of 100 adults have symptoms of constipation. About 33 out of 100 adults ages 60 and older have symptoms of constipation.

Certain people are more likely to become constipated, including

• women, especially during pregnancy or after giving birth
• older adults
• non-Caucasians
• people who eat little to no fiber
• people who take certain medicines or dietary supplements
• people with certain health problems, including functional gastrointestinal disorders

You may be constipated for many reasons, and constipation may have more than one cause at a time. Causes of constipation may include

• slow movement of stool through your colon
• delayed emptying of the colon from pelvic floor disorders, especially in women, and colon surgery
• functional gastrointestinal disorders, such as irritable bowel syndrome

Certain medicines and dietary supplements

Medicines and dietary supplements that can make constipation worse include

• antacids that contain aluminum and calcium
• anticholinergics and antispasmodics
• anticonvulsants—used to prevent seizures
• calcium channel blockers
• diuretics
• iron supplements
• medicines used to treat Parkinson’s disease
• narcotic pain medicines
• some medicines used to treat depression

Life changes or daily routine changes

Constipation can happen when your life or daily routine changes. For example, your bowel movements can change

• if you become pregnant
• as you get older
• when you travel
• when you ignore the urge to have a bowel movement
• if you change your medicines
• if you change how much and what you eat

Certain health and nutrition problems

Certain health and nutrition problems can cause constipation

• not eating enough fiber
• not drinking enough liquids, or dehydration
• not getting enough physical activity
• celiac disease
• disorders that affect your brain and spine, such as Parkinson’s disease
• spinal cord or brain injuries
• conditions that affect your metabolism, such as diabetes
• conditions that affect your hormones, such as hypothyroidism
• inflammation linked to diverticular disease or proctitis
• intestinal obstructions, including anorectal blockage and tumors
• anatomic problems of your digestive tract

Symptoms of constipation may include

• fewer than three bowel movements a week
• stools that are hard, dry, or lumpy
• stools that are difficult or painful to pass
• a feeling that not all stool has passed

Some doctors suggest asking these questions to decide if you are constipated:

• Do you often have fewer than three bowel movements a week?
• Do you usually have a difficult time passing stools?
• Are stools often lumpy or hard?
• Do you have a feeling of being blocked or of not having fully emptied your bowels?

Did you answer “yes” to one or more of these questions? If so, you may have a constipation problem. Otherwise, you probably don’t.

You should see a doctor if your symptoms do not go away with self-care or you have a family history of colon or rectal cancer.

You should see a doctor right away if you have constipation and any of the following symptoms

• bleeding from your rectum
• blood in your stool
• constant pain in your abdomen
• inability to pass gas
• vomiting
• fever
• lower back pain
• losing weight without trying

Doctors use your medical and family history, a physical exam, or medical tests to diagnose and find the cause of your constipation.

Medical and family history

Your doctor will ask you questions about your medical history, such as

• whether you have ever had surgery to your digestive tract
• if you have recently lost or gained weight
• if you have a history of anemia

Your doctor also is likely to ask questions about your symptoms, such as

• How often do you have a bowel movement?
• How long have you had symptoms?
• What do your stools look like?
• Do your stools have red streaks in them?
• Are there streaks of blood on your toilet paper when you wipe?

Your doctor is likely to ask questions about your routines, such as

• What are your eating habits?
• What is your level of physical activity?
• What medicines, including supplements, and complementary and alternative medicines, do you take?

You may want to track your bowel movements and what your stools look like for several days or weeks before your doctor’s visit. Write down or record the information so you can share it with your doctor.

If you’ve been constipated a long time, your health care professional may ask whether anyone in your family has a history of conditions that may cause long-lasting constipation, such as

• anatomic problems of the digestive tract
• intestinal obstruction
• diverticular disease
• colon or rectal cancer

Physical exam

During a physical exam, a health care professional may

• check your blood pressure, temperature, and heart rate
• check for dehydration
• use a stethoscope to listen to sounds in your abdomen
• check your abdomen for
  • swelling
  • tenderness or pain
  • masses, or lumps
• perform a rectal exam

Depending on your symptoms and health, your doctor may first try a treatment to improve your symptoms before using tests.

Lab tests

Your doctor may use one or more of the following lab tests to look for signs of certain diseases and conditions that may be causing your constipation

• Blood tests can show signs of anemia, hypothyroidism, and celiac disease.
• Stool tests can show the presence of blood and signs of infection and inflammation.
• Urine tests can show signs of diseases such as diabetes.

Endoscopy

Your doctor may perform an endoscopy to look inside your anus, rectum, and colon for signs of problems in your lower digestive tract. Endoscopies for constipation include

• colonoscopy
• flexible sigmoidoscopy

During these two tests, your doctor may also perform a biopsy. A biopsy is a procedure that involves taking small pieces of tissue and examining them under a microscope. A doctor can use a biopsy to look for signs of cancer or other problems.

Colorectal transit studies

Your doctor may use bowel function tests called colorectal transit studies to see how well your stool moves through your colon.

• Radiopaque markers—an x-ray that tracks radioactive markers while they pass through your digestive system. You swallow capsules with the markers, which take about 3 to 7 days to come out with a bowel movement.
• Scintigraphy—a test that involves eating a meal with a small dose of a radioactive substance. Your doctor tracks the substance using special computers and cameras as the substance passes through your intestines.

Other bowel function tests

Your doctor may also use one or more of the following tests to look for signs of certain diseases and conditions that may be causing your constipation

• defecography—an x-ray of the area around the anus and rectum to see how well you can hold and release stool
• anorectal manometry—a test to check how sensitive your rectum is, how well it works, and how well the anal sphincters work
• balloon expulsion test—a test that involves pushing a small water balloon from your rectum to see if you have a problem pushing out stool

Imaging tests

To look for other problems that may be causing your constipation, your doctor may perform an imaging test such as

• lower gastrointestinal (GI) series
• magnetic resonance imaging
• computed tomography (CT) scan

You can most often treat your constipation at home by doing the following

Change what you eat and drink

Changing what you eat and drink may make your stools softer and easier to pass. To help relieve your symptoms

• eat more high-fiber foods
• drink plenty of water and other liquids if you eat more fiber or take a fiber supplement

Depending on your age and sex, adults should get 25 to 31 grams of fiber a day.

Get regular physical activity

Getting regular physical activity may help relieve your symptoms.

Try bowel training

Your doctor may suggest that you try to train yourself to have a bowel movement at the same time each day to help you become more regular. For example, trying to have a bowel movement 15 to 45 minutes after breakfast may help, because eating helps your colon move stool.

Make sure you give yourself enough time to have a bowel movement, and use the bathroom as soon as you feel the need to go. Try to relax your muscles or put your feet on a footstool to make yourself more comfortable.

Stop taking certain medicines or dietary supplements

If you think certain medicines or dietary supplements are causing your constipation, talk with your doctor. He or she may change the dose or suggest a different medicine that does not cause constipation. Don’t change or stop any medicine or supplement without talking with a health care professional.

Take over-the-counter medicines

Your health care professional may recommend using a laxative for a short time. He or she will tell you what type of laxative is best for you

• fiber supplements (Citrucel, FiberCon, Metamucil)
• osmotic agents (Milk of Magnesia, Miralax)
• stool softeners (Colace, Docusate)
• lubricants, such as mineral oil (Fleet)
• stimulants (Correctol, Dulcolax)

You should only use stimulants if your constipation is severe or other treatments have not worked.

If you’ve been taking laxatives for a long time and can’t have a bowel movement without taking a laxative, talk with your doctor about how you can slowly stop using them. If you stop taking laxatives, over time, your colon should start moving stool normally.

Eat enough fiber. Drink plenty of liquids to help the fiber work better.

Fiber

Depending on your age and sex, adults should get 25 to 31 grams of fiber a day. Older adults sometimes don’t get enough fiber because they may lose interest in food.

Talk with a health care professional, such as a dietitian, to plan meals with the right amount of fiber for you. Be sure to add fiber to your diet a little at a time so your body gets used to the change.

Good sources of fiber are

• whole grains, such as whole wheat bread and pasta, oatmeal, and bran flake cereals
• legumes, such as lentils, black beans, kidney beans, soybeans, and chickpeas
• fruits, such as berries, apples with the skin on, oranges, and pears
• vegetables, such as carrots, broccoli, green peas, and collard greens
• nuts, such as almonds, peanuts, and pecans

Plenty of water

You should drink water and other liquids, such as naturally sweetened fruit and vegetable juices and clear soups, to help the fiber work better. This change should make your stools softer and easier to pass.

Drinking enough water and other liquids is also a good way to avoid dehydration. Staying hydrated is good for your overall health and can help you avoid getting constipated. Ask a health care professional how much liquid you should drink each day based on your size, health, activity level, and where you live.

To help prevent or relieve constipation, avoid foods with little to no fiber, such as

• chips
• fast food
• meat
• prepared foods, such as some frozen meals and snack foods
• processed foods, such as hot dogs or some microwavable dinners

If self-care treatments don’t work, your doctor may prescribe a medicine to treat your constipation. If you’re taking an over-the-counter or prescription medicine or supplement that can cause constipation, your doctor may suggest you stop taking it, change the dose, or switch to a different one. Talk with your doctor before changing or stopping any medicines.

Prescription medicines

Your doctor may prescribe one of the following medicines for constipation

• lubiprostone—a medicine prescribed to increase fluid in your digestive tract, which can help reduce pain in your abdomen, make your stool softer, and increase how often you have bowel movements
• linaclotide or plecanatide—medicines that help make your bowel movements regular if you have irritable bowel syndrome with constipation or long-lasting constipation without a known cause
• prucalopride—a medicine that helps your colon move stool if you have long-lasting constipation without a known cause

Biofeedback therapy

If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback therapy to retrain your muscles. By using biofeedback therapy, you can change how you make your muscles work.

Surgery

Your doctor may recommend surgery to treat an anorectal blockage caused by rectal prolapse if other treatments don’t work. Your doctor may perform surgery to remove your colon if your colon muscles don’t work correctly. If your doctor recommends surgery, ask about the benefits and risks.

You can help prevent constipation by doing some of the same things that treat constipation

• get enough fiber in your diet
• drink plenty of water and other liquids
• get regular physical activity
• try to have a bowel movement at the same time every day

Constipation can be uncomfortable and worrisome. If you’re having fewer bowel movements than usual, taking a long time to pass stools, or the stools are hard, you may be constipated.

Nearly everyone becomes constipated at one time or another, and older people are more likely than younger ones to experience this condition. In fact, about one-third of older adults have occasional symptoms of constipation. The good news is that most of the time constipation is not serious and is treatable.

Symptoms of constipation

Some people worry they are constipated if they don’t have a bowel movement every day, but there is no “right” number of daily or weekly bowel movements. Being regular can be different for each person. For some, it can mean twice a day, and for others, three times a week is normal. However, if you often have infrequent bowel movements, you may be constipated.

Symptoms of constipation include:

• Fewer than three bowel movements a week
• Difficult time passing stools
• Lumpy or hard stools
• A feeling of being blocked or of not having fully emptied your bowels.

What causes constipation?

Many medical conditions common for older adults, as well as medications, can cause constipation.

Medical conditions

• Disorders that affect the muscles or nerves used for normal bowel movements — for example, stroke, Parkinson’s disease, or a spinal cord injury — can cause constipation.
• Conditions that affect hormones or metabolism, such as diabetes, can also lead to constipation.
• Other medical conditions that can lead to constipation include tumors or other blockages, pelvic floor disorders, and gastrointestinal disorders such as irritable bowel syndrome.
• Changes in diet and exercise due to medical procedures can also lead to constipation.

In addition, people living with diseases that affect their diet and daily habits, such as Alzheimer’s disease or another form of dementia, may be more likely to experience constipation.

Medicines and dietary supplements

Some medicines — both prescription and over the counter — can lead to constipation.

• These include some drugs used to treat depression, antacids containing aluminum or calcium, some allergy medicines (antihistamines), certain painkillers, some medicines for high blood pressure, diuretics, anticholinergics, antispasmodics, anticonvulsants, and drugs used to treat Parkinson’s disease.
• Certain dietary supplements, such as iron, can also lead to constipation.
• Anesthesia, which is used during medical procedures to keep a person from feeling pain, can also lead to constipation.

Nutrition, activity, and routine

What you eat, drink, and do can also contribute to constipation. For example:

• Not enough fiber. You may become constipated if you don’t eat enough high-fiber foods, such as vegetables, fruits, and whole grains. Eating a lot of high-fat meats, dairy products and eggs, sweets, or processed foods may cause constipation.
• Not enough fluids. Water and other fluids help fiber work better, so not drinking enough liquids can contribute to harder stools that are more difficult to pass.
• Lack of physical activity. Not getting enough exercise or long periods of inactivity due to illness or following surgery may cause constipation.
• Changes in routine. Altering your daily routine — traveling, for example — can cause constipation.

Treatment for constipation

Many cases of constipation can be treated at home. Try these changes to help make your stools softer and easier to pass and to prevent constipation in the future.

• Eat a healthy diet. Your diet should contain ample natural fiber from sources like fresh fruits and vegetables, either cooked or raw, along with whole-grain cereals and breads.
• Be sure to get enough fluids. With too little fluid, constipation can get worse. Drinking enough water, juice, and other fluids can help you have regular bowel movements.
• Stay active. Do things that keep you moving and active. For example, go for walks. Participate in physical activity that you enjoy and make it a part of your everyday life.

There are also several over-the-counter laxatives, including fiber supplements and stool softeners, that may help with constipation. Your doctor or other health care provider can help you decide which laxatives may be best for you.

If these changes don’t work or you are experiencing pain, bleeding, or other serious symptoms, talk with your doctor about other treatments. Your doctor may suggest changes to your diet or activity; prescribe a supplement or medication for constipation; or recommend biofeedback training, which helps people learn to control their muscles through the use of electronic devices and a coach. In some rare cases, surgery may be recommended, for example, to treat a blockage or remove part of the colon if those muscles don’t work. Talk with your doctor about the risks and benefits of surgery and other treatments.

When should you see a doctor?

Sometimes constipation can be a symptom of more severe illness, including colorectal and other types of cancer. See your doctor or other health care provider if your bowel habits change and are accompanied by any one of the following:

• There is blood in your stool or you are bleeding from your rectum
• You are having serious stomach pains or are unable to pass gas
• You are vomiting or have a fever
• You lose weight without trying
• You are experiencing lower back pain
• Fiber and exercise haven’t helped