Overcome Constipation and Get Regular

If your bowels are backed up, don’t be embarrassed.

Constipation affects anywhere from 10% to 20% of people in the United States, and if it’s bothering you, don’t be shy about telling your doctor. Constipation, especially if it’s chronic, may signal an underlying health concern that, in many cases, is correctable.

“It’s a very prevalent problem, and a lot of times, the symptoms can be very bothersome,” says Samita Garg, MD, a Cleveland Clinic gastroenterologist. “There are many causes of constipation, so it should be evaluated.”

Seek help for constipation, and work with your health-care team on a strategy of behavioral modifications and treatments that can help you regain regularity and tame your bothersome bowels.

What Causes Constipation?

While some people move their bowels daily, those with constipation do so fewer than three times a week. Constipation symptoms can include hard, dry stools, straining and sometimes needing help to pass stools, a sense of incomplete emptying and abdominal discomfort and bloating.

With chronic idiopathic constipation, these symptoms last several months or more, with no easily identifiable cause, Dr. Garg explains. People with this type may have slow-transit constipation, abnormal motility that occurs when the muscles of the colon fail to contract properly to push stool through normally. Others have normal-transit constipation, in which the waste passes through the colon normally but they have difficulty evacuating the stool, or dyssynergia, caused by dysfunction of the pelvic floor and anal sphincter muscles. In some cases, irritable bowel syndrome with constipation (IBS-C) is to blame. IBS-C and chronic idiopathic constipation share several overlapping symptoms, but pain is the predominant symptom of IBS-C.

Additionally, an array of medications (see “Medications That Cause Constipation”) can cause constipation, as can chronic medical conditions such as diabetes, hypothyroidism, colorectal cancer, Parkinson’s disease, multiple sclerosis, advanced kidney disease, and others.

In many cases, constipation results from lifestyle or behavioral factors:

• Your eating habits: A diet low in fiber is one of the most common underlying contributors to constipation.
• Your fluid intake: Dehydration deprives your colon of the water it needs to help move stools along.
• Your activity level: A sedentary lifestyle promotes constipation, whereas “mobility stimulates motility,” Dr. Garg says.
• Your bathroom habits: “Holding it in” and ignoring the urge when you should be heading to the bathroom is a common constipation contributor.
• Traveling: Your normal bowel schedule and routine can often be upset when you’re away from home.
• Sleep and stress: Emotional stress and poor sleep can also contribute to constipation.
• Cutting back on/stopping caffeine: A few cups of caffeinated coffee or tea each day can increase digestive motility, but missing out on caffeine may contribute to constipation.
• Certain supplements: Examples include zinc and protein powders.

“A big part of being able to have a regular bowel movement is related to overall health, schedule, routine, lifestyle, sleep, and stress,” Dr. Garg says. “So having a regular sleep cycle, minimizing stress, eating a good diet, staying hydrated, and being physically active are very important.

“We call the gastrointestinal (GI) tract the enteric nervous system,” she adds. “It’s the biggest peripheral nervous system, so it’s very sensitive to medications, travel, diet, and other things that affect your GI nervous system.”

Find Constipation Relief

If your constipation persists for more than a few weeks or worsens, especially if it’s accompanied by changes in bowel habits, persistent abdominal pain, weight loss or rectal bleeding, see your doctor.

Constipation relief starts with consuming adequate fiber and fluids. Aim to get 25 to 30 grams of fiber a day from your diet (see “What You Can Do” for food sources of fiber). If you can’t get sufficient dietary fiber, you may need a psyllium fiber supplement (Metamucil). “The main side effect of increasing fiber intake would be bloating and cramping,” Dr. Garg says. “Fiber takes one to three days to take effect, so if you slowly increase your intake by about 5 grams every three days, you can see how it’s working for you and how you feel.”

Stay well hydrated, and try to drink at least 10 cups of fluids a day, she adds. Discuss your fluid needs with your physician, and if there’s a concern about loss of electrolytes (e.g., sodium, potassium) with overhydration, add some Gatorade or other sports drink to your water, Dr. Garg advises.

If constipation persists despite these measures, your physician may recommend an over-the-counter osmotic laxative, such as polyethylene glycol (MiraLAX) or a magnesium product (e.g., milk of magnesia), or, sometimes, short-term use of nonprescription stimulant laxatives, such as bisacodyl (Dulcolax) or senna (Senokot). If necessary, your doctor may prescribe medications such as linaclotide (Linzess), lubiprostone (Amitiza), plecanatide (Trulance), prucalopride (Motegrity) or, specifically for IBS-C, tenapanor (Ibsrela).

Other treatments can complement lifestyle changes and medical therapy. Abdominal physical therapy and massage can help relieve bloating and abdominal distension, while a specialized form of physical therapy, known as pelvic floor physical therapy, can be effective if you have dyssynergia.

“In many cases, if you increase physical activity and your fiber intake and make lifestyle adjustments, you can improve with these simple measures,” Dr. Garg says. “And a lot of times we manage patients in a multidisciplinary fashion. These treatments are very safe and they have the potential to help, so we often include them in our treatment algorithm.”