What Are the Five Common Causes of Constipation?

Here are five common causes of constipation, which include poor diet and lifestyle habits, medical conditions, and medications.

1. Poor diet
   • Lack of fiber in the diet
     • Fiber helps absorb water, promotes smooth bowel movements, and causes large, soft, and bulky stool formation
   • Less liquid consumption or decreased water intake
   • Excess consumption of dairy products
   • Too much alcohol or caffeine
2. Lifestyle and habits
   • Lack of exercise
     • Good tone of the abdominal muscles and diaphragm plays a crucial role in the process of defecation
     • Regular exercise can effectively improve constipation in older people and people who have more of a sedentary lifestyle
3. Medical conditions
   • Gastrointestinal
     • Irritable bowel syndrome (sluggish bowel movements with abdominal discomfort, constipation is often the predominant symptom, as well as diarrhea)
     • Diverticulitis
     • Celiac disease
     • Intestinal obstructions (such as adhesions due to past surgery)
     • Bowel cancer
     • Structural defects, such as fistula, volvulus, and imperforated anus
   • Metabolic and endocrine disorders
     • Hypothyroidism
     • Diabetes
     • Hypercalcemia
     • Uremia
     • Chronic kidney disease
   • Neurological
     • Multiple sclerosis
     • Parkinson’s disease
     • Spinal cord injury
     • Stroke
   • Multiple organ involvement
     • Lupus
     • Scleroderma
     • Amyloidosis
   • Congenital
     • Hirschsprung’s disease (a birth defect characterized by the absence of nerves in parts of the intestine)
4. Medications
   • narcotics, aluminum-containing antacids, antispasmodics, antidepressants, tranquilizers, iron supplements, anticonvulsants, diuretics, sedatives, anticholinergics, and antihypertensive calcium channel blockers
   • Opioid-induced constipation occurs in most cancer patients who take opioids for pain
5. Other causes
   • Aging: The prevalence of constipation tends to increase as people age.
   • Change in routine, such as travel
   • Abuse of laxatives
   • Stress
   • Ignoring the urge to defecate
   • Pregnancy
     • Hormonal disturbances
     • Enlarged uterus pressing the intestines
     • Diet and activity changes

Constipation is a common condition, causing infrequent and unsatisfactory bowel movements.

The frequency of bowel movements varies with people; however, a person is constipated when there is any of the following:

• Stools are hard, dry, or lumpy
• Stools have not passed for three or more days (fewer than three bowel movements a week)
• Passage of stool requires considerable straining or causes pain
• A feeling that there is incomplete bowel emptying

Constipation is the most common gastrointestinal complaint, approximately 4 million people in the United States are estimated to suffer from this condition.

Normally, the colon (large intestine) absorbs water from the food that passes through it and the waste products or stools are pushed toward the rectum by the muscle contractions caused by the colon. Water absorption throughout this stool movement makes the stool solid, and then, it is eliminated through the anus.

When these muscle contractions are slow or sluggish, the stool moves through the colon very slowly, resulting in too much water absorption, thus making hard and dry stools.

Symptoms may vary with people, but the most common include:

1. Difficulty passing stools
2. Pain during bowel movements
3. Uncomfortable, unsatisfied bowel movements
4. Hard, dry stools that require straining
5. Bloating
6. Abdominal pain
7. Loss of appetite
8. Sluggish feeling

5 Complications of constipation

Constipation is a symptom and not a disease. It is typically not a life-threatening condition, but if left untreated for a long period, it can lead to complications, such as:

1. Hemorrhoids (inflamed veins in the rectum)
2. Anal fissures (tears in the skin around the anus)
3. Rectal bleeding
4. Rectal prolapse
5. Fecal impaction (accumulation or pile-up of hardened stools in the rectum or the lower part of the colon)

Most people experience constipation at one time or another.

Doctors recommend tests depending on factors such as age, duration, severity, presence of blood in the stools, and recent weight loss.

• Medical history: In-depth questions regarding the duration and severity of the complaint to determine the exact cause.
• Physical examination:
  • Abdominal examination: To check for tenderness or pain.
  • Digital rectal examination (DRE): The doctor inserts a lubricated finger into the rectum to evaluate the anal muscle tone and identify any abnormalities, such as hemorrhoids or rectal polyps.
• Abdominal X-ray
• Barium enema: A procedure that uses barium, a fluid administered as an enema into the rectum.
  • This fluid coats the inside of the gut to show up on X-rays.
  • X-rays confirm the presence of strictures, obstructions, polyps, and other problems.
• Sigmoidoscopy: A diagnostic procedure to examine the inside of the large intestine using a short, flexible, lighted tube called a sigmoidoscope that is inserted into the intestine through the rectum.
• Colonoscopy:
  • A procedure that involves inserting a long, flexible, lighted tube called a colonoscope through the rectum up into the colon.
  • This helps identify abnormal growths, inflamed tissues, ulcers, and bleeding.
• Colorectal transit study:
  • A test to analyze the movement of food through the colon.
  • Marked capsules are swallowed by the patient, multiple abdominal X-rays are taken three to seven days later while the patient is on a high-fiber diet.
• Anorectal function test: To determine the functioning of the anus and rectum.

Most often, diet and lifestyle modifications can relieve the symptoms and help prevent the condition.

• Diet changes
  • Including at least 20 to 35 grams of fiber daily helps form soft and bulky stools
  • Add foods, such as beans, whole grains, nuts, lentils, bran cereals, fresh fruits, and green leafy vegetables to the diet
  • Avoid or limit foods, such as ice cream, cheese, meats, eggs, and processed foods, which contain little or no fiber
  • Increase water intake to keep the body hydrated
• Stay physically active, regular exercise or a brisk walk for at least 30 minutes a day
• Change or opt for replacement of medications that cause constipation after consulting with the doctor
• Do not ignore the urge to have a bowel movement
• Laxatives may be prescribed along with diet and lifestyle changes
  • Stimulants
  • Fiber supplements
  • Stool softeners
  • Lubricants