Not being able to have a bowel movement—you know, pooping—and the discomfort that results is called constipation. This includes bowel movements that are infrequent, incomplete or difficult to pass. It is a fairly common issue in the United States, affecting around 16 out of 100 adults.
Technically, constipation is having three or fewer bowel movements per week. However, UNC Health gastroenterologist Sarah McGill, MD says each person’s body runs on a different schedule, so constipation is really dependent on what your normal is. If you typically have a bowel movement every three days and you feel good, that’s not necessarily constipation. If your normal becomes more infrequent, if you feel discomfort when you try to go, or if you feel that your bowels have not completely emptied after going, that’s probably constipation.
Because constipation happens to almost everyone at some point, read on to understand common causes and steps you can take to get back to normal.
Causes of Constipation
- Low-fiber diet
“A diet with low fiber is a common cause of constipation,” Dr. McGill says. “The World Health Organization recommends adults eat 30 grams of fiber a day. In general, Americans eat half of that.”
A big part of Americans’ fiber problem is highly processed and refined foods, which tend to be low in fiber. “We’re eating less fiber than humans have historically, and less than many other cultures,” Dr. McGill says.
Fiber is important for two things, colon motility—the way a colon moves—and the quality of stool. The good bacteria in the gut get energy from fiber and convert it into nutrients. This conversion process signals the colon, the longest part of the large intestine, to move the digested food along. Without enough fiber, the colon gets sluggish, and we have fewer bowel movements. Fiber also increases the weight and size of stool while also making it softer. This all creates stool that’s easier to pass.
- Pelvic floor issues
The pelvic floor is a group of muscles at the base of the pelvis. By relaxing and contracting, they aid in function of many of the organs found in the pelvis: the bladder, rectum, uterus (in women) and prostate (in men). The pelvic floor can be damaged during birth in women and radiation treatments for prostate cancer in men; it can even be affected by stress. If you aren’t able to activate these muscles in the right way, bowel movements can be difficult to achieve.
- Medical conditions
Gastrointestinal disorders like irritable bowel syndrome (IBS) and other disorders that disrupt the gut-brain connection can cause constipation. The enteric nervous system (ENS), sometimes called the “second brain,” governs digestion through hundreds of millions of nerve cells that report back to the brain. When the communication between the ENS and brain is interrupted or impacted, that can disrupt digestion and bowel movements. Certain neurological conditions like stroke, cerebral palsy and injuries to the spinal cord can also impact colon motility because they impede the gut-brain connection.
- Medication side effects
“Certain medications can also lead to constipation,” Dr. McGill says. “Prescription medications for pain relief, depression and anxiety, and a variety of over-the-counter medicines for other conditions, can have side effects on the gastrointestinal tract that impact your bowel movements.”
- Change in routine
A different shift at work, an all-night study session and travel are all examples of a change in routine that can disrupt your body’s typical functions. Whether it’s throwing off your digestive tract’s internal clock by not sticking to your normal poop schedule, or changing your usual diet or exercise routine on vacation, this is enough to cause constipation.
Tips to Relieve Constipation
- Eat more fiber
Beans, nuts, fruits, vegetables and whole grains are good sources of fiber. A medium apple has about 4 grams of fiber, a cup of green peas has about 9 grams of fiber, and a cup of whole-grain spaghetti has about 6 grams of fiber. Studies have shown that eating prunes and kiwis can help relieve constipation as well. Incorporating these foods into your daily diet to reach around 30 grams of fiber can help keep you regular.
“You can also add a fiber supplement to your daily routine to help reach this goal,” Dr. McGill says. “However, these supplements do not have the vitamins and other nutrients that are found in foods high in fiber, so eating your fiber is preferred.”
Exercise can get things moving and keep them moving consistently. Dr. McGill says having a fitness routine, whether it’s walking or weightlifting, increases good hormones in the gut, which help with colon motility.
- Use a toilet stool
“Humans were made to have bowel movements while squatting, not sitting on what is essentially a chair,” Dr. McGill says. “Ideally, your feet should not be on the floor. Put a stool in front of your toilet to raise your feet and mimic the position of squatting to prevent straining and make the process easier on your body.”
Dr. McGill also says it is not good for your rectum to sit on the toilet for too long. She says the commode is not a place to read or catch up on email—you should be in and out. If it’s taking longer than two minutes to do your business, try again later.
Drinking enough fluids keeps stool soft, which allows it to pass through your system more easily. Drink plenty of water to keep your body hydrated.
- Try a laxative or stool softener
If you’ve tried the previous changes and still aren’t able to go, an over-the-counter laxative or stool softener is a safe next step. There are multiple types of laxatives available in different forms: pill, capsule, liquid, suppository and enema. Suppositories and enemas are inserted into the rectum, and though not as easy—or pleasant—as other forms of laxatives, they often work quicker.
When to See a Doctor About Constipation
Sometimes, a doctor’s help is needed. Dr. McGill says these are reasons to see a healthcare provider about your constipation:
- If you’ve made the suggested lifestyle changes and don’t experience consistently better bowel movements after two or three months.
- If at any time you have blood in your stool or bleeding from your rectum.
- If you need to use laxatives long term (more than two weeks) to achieve bowel movements.
- If your constipation is accompanied by weight loss or abdominal pain that isn’t relieved by having a bowel movement.
If you are experiencing digestive health issues, talk to your doctor. If you need a doctor, find one near you.