When your body doesn’t follow its natural rhythm, it can lead to constipation — the most common gastrointestinal issue. While occasional constipation is normal, understanding its symptoms and causes can help you address it effectively. Here’s what you need to know to recognize and manage this condition.

What are the symptoms of constipation?

How do you know you’re constipated? According to Northwestern Medicine Gastroenterologist, Christian G. Stevoff, MD, there are several symptoms, but not all of them need to be present to have constipation.

You may be constipated if you have one or more of these symptoms:

• Infrequent bowel movements (fewer than three per week)
• Hard poop, often in small, dry pieces
• Excessive straining to poop
• Incomplete emptying of the bowels
• Need for manual maneuvers, such as digital stimulation of the rectum under physician guidance

What causes constipation?

Constipation can be categorized into three types, each with different causes.

• Mechanical blockage constipation: This occurs due to either a mass in the colon or the narrowing of the colon, which is also called a stricture.
• Slow transit constipation: This occurs when your colon is sluggish. Sometimes this happens randomly with no medical explanation, but it is often due to side effects of medications or related to other diseases, such as thyroid disease or neurological conditions like Parkinson’s disease. Slow transit constipation can occur as part of the normal aging process or due to spinal cord injury.
• Dyssynergic defecation: Also known as anismus, this happens when the muscles in the abdomen or pelvic floor do not coordinate properly, making it difficult to push out your stool effectively. This can happen for a variety of reasons, including spinal cord injury.

Constipation of any type may cause bloating and discomfort in your abdomen and lower back pain.

What puts you at risk for developing constipation?

There are many things that can cause constipation, but some general risk factors for constipation include:

• Age: Older adults are more likely to experience constipation than younger adults.
• Sedentary lifestyle: If you have a job where you sit frequently, your lifestyle is considered sedentary. This can increase your risk of developing constipation.
• Diets that are low in fiber: The daily recommended value for fiber intake is 25 grams. Fiber is found naturally in healthy whole foods, such as whole grain breads and cereals, fruit, vegetables, beans, nuts and seeds.
• Dehydration (not drinking enough liquids).
• Taking medications known to cause constipation: These include narcotics, some blood pressure medications, iron supplements, some anti-depressants and many other medications. Check with your physician to see if you are on any medications that can cause constipation.
• Underlying health conditions: Sometimes pregnancy can cause constipation. Certain diseases like neurological disorders or irritable bowel syndrome can cause constipation as well.
• Stress: There is a connection between your mind and your gut. Increased periods of stress can contribute to constipation.

How do you treat constipation?

You don’t have to turn to medication right away to relieve constipation. There are many other simple interventions that you can try first.

• Tell your clinician: Start by informing your primary care clinician that you are experiencing constipation. They may recommend additional testing based on your personal health history.
• Stay hydrated: Dehydration can cause and worsen constipation. Aim to drink at least eight to 10 cups of water per day if you are not on a fluid restriction for other medical reasons. Dr. Stevoff mentions that people may think hot herbal tea can help encourage a bowel movement, but this is purely anecdotal and there is no evidence that tea can help you poop.
• Adjust your diet: A high-fiber diet is essential. Aim for 25 to 30 grams of fiber daily from food or supplements, which you can get at your pharmacy. Prune juice is a common remedy, but be mindful of its high sugar content, especially if you have high blood sugar or pre-diabetes.
• Stay physically active: Regular movement can promote bowel health. Walking is an effective way to encourage bowel movements. Yoga is a type of exercise that can help with constipation. Meditation and other interventions like hypnotherapy and diaphragmatic breathing can also help relieve constipation. Always discuss any physical activity limitations with your clinician.
• Consider over-the-counter medications and supplements: Before using stool softeners, laxatives or suppositories, talk to your primary care clinician to make sure they won’t interfere with any other medications you may be taking.
• Stool softeners: These make it easier to pass stool. Docusate is an example of a stool softener.
• Lubricant laxatives: These prevent your digestive tract from absorbing water from your poop so it can pass easily. Some people may use mineral oil or castor oil as laxatives, but you should discuss the use of these with your clinician before consuming.
• Stimulant laxatives: These cause the nerves that control your colon to contract. This helps move the poop along in your digestive tract.
• Suppositories: These are inserted into the rectum and can act as both lubricant and stimulant laxatives. They are often a good option for children who may not tolerate oral medications.
• Try physical therapy (PT) for chronic constipation: Chronic constipation related to pelvic floor issues may benefit from pelvic floor therapy, including biofeedback. Biofeedback uses sensors to help you identify and relax the right muscles for bowel movements. Pelvic PT may also teach you positions that reduce straining during bowel movements.

Can using a “Squatty Potty” regularly help prevent constipation?

“Squatty Potties,” also known as poop stools, have become more popular in the United States in recent years, but have been used for hundreds of years in other countries. This device is a stool placed around your toilet to adjust your posture, raising your knees toward your abdomen. This position helps elongate your colon, which may make it easier to have a bowel movement without straining.

However, there is no evidence linking the regular use of these stools to the prevention of constipation.

Why am I still constipated?

Constipation is considered chronic if it has been going on for at least three months. Sometimes chronic constipation can lead to impacted stool (when a large, hard mass of poop gets stuck in your colon).

If you have been constipated for more than a few weeks, even though this timeframe technically doesn’t meet the requirements for chronic constipation yet, talk to your primary care clinician who can help you get to the bottom of it.

Learn more about your poop.