Chronic Constipation: Causes, Treatment, and More

The difficulty in using the toilets, the pain during bowel movements, and the gastrointestinal discomfort that characterise constipation affect up to 20% of the United Kingdom’s population today.

The real question is: is there anything that can relieve constipation? Well, we have good news for you! You can do quite a lot, from changing your habits to using certain medications and supplements that will alleviate it. Keep reading to find out everything there is to know!

Key Facts

  • Constipation is a symptom that primarily affects people over the age of 65 because of changes in their bodies and women because of hormonal (especially during pregnancy) and cultural factors.
  • For it to be called constipation, a person must pass fewer than three bowel movements a week, usually associated with hard, dry, difficult-to-release stools. These symptoms must last for over 3 months to be considered chronic.
  • The main cause of constipation is an unhealthy lifestyle that includes a poor diet, low water intake, and a sedentary lifestyle. But chronic constipation can result from diseases that need medical attention or the use of certain medications.

Chronic Constipation: What You Need to Know

Chronic constipation is a problem that affects many people around the world. In the UK, an estimated two out of ten people may suffer from this symptom, often resulting in severe discomfort that can impact their quality of life.

What is chronic constipation?

Constipation is a symptom (not a disease) that occurs when a person has fewer than three bowel movements a week, typically accompanied by hard stools, difficulty and/or pain in passing them (1)

This symptom can be either acute or chronic. Acute constipation refers to recent onset, while chronic (long-term) constipation must persist for at least three months (2, 3, 4).

Man feels strong stomach pain. People, healthcare and medicine concept
Constipation is a symptom that mainly affects people over 65 due to changes in their body and women due to hormonal factors. (Source: Sarifulin: 131197517 / 123rf.com)

What are the symptoms of chronic constipation?

Constipation can present itself in different ways, as it could be caused by a change in your lifestyle or a symptom of other major diseases. 

This is why you should be aware of the common symptoms and warning signs that you may experience during constipation (5, 6):

Common symptomsWarning signs
Fewer than three bowel movements per weekWeight loss
Difficulty in passing stoolsPain that keeps you awake
Hard or lumpy bowel movementsBloody stools or rectal bleeding
Mild abdominal pain or swellingVery swollen or bloated abdomen
Need to use your hands to help you pass stoolsVomiting
Feeling of blockageIn the elderly, severe constipation or worsening of constipation

Consult your doctor immediately if you experience any warning signs or unusual symptoms.

What causes chronic constipation?

Constipation can be triggered by anything that hinders your ability to pass stool, whether it’s a blockage, reduced bowel movements, or hard stools that are difficult to pass.

Here are the main reasons for this: 

A changing or unhealthy lifestyle

Constipation can often be the result of unhealthy habits or changes in your daily life that may affect your normal bowel activity. The most important factors are (6, 7, 8, 9):

  • A diet low in fibre and high in foods rich in fat and sugar
  • Not drinking enough water
  • Consuming a lot of alcohol or caffeine
  • Lack of physical activity
  • Ignoring the urge to go to the toilet
  • Recent travels

These causes are typically linked to short-term or acute constipation.

Health conditions

Certain conditions may increase the likelihood of constipation (6)

  • Hypothyroidism (decreased function of the thyroid gland)
  • Psychological disorders such as anxiety, depression, or eating disorders
  • Diabetes and other metabolic disorders
  • Cancer of the colon, rectum, or other abdominal cancers
  • Irritable bowel syndrome
  • Parkinson’s disease
  • Multiple sclerosis

The consumption of medication

In addition to the diseases that can cause constipation, some medicines also slow down bowel movements and make it difficult to pass stools (11, 12):

  • Pain relief medication (morphine or codeine) 
  • Antihypertensives that block calcium channels such as amlodipine or verapamil
  • Medications for Parkinson’s disease
  • Treatments for psychiatric disorders 
  • Diuretics (drugs that help you urinate)
  • Supplements (iron and calcium)
  • Anti-seizure medication (clonazepam or phenytoin)

Some drugs not mentioned in this list may also cause constipation. If you experience this symptom during your treatment, be sure to discuss it with your doctor!

Young woman doing exercises on pier
Many times constipation could be due to certain unfavorable habits for your health or changes in your daily life that could change your normal intestinal activity, such as lack of physical activity. (Source: Yastremska: 96078973 / 123rf.com)

Who can suffer from chronic constipation?

We can all experience chronic constipation, as this symptom has many possible causes. However, some population groups are more vulnerable to it:

  1. The elderly: people over the age of 65 are three times more likely to develop constipation than people in other age groups (1). This is due to age-related changes, the development of diseases such as diabetes or Parkinson’s, the use of medications and lifestyles that condition constipation (13).
  2. Women: women are much more prone to constipation than men. This is primarily a result of hormonal factors, but also of social conditioning, where women constantly avoid going to the toilet in public places because they feel embarrassed (14, 15). This hinders the normal functioning of your intestines.
  3. Pregnant women: developing constipation is very common during this important stage of life due to hormonal changes, reduced physical activity, the use of certain medications (such as iron supplements), and the movements the digestive system has to make to adapt to accommodate your baby (16, 17).

What You Can Do to Alleviate Chronic Constipation

Now that you know the basics about constipation, one big question remains: What can I do to relieve it? Luckily for you, we’ve got you covered in the following section!

Major lifestyle changes

One of the first steps in easing constipation is to change your daily habits. You can start with the following (18, 19, 20):

  • Include more fibre in your diet: you can find it in cereals, vegetables, and fruits. Remember to increase your intake gradually to avoid gastrointestinal discomfort.
  • Drink plenty of water: if you tend to forget to drink water, you could be contributing to your constipation without even knowing it. Drinking enough every day (about 8 glasses for a normal adult) will help hydrate your stools so they pass more easily.
  • Increase your physical activity: you can do anything to get your body moving! Whether you want to dance, walk, walk your pets, or play with your loved ones, everything matters! This is a great way to encourage your gut to move.
stylish mother with daughter
If you are the type of person who easily forgets to drink water, you could be contributing to your constipation without realizing it. (Source: Hetman: 121841733 / 123rf.com)

Sit correctly on the toilet

The toilet may be one of mankind’s most significant inventions. However, they forgot to consider a very important detail: the position of our rectum (the final part of the intestine) when we are sitting.

The natural way to pass stool is by squatting, as this straightens the rectum and makes it much easier to pass stool. However, the rectum bends when sitting with the knees at the same level as the pelvis, making going to the toilet more difficult (21)

Don’t worry! There is a very simple solution. You can use a stool to raise your knees to chest level, making your bowel movements easier.

Helpful probiotics

Probiotics are supplements that contain living microorganisms similar to those in a healthy intestine. A disrupted gut flora could make your constipation worse (22)

Certain probiotics may be effective in relieving chronic constipation. To choose and use them correctly, focus on the following points (23):

  1. Try to get probiotics with 100 million to 1 billion Colony-Forming Units (CFUs)
  2. Choose probiotics with an enteric coating. This makes it easier for microorganisms to reach your gut intact without being attacked by stomach acids
  3. Prevent your probiotics from being damaged by environmental conditions such as heat and humidity
  4. Follow the manufacturer’s specifications and your doctor’s instructions
Woman shopping fruits
Include more fiber in your diet, you can get fiber from cereals, vegetables and fruits. (Source: Trendsetter Images: 42936598 / 123rf.com)

Constipation medication

Chronic constipation often requires the use of certain medications for relief, as conventional methods alone cannot stimulate your bowel enough to pass stool.

This is where laxatives come in, a very varied group of medicines to help you go to the toilet. You can use (24):

  • Osmotic agents: the most affordable and fast-acting type of laxative. Pregnant women can use them under medical supervision. They absorb large amounts of water into the intestine to facilitate the passage of stools.
  • Stimulants: mainly used to treat constipation caused by certain drugs, this type of laxative stimulates bowel movement. 
  • Emollients: they help to mix the faeces with water and fats to facilitate their passage through the digestive tract. While their effect is delayed, they can be taken by people with heart and blood pressure conditions.

Don’t forget to speak to your doctor before choosing or using a laxative.

See your doctor

Chronic constipation is a symptom that can be the consequence of many factors, including major diseases.

Your general practitioner can then diagnose and treat these diseases to relieve the symptoms of your constipation and many others linked to these conditions.

That said, constipation is often a consequence of the medical treatments you may need. Talking to your doctor about this side effect may also result in a change in your medication or association with other drugs that may help relieve your constipation. 


Summary

Constipation is defined as a decrease in the frequency of bowel movements to less than three a week. It becomes chronic when this symptom lasts more than three months; in these cases, it may be associated with more severe health conditions.

Treating constipation should start at home. You can identify whether a lifestyle change might improve your symptoms. In addition, you should always seek medical advice when constipation becomes chronic, as a lifestyle change may not be enough to alleviate it.

If you found this article useful, share it with your loved ones and leave us a comment with your doubts and opinions. We’ll be happy to answer you!

(Source of featured image: Georgerudy: 81320080 / 123rf.com)

References(17)

  1. Fundación Española del Aparato Digestivo. Guía para prevenir y tratar el estreñimiento. SaludigestivoEs n.d.
  2. Anti M. y Cols. Water Supplementation Enhances the Effect of High-fiber Diet on Stool Frequency and Laxative Consumption in Adult Patients with Functional Constipation.
  3. Dinning PG, Smith TK, Scott SM. Pathophysiology of colonic causes of chronic constipation. Neurogastroenterol Motil 2009;21 Suppl 2:20–30.
  4. Wong M. Sociodemographic and lifestyle factors associated with constipation in an elderly Asian community. Am J Gastroenterol 1999;94:1283–91.
  5. Branch RL, Butt TF. Drug-induced constipation. Adverse Drug React Bull 2009;NA;987–90.
  6. Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in the elderly. Am J Gastroenterol 2012;107:18–25; quiz 26.
  7. Oh J-E, Kim Y-W, Park S-Y, Kim J-Y. Estrogen rather than progesterone cause constipation in both female and male mice. Korean J Physiol Pharmacol 2013;17:423–6
  8. McCrea GL, Miaskowski C, Stotts NA, Macera L, Paul SM, Varma MG. Gender differences in self-reported constipation characteristics, symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation. Gend Med 2009;6:259–71.
  9. Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev 2001:CD001142.
  10. Societat Catalana de Digestología. Información para pacientes: Estreñimiento. IngotmScdigestologiaOrg n.d.
  11. Tramonte SM, Brand MB, Mulrow CD, Amato MG, O’Keefe ME, Ramirez G. The treatment of chronic constipation in adults. A systematic review. J Gen Intern Med 1997;12:15–24.
  12. Müller L y Cols. Myths and Misconceptions About Chronic Constipation. American Journal of Gastroenterology. 2005
  13. Gao R, Tao Y, Zhou C, Li J, Wang X, Chen L, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol 2019;54:169–77
  14. Sikirov BA. Primary constipation: an underlying mechanism. Med Hypotheses 1989;28:71–3.
  15. Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2014;100:1075–84.
  16. Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2014;100:1075–84.
  17. Personal de Mayo Clinic. Laxantes de venta libre para tratar el estreñimiento: Úsalos con precaución. [Internet]. Mayoclinic.org. 2018.
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Scientific Article
Fundación Española del Aparato Digestivo. Guía para prevenir y tratar el estreñimiento. SaludigestivoEs n.d.
Go to source
Human Clinical Trials
Anti M. y Cols. Water Supplementation Enhances the Effect of High-fiber Diet on Stool Frequency and Laxative Consumption in Adult Patients with Functional Constipation.
Scientific Article
Dinning PG, Smith TK, Scott SM. Pathophysiology of colonic causes of chronic constipation. Neurogastroenterol Motil 2009;21 Suppl 2:20–30.
Go to source
Human Clinical Trials
Wong M. Sociodemographic and lifestyle factors associated with constipation in an elderly Asian community. Am J Gastroenterol 1999;94:1283–91.
Go to source
Scientific Article
Branch RL, Butt TF. Drug-induced constipation. Adverse Drug React Bull 2009;NA;987–90.
Go to source
Scientific Article
Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in the elderly. Am J Gastroenterol 2012;107:18–25; quiz 26.
Go to source
Animal Clinical Trials
Oh J-E, Kim Y-W, Park S-Y, Kim J-Y. Estrogen rather than progesterone cause constipation in both female and male mice. Korean J Physiol Pharmacol 2013;17:423–6
Go to source
Human Clinical Trials
McCrea GL, Miaskowski C, Stotts NA, Macera L, Paul SM, Varma MG. Gender differences in self-reported constipation characteristics, symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation. Gend Med 2009;6:259–71.
Go to source
Scientific Article
Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev 2001:CD001142.
Go to source
Scientific Article
Societat Catalana de Digestología. Información para pacientes: Estreñimiento. IngotmScdigestologiaOrg n.d.
Go to source
Scientific Article
Tramonte SM, Brand MB, Mulrow CD, Amato MG, O’Keefe ME, Ramirez G. The treatment of chronic constipation in adults. A systematic review. J Gen Intern Med 1997;12:15–24.
Go to source
Scientific Article
Müller L y Cols. Myths and Misconceptions About Chronic Constipation. American Journal of Gastroenterology. 2005
Go to source
Literature review
Gao R, Tao Y, Zhou C, Li J, Wang X, Chen L, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol 2019;54:169–77
Go to source
Medical examination
Sikirov BA. Primary constipation: an underlying mechanism. Med Hypotheses 1989;28:71–3.
Go to source
Scientific Article
Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2014;100:1075–84.
Go to source
Scientific Article
Dimidi E, Christodoulides S, Fragkos KC, Scott SM, Whelan K. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2014;100:1075–84.
Go to source
Official website
Personal de Mayo Clinic. Laxantes de venta libre para tratar el estreñimiento: Úsalos con precaución. [Internet]. Mayoclinic.org. 2018.
Go to source