Causes
Constipation happens when stool moves too slowly through the colon or is difficult to pass. Common contributors include:- Diet and lifestyle: Too little fiber, not enough fluids, and physical inactivity are the most frequent culprits.
- Medications: Opioid pain relievers, some blood pressure medicines, certain antidepressants, iron supplements, and some antacids can all slow the bowel.
- Medical conditions: An underactive thyroid (hypothyroidism), diabetes, and irritable bowel syndrome with constipation are common examples.
- Pelvic floor dysfunction: The muscles that coordinate a bowel movement do not relax properly, causing straining even when stool is soft.
- Slow-transit constipation: In some people the colon simply moves stool more slowly than normal.
Symptoms
Beyond infrequent stools, people with chronic constipation often report:- Straining: Needing to push hard or spend a long time on the toilet.
- Hard or lumpy stools: Often accompanied by bloating and abdominal discomfort.
- A sense of incomplete emptying: Feeling that stool is left behind after a bowel movement.
- A feeling of blockage: As if stool cannot pass despite the urge.
- Hemorrhoids and anal fissures: Repeated straining and hard stools can cause painful complications around the anus over time.
Diagnosis
Evaluation starts with a careful history and physical examination, including a review of all medications and supplements. Blood tests may check thyroid function, blood sugar, and calcium. A colonoscopy is recommended when warning signs are present — blood in the stool, unintended weight loss, anemia, or new constipation after age 50 — to rule out structural problems such as colon polyps or narrowing of the colon. Specialized testing of colonic transit or pelvic floor function is reserved for persistent cases.Treatment
Most chronic constipation improves with a stepwise approach.- Fiber, fluids, and movement: Gradually increasing dietary fiber toward 25 to 35 grams daily, drinking plenty of water — especially important in Florida's heat — and regular exercise are the foundation.
- Bowel habits: Setting aside unhurried time after meals, when the colon is naturally most active, and using a footstool to improve positioning.
- Over-the-counter laxatives: Fiber supplements and osmotic laxatives such as polyethylene glycol are effective and safe for regular use; stimulant laxatives are generally reserved for short-term or rescue use.
- Prescription medications: When first-line measures are not enough, options include secretagogues such as linaclotide, lubiprostone, and plecanatide, which draw fluid into the bowel, and prucalopride, which stimulates colonic movement.
- Pelvic floor physical therapy: Biofeedback-based therapy is the treatment of choice when the pelvic floor muscles are not coordinating properly.