Almost everyone experiences constipation at some point. But chronic constipation can have a significant impact on quality of life.
If you’re living with chronic constipation, you’re not alone. It can be a difficult topic to discuss. So, it may surprise you to know that chronic constipation has a worldwide prevalence of 15 percent.
When chronic constipation has no clear relationship to another health condition, it’s considered the primary disorder. When it’s due to another health problem, constipation is considered a secondary disorder.
Chronic constipation can lead to complications. Sometimes, treating the primary condition can get it under control. If not, there are other treatments to address constipation.
If you have chronic constipation, it may be time to see a doctor. Knowing the cause can help you find the best treatment.
Irritable bowel syndrome (IBS) is a gastrointestinal disorder. Constipation is one potential symptom. Other symptoms include bloating and abdominal pain. And some people with IBS have alternating diarrhea and constipation.
More than one-third of people with IBS have a subtype called constipation-predominant IBS, or IBS-C. In IBS-C, the digestive system tends to contract too slowly. Slow movement through the intestines makes stools hard and difficult to pass.
About 60 percent of people with long-standing diabetes have problems with constipation. This may be due to:
- uncontrolled blood sugar over a long period
- Diabetic neuropathy (nerve damage)
- medications that slow gut mobility
Other endocrine and metabolic disorders that can lead to chronic constipation include:
- hypercalcemia (too much calcium in the blood)
- hypokalemia (low potassium)
- hypomagnesemia (low magnesium)
- hypothyroidism (underactive thyroid)
- uremia (waste products in the blood due to poor kidney function)
Muscles in your gastrointestinal tract contract to move food through your intestines. Muscles and nerves around the rectum and anus let you know it’s time to move your bowels. Any disorder that affects these nerves and muscles can affect the ability to move your bowels.
Constipation is one of the most common symptoms of Parkinson’s disease. This may be due to weakening motor performance. Parkinson’s disease and other neurological disorders can make it hard to move around like you used to. This decrease in physical activity can also contribute to constipation.
Other neurological conditions that may cause constipation include:
- cerebrovascular disease (conditions that affect blood flow to the brain)
- multiple sclerosis (MS)
- lateral amyotrophic sclerosis (ALS)
- spinal cord injury or tumor
Research suggests that people with chronic constipation often have psychological disorders. These may include:
- eating disorders
The reasons for this aren’t entirely clear. A 2019 mouse model study suggested that depression and gastrointestinal distress are both related to low serotonin. More research is needed to understand these links in humans.
People with dementia can also experience chronic constipation. Decrease in exercise and fluid intake may play a role. In addition, people with dementia tend to be older and may have other underlying conditions that contribute to constipation.
Some medications used to treat mental health conditions can cause constipation.
A study published in 2019 found that participants with constipation had:
- 11 percent higher risk of developing heart disease
- 19 percent higher risk of developing ischemic stroke
Similar risks were found among people who took laxatives. This research involved more than 3 million US veterans. Fewer than 7 percent were women.
The study authors noted that the results were similar to earlier studies involving postmenopausal women. They also acknowledged that their work didn’t prove cause and effect.
Medications and other associations
Constipation is a common side effect of certain medications. Some of these are:
- Drugs to lower blood pressure or cholesterol
- muscle relaxants
- oral iron supplements
Constipation can also be related to conditions such as:
- obstruction from colon cancer or other types of tumors
- strictures (narrowing of the intestines)
- large rectocele (weakening of the wall between the rectum and vagina)
- megacolon (dilation of the colon)
- inflammatory bowel disease (IBD)
Frequent constipation and straining can lead to complications such as:
- anal fissures (tears in the skin around the anus)
- hemorrhoids (swollen veins around the rectum and anus)
- rectal bleeding
- rectal prolapse (the rectum falls out of its normal position)
- fecal impaction (hardened stool that gets stuck in the rectum)
Chronic constipation may be related to an underlying condition. It can also lead to complications. That’s why it’s important to see a doctor and get a diagnosis.
Your doctor may start by recommending:
- drinking more fluids
- increasing dietary fiber or adding fiber supplements
- getting regular physical activity
- scheduling a bowel movement at the same time every day
- using digital rectal stimulation
- taking stool softeners or laxatives
When constipation is a side effect of medication, your doctor may be able to prescribe an alternative.
Treating any underlying conditions may help relieve constipation. Other treatment options include:
- lubiprostone (Amitiza), a prescription-strength laxative
- linaclotide (Linzess) or plecanatide (Trulance), guanylate cyclase-C agonists that help regulate bowel movements
- prucalopride (Motegrity), a serotonin receptor agonist that helps your colon move stool faster
- biofeedback therapy to help retrain the muscles that help you move your bowels
- surgery to remove or repair blockages
Occasional constipation is not unusual. It’s often a matter of dietary changes or increased exercise. But chronic constipation can lead to serious complications.
Constipation can also be related to an underlying condition, such as IBS-C or diabetes. Treating the primary condition may help relieve constipation. When that isn’t enough, there are treatments specifically for constipation.
If you can’t find relief on your own, it may be time to see a doctor. Once you understand the cause, you can work with your doctor to find the best solution.