Constipation, without the jargon

What counts as constipation

Constipation can mean fewer than three bowel movements a week, stools that are hard, dry or lumpy, stools that are difficult or painful to pass, or a feeling that not everything has passed.¹ But people have different patterns, and only you know what is normal for you.² You don’t need a bowel movement every day; a change in your habits is the thing to notice.³

Almost everyone is constipated at some point, and most of the time it is short and not serious.⁴ About 16 out of 100 adults have symptoms, rising to about 33 out of 100 at 60 and older.⁶

Why it happens

Constipation is not a disease, but it can be a symptom of another problem.⁵ Common causes are slow movement of stool through the colon, pelvic floor problems that delay emptying, and conditions such as irritable bowel syndrome.⁸ Too little fluid or activity, and hormone conditions such as an underactive thyroid, play a part too.¹¹

Routine matters: pregnancy, getting older, travel and ignoring the urge to go can all change your habits.¹⁰ It is more likely in women, especially in pregnancy and after birth, in people who eat little fiber, and with certain medicines.⁷

What to try first

Most constipation can be treated at home.¹⁴ Start with fiber: adults should get 22 to 34 grams a day.¹⁵ Most fruits help, especially with their edible skins on, and so do beans, chickpeas, lentils and nuts.³⁰

Go slowly. Adding fiber quickly can cause bloating and gas,²⁶ and fiber needs water to work, so drink more as you add it.²⁷ Regular physical activity may help — try to be active at least 3 or 4 times a week.¹⁶²⁸

Routine helps the bowel too. Trying 15 to 45 minutes after breakfast may help, because eating helps the colon move stool.¹⁷ Give yourself enough time, go when you feel the urge, and try resting your feet on a footstool.¹⁸²⁹

Laxatives: short-term, and the type matters

If you need a laxative, a health care professional may recommend one for a short time and tell you which type is best.²⁰ They are not interchangeable. Psyllium is bulk-forming: it absorbs liquid and swells, so it must be taken with plenty of liquid.³² Polyethylene glycol is osmotic: it keeps water in the stool and may take 2 to 4 days to work.³⁴ Senna is a stimulant: it works within hours by increasing activity of the intestines.³⁶

Most product information says not to keep going beyond about a week without your provider,³¹³²³⁷ and stimulants should be kept for severe constipation or when other treatments have not worked.²¹ Frequent senna use may make you dependent on laxatives, and older adults should not usually take it long-term.³⁷ If you already can’t go without one, talk with your doctor about stopping slowly; over time the colon should start working normally again.²²

Two safety notes. Psyllium should be kept 3 hours apart from digoxin, aspirin and nitrofurantoin.³³ And tell your doctor before polyethylene glycol if you have ever had a bowel blockage or have symptoms of one.³⁵

Why a cleanse is not the answer

Colon “cleanses” use enemas, laxatives or colon hydrotherapy. NCCIH notes that evidence for colonic irrigation is limited and that colon cleansing can have side effects, some serious.³⁸ “Detox” programs that include laxatives can cause diarrhea, and sudden diarrhea can lead to dehydration.³⁹

A historical perspective: Dr. Majid Ali

“For them, their constipation is not just a colon problem.”

— Dr. Majid Ali, 28 July 2016

Dr. Ali wrote this about people who had lived with severe constipation for years and tried many treatments. His most useful contribution was tone: he took the complaint seriously, and he started with self-compassion, hydration and fiber. That food-first ordering matches current guidance.¹⁴

Beyond that, his list went on to antifungal medicine, oil rubs, enemas and colonics, and much of his constipation writing sits inside bowel-detox material. The sources used here do not support those.³⁸

When to see a doctor, and what to do this week

See a doctor if symptoms don’t go away with self-care, or if you have a family history of colon or rectal cancer.¹² See a doctor right away for bleeding, blood in the stool, constant belly pain, being unable to pass gas, vomiting, fever, lower back pain or weight loss without trying.¹³ A doctor may try treatment first, and blood tests can look for causes such as anemia or an underactive thyroid.²⁵ A diary of your bowel movements helps.²⁴

1. Add one high-fiber food, and more water

   Fruit with its skin, beans or lentils.³⁰ Add slowly, and drink more alongside.²⁶²⁷

2. Try a routine after breakfast

   15 to 45 minutes after breakfast, with time and a footstool if it helps.¹⁷¹⁸

3. Go when you feel the urge

   Don’t wait or hold it in.²⁹

4. Keep a short diary

   Track bowel movements and what they look like for a week or two before your visit.²⁴

5. Bring your medicine list

   Iron, some antacids, diuretics and pain medicines can contribute.⁹ Don’t stop any on your own.¹⁹

Every numbered marker links to the exact passage it rests on. Check the sources.