By: Gregory Lam, D.O.

There are certain movements you should aim to have at least three times a week. Exercising is one of them; bowel movements are another.

But what if you’re not ­– and haven’t for a while? Then it could be chronic constipation. No big deal, right? After all, constipation is one of the most common gastrointestinal complaints, affecting about 16% of adults and one-third of people older than 60. It’s probably nothing more fiber and water can’t fix.

Well, that might depend on the cause, and how long you’ve had it.

How To Tell If You Have Chronic Constipation

Constipation is an over-absorption problem. When the muscles in your colon (large intestine) contract slowly or sluggishly, the waste moving through slows down, too. The longer waste remains in your system, the more water the colon absorbs, which dries out the stool.

This can make for a stool that is hard and difficult to pass. If this persists for a few months, it is considered chronic constipation. Symptoms include:

• Making fewer than three bowel movements per week.
• Strain and discomfort when you try to go.
• Hard, dry, and/or small stools.
• Feeling as if there’s still stool in your bowel (incomplete movements).
• A sense that your rectum is blocked.

If you experience these issues, you’re in better company than you might think.

What Causes Chronic Constipation? It’s Not Always What You Eat

Research suggests 9% to 20% of American adults suffer from long-term, or chronic constipation. Typically, it’s brought on by a lack of fiber, fluids, and physical activity.

However, other illnesses or body issues can interfere with healthy digestion and require their own treatments. Among these causes:

• Pelvic floor dysfunction – If the muscles at the bottom of your torso (pelvis) have weakened, passing a stool can become difficult.
• Pregnancy – The hormone progesterone, which prepares the body for pregnancy, can slow the colon’s efficiency and, therefore, digestion. Pregnancy supplements also can contribute.
• Irritable bowel syndrome – IBS is a chronic disorder of the small intestine and colon that can cause constipation, as well as cramping, bloating, and diarrhea. It requires long-term treatment.
• Blockages – Damage to the colon tissue or tumors that block stools from passing.
• Chronic dehydration – Your waste needs water. Drink at least 10 cups a day, or one cup every 90 minutes.
• Certain medications – Treatments for some conditions can cause digestion problems. These include pain killers, antidepressants, antihistamines, and beta blockers (for high blood pressure).

A word about diet and activity: If you suffer chronic or occasional constipation, cut back on high-fat foods including processed meats, commercially baked goods, and fried food. Fats can take a long time to break down in the colon. Physical activity, meanwhile, strengthens your digestive muscles to process waste quickly.

When You Should See a Doctor

Untreated, chronic constipation can cause hemorrhoids – when the veins in the rectum swell due to repeated strain. Long-term, extreme straining can even force part of your rectum to bulge out, a condition called prolapse.

Other, more urgent signs to look for include blood in the stool (or toilet paper), unexplained weight loss, and stomach pain.

The first course of treatment for constipation involves lifestyle modifications ­– eating more vegetables, fruits, and fiber-rich foods; drinking more fluids; and exercising more. This approach can ease symptoms of IBS, as well. Stool softeners and fiber supplements can provide relief for occasional constipation.

If your constipation persists, medical options can include:

• Medications– These include drugs that draw more water into the colon, or reverse the side effects of other medications.
• Biofeedback– A common therapy option in which a gastroenterologist inserts a small into the rectum to measure how well your pelvic muscles tighten and relax. The feedback trains you to improve these contractions.
• Surgery – If the colon is blocked by hardened stools or ulcers, surgery might be necessary.

Find a GI Doctor You Trust

Constipation is common, but that doesn’t always mean it’s normal. If you don’t go every day, that’s fine. But if “regular” for you is fewer than three times a week, then it might be time to schedule a visit with your gastroenterologist.

Have you noticed an unexplained change in your bowel movements? You should talk about it with someone you trust. We offer easy online scheduling so you can request an appointment with one of Cincinnati GI’s physicians. If you just want to learn more, visit our web page about constipation here.