Constipation: Why Can’t I Go?

Amanda Pressman, MD, FACG

Everyone is different. That mantra holds true for many things, including some that might be a little uncomfortable to discuss: bowel movements.

According to the National Institutes of Health, constipation is one of the most common gastrointestinal problems in the U.S., affecting about 42 million people.

Because most would prefer to avoid the topic, here are the answers to some of the most common questions.

How often should I have a bowel movement? What is considered “normal”?

Normal bowel movements vary depending on the person. They may happen as often as three times a day, or just three times a week.

What is constipation?

When you are constipated, your bowel movements are painful or do not happen often enough. You may have constipation if you have bowel movements less than three times a week and/or your stool is hard, dry, or is passed in small pieces. It is important to note when you are not having a bowel movement as often as you usually do.

Sometimes I do not have a bowel movement for a few days. When should I worry that this is a problem?

Each person’s symptoms may vary, but common symptoms of constipation include:

  • difficult and painful bowel movements
  • less than three bowel movements a week
  • feeling bloated
  • the feeling of incomplete evacuation
  • abdominal pain
  • straining to move your bowels without results, even with soft stools
  • multiple medications tried without effect
  • enemas or suppositories do not resolve your constipation

Many of these symptoms of constipation can mirror other health problems. Speak with your health care provider if you notice any of these symptoms.

What causes constipation?

Not drinking enough water, a lack of fiber from the foods you eat, and inadequate exercise are the most common causes of constipation. Stress in your life can also be a factor. Many medications taken for other conditions cause constipation as a side effect as well.  

How can I avoid constipation?

A healthy lifestyle is key. Getting regular exercise, drinking six to eight glasses of water a day, and eating a diet that includes fruits, vegetables, whole grain breads, and cereals for fiber are a good start. These will all help to keep stools soft and easier to pass. Fiber supplements, such as Metamucil, are also safe to take daily to prevent constipation.

Be mindful of your body’s signals that you need to have a bowel movement. Do not delay going to the bathroom or try to rush while having a bowel movement.

Is there a safe over-the-counter remedy for constipation?

A mild, over-the-counter laxative, such as Miralax, can help to relieve constipation. If you do not have relief in seven days, see your health care provider.

Consider investing in a bathroom foot support, like a Squatty Potty, which lifts your legs to put your body in the best position for bowel movements.

What is chronic constipation?

Chronic constipation can mean different things. For some individuals, it is defined by having infrequent bowel movements for weeks at a time. For others, it means straining or having difficulty passing stool. Approximately 20 percent of adults have chronic constipation. In adults over 60, it occurs more often, affecting about 33 percent of people. It is important to note that women are one and a half times more likely to have constipation than men.

When should I make an appointment with a gastroenterologist?

Everyone is constipated from time to time. However, you should speak with your health care provider if you have:

  • constipation that lasts longer than three weeks
  • pain from constipation that is interrupting your daily routine
  • bleeding or black stools
  • constipation that does not respond well to stool softeners or laxatives
  • symptoms of any of the complications of constipation, including impacted stool, hemorrhoids, anal fissures, or rectal prolapse

A gastroenterologist is a physician who specializes in the digestive system. They can identify the cause of your constipation and discuss treatment options. Our team at the women’s gastroenterology program offers a comprehensive approach to women’s gastrointestinal issues. Visit our website for more information.

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