Chronic Constipation: Causes, Symptoms, and Treatment

Constipation is not defined only by going several days without a bowel movement. It can also involve hard stools, excessive straining, a sensation of blockage, or feeling that the bowel has not emptied completely.

When these problems persist for months, interfere with everyday activities, or do not improve with basic measures, they may indicate chronic constipation. Identifying the cause is important because not everyone needs more fiber or another laxative. Some people have slow intestinal transit, medication side effects, or difficulty coordinating the pelvic floor muscles.

Constipation may involve one or more of the following:

• Fewer than three bowel movements per week.
• Hard, dry, or lumpy stools.
• Frequent straining.
• A feeling of incomplete evacuation.
• A sensation of rectal blockage.
• The need to use manual maneuvers to pass stool.

Normal bowel frequency varies. A person may have fewer than one bowel movement per day without being constipated if the stools are soft, pass without significant effort, and leave a feeling of complete evacuation.

To diagnose chronic constipation, specialists consider the combination, frequency, and duration of symptoms. Clinical criteria generally require symptoms during the previous three months, with their onset at least six months before the evaluation.

The number of bowel movements alone is not enough to make a diagnosis.

Common symptoms include:

• Infrequent bowel movements.
• Hard or pellet-like stools.
• Pain or straining during bowel movements.
• A sensation of blockage.
• Incomplete evacuation.
• Spending excessive time on the toilet.
• Abdominal bloating.
• Abdominal discomfort.
• Excess gas.
• The need to press on the abdomen or near the rectum.
• Frequent use of laxatives or enemas.

Recurrent abdominal pain associated with bowel movements may suggest constipation-predominant irritable bowel syndrome, or IBS-C. This is a different condition that may require a specific approach.

Contrary to a common belief, most cases are not caused by a physical blockage of the colon. Causes may be primary or secondary.

Chronic idiopathic constipation is diagnosed when no structural or metabolic disease explains the symptoms. It is considered a disorder of gut-brain interaction and may occur with normal or slow intestinal transit.

In some people, the colon moves stool more slowly than usual. The colon then absorbs more water, making the stool dry and difficult to pass.

Slow transit cannot be confirmed based only on symptoms. Specialized testing may be required.

For a bowel movement to occur, the rectal and pelvic floor muscles must relax and coordinate correctly. When this coordination fails, a person may feel blocked, strain excessively, or need manual assistance.

This condition, known as a defecatory disorder or dyssynergic defecation, usually responds better to biofeedback therapy than to the repeated addition of laxatives.

Medications associated with constipation include:

• Opioid pain medication.
• Certain antidepressants.
• Medications with anticholinergic effects.
• Iron supplements.
• Some blood pressure medications.
• Certain antacids containing aluminum or calcium.
• Anticonvulsants.
• Some medications used for Parkinson’s disease.

Do not stop a prescribed medication on your own. Your physician may adjust the dose, switch treatments, or recommend a preventive strategy.

Constipation may also be related to:

• Hypothyroidism.
• Diabetes.
• Parkinson’s disease.
• Multiple sclerosis.
• Spinal cord injuries.
• Pregnancy.
• Abnormal calcium levels.
• Kidney disease.
• Other neurological disorders.
• Connective tissue diseases.

Some patients have more than one contributing factor.

Structural blockages are less common, but they should be ruled out when warning signs are present. Possible causes include:

• Colon or rectal cancer.
• Intestinal strictures.
• Severe inflammation.
• Rectal prolapse.
• Other structural abnormalities.

New constipation does not automatically mean cancer. However, it requires evaluation when accompanied by bleeding, anemia, unexplained weight loss, or a relevant family history.

Factors that may increase the likelihood of constipation or worsen existing symptoms include:

• A low-fiber diet.
• Inadequate fluid intake when dehydrated.
• Limited physical activity.
• Frequently ignoring the urge to have a bowel movement.
• Travel or schedule changes.
• Pregnancy.
• Older age.
• Hospitalization or limited mobility.
• Pelvic floor dysfunction.
• Certain medications.
• Anxiety, depression, or other factors affecting gut-brain interaction.

Drinking more water does not always solve constipation when a person is already adequately hydrated.

Schedule an evaluation if:

• Symptoms continue for several weeks.
• Constipation returns frequently.
• You need laxatives regularly.
• You feel a blockage during bowel movements.
• You require manual assistance.
• Dietary changes have not helped.
• You alternate between constipation and diarrhea.
• Symptoms began after starting a medication.
• Constipation affects your quality of life.
• You have a family history of colorectal cancer.

Persistent constipation should not be considered normal, particularly when it represents a change from your usual bowel pattern.

Seek prompt medical attention if constipation occurs with:

• Rectal bleeding or blood in the stool.
• Severe or constant abdominal pain.
• Inability to pass gas.
• Vomiting.
• Fever.
• A severely swollen or rigid abdomen.
• Unintentional weight loss.
• Severe weakness or fainting.

These symptoms may indicate an intestinal obstruction, fecal impaction, inflammation, or another condition requiring urgent care.

The gastroenterologist will review:

• Bowel movement frequency and stool consistency.
• The amount of straining required.
• Feelings of incomplete evacuation.
• Diet and fluid intake.
• Physical activity.
• Medications and supplements.
• Previous surgeries.
• Personal and family medical history.

Keeping a record of bowel movements, symptoms, foods, and laxative use for one or two weeks may be helpful. The Bristol Stool Form Scale can help describe stool consistency.

The evaluation may include:

• An abdominal examination.
• Assessment for dehydration.
• A neurological evaluation when appropriate.
• A digital rectal examination.

A rectal examination can provide information about masses, fissures, fecal impaction, and pelvic floor coordination.

Not everyone needs every test. The physician selects studies based on symptoms, age, medical history, and warning signs.

Blood tests may be used to investigate anemia, hypothyroidism, diabetes, calcium abnormalities, or other secondary causes.

A colonoscopy examines the colon for polyps, tumors, inflammation, and strictures.

It is not performed automatically because someone has constipation. It is generally recommended when warning signs are present, colorectal cancer screening is due, or the patient has relevant risk factors.

This test measures the strength and coordination of the rectal and anal muscles during an attempted bowel movement.

A small balloon is placed in the rectum to measure the patient’s ability to expel it. This test is commonly combined with anorectal manometry to evaluate a defecatory disorder.

This study measures how quickly material moves through the colon. It may use markers visible on X-rays or specialized recording devices.

Defecography captures images during evacuation and may identify functional or structural pelvic floor problems.

Before constipation is labeled refractory, 2026 clinical guidance recommends that most patients undergo anorectal manometry with balloon expulsion testing and complete biofeedback therapy when indicated.

Treatment is based on the cause, symptoms, and response of each patient. It is often introduced gradually.

Fiber increases stool volume and may improve its consistency. Sources include:

• Fruits.
• Vegetables.
• Legumes.
• Whole grains.
• Seeds.
• Nuts.

A fiber supplement particularly psyllium may also be helpful.

Increase fiber gradually. Adding a large amount suddenly can cause gas, pain, and bloating. In people with severe slow transit or pelvic floor disorders, more fiber may not improve symptoms.

Do not significantly increase fiber when an obstruction is suspected until you receive medical advice.

Adequate hydration helps prevent stools from becoming excessively dry. Fluid needs depend on the climate, physical activity, diet, and underlying health conditions.

Drinking excessive amounts does not provide additional benefit and may be unsafe for people with heart or kidney disease.

Regular activity can support bowel function and overall health. Walking, swimming, or another form of exercise adapted to your physical condition may be beneficial.

Practical recommendations include:

• Do not ignore the urge to have a bowel movement.
• Try using the bathroom after breakfast or another meal.
• Avoid prolonged straining.
• Use a small footstool if it improves your position.
• Allow enough time without sitting on the toilet for too long.
• Maintain regular schedules when possible.

Drinking a glass of water upon waking may be part of a personal routine, but it is not a specific treatment and does not work for everyone.

Not all laxatives work in the same way. The appropriate option depends on the type of constipation, other medical conditions, and current medications.

Polyethylene glycol, or PEG, is an osmotic laxative that keeps water in the stool. Joint AGA and ACG guidelines strongly recommend it for adults with chronic idiopathic constipation.

Psyllium has the best evidence among fiber supplements. It should be taken with adequate fluid and introduced gradually.

These may be appropriate for selected patients. Magnesium products require caution in people with kidney disease.

Bisacodyl and sodium picosulfate are recommended for short-term use or as rescue treatment. Senna may also be appropriate for certain patients.

These medications can cause cramping or diarrhea. Increasing the dose repeatedly without medical guidance is not a good strategy for persistent constipation.

When over-the-counter treatments do not provide adequate relief, the gastroenterologist may consider:

• Lubiprostone.
• Linaclotide.
• Plecanatide.
• Prucalopride.

The choice depends on symptoms, potential side effects, other health conditions, availability, and cost.

Colchicine, probenecid, misoprostol, and botulinum toxin are not considered routine treatments for chronic constipation.

Biofeedback is one of the main treatments for dyssynergic defecation. It teaches patients how to relax and coordinate the pelvic floor muscles during a bowel movement.

Biofeedback is not simply a series of Kegel exercises. Strengthening muscles that do not relax correctly may not solve the problem.

Treatment should be provided by trained professionals and based on a functional assessment.

Surgery is reserved for carefully selected cases after a comprehensive specialist evaluation.

Before surgery is considered, slow colonic transit should be confirmed and a pelvic floor disorder ruled out. Appropriate medication and biofeedback treatments should also be tried.

Surgery performed without correctly identifying the underlying mechanism may fail to improve symptoms and can cause new complications.

Without appropriate management, chronic constipation may contribute to:

• Hemorrhoids.
• Anal fissures.
• Fecal impaction.
• Rectal bleeding.
• Rectal prolapse.
• Overflow fecal incontinence.
• Reduced quality of life.

Frequent enemas or incorrectly performed manual maneuvers may also cause injury.

At BlueNetHospitals Los Cabos, our Gastroenterology specialists can determine whether constipation is related to slow transit, medication use, a metabolic condition, or pelvic floor dysfunction.

An accurate evaluation helps select the appropriate treatment and prevents the repeated use of products that do not address the cause.

If constipation persists, you need laxatives frequently, or you cannot empty your bowel completely, schedule an evaluation.

📲 Appointments via WhatsApp: +52 (624) 151 0693

If you have severe pain, vomiting, significant abdominal swelling, bleeding, or an inability to pass gas:

📞 24-hour Emergency Care: +52 (624) 1043 911

It is the persistent presence of infrequent bowel movements, hard stools, straining, a sensation of blockage, or incomplete evacuation over several months.

Fewer than three bowel movements per week is one criterion, but stool consistency, straining, and incomplete evacuation are also important.

It may be related to slow intestinal transit, pelvic floor disorders, medications, metabolic or neurological conditions, and, less commonly, an obstruction.

Polyethylene glycol has a strong recommendation for chronic idiopathic constipation in adults. Treatment should still be individualized.

It depends on the type, dose, and indication. Some may be used long term under medical supervision, while others are intended for short periods or rescue treatment.

No. Psyllium may help, but fiber can also increase bloating. It may not be sufficient for severe slow-transit constipation or pelvic floor dysfunction.

Correcting dehydration can help, but drinking additional water when you are already adequately hydrated does not always improve symptoms.

A colonoscopy may be recommended when warning signs or relevant risk factors are present or when colorectal cancer screening is due. It is not automatically required for every patient.

It is a therapy that teaches patients to coordinate and relax the pelvic floor muscles during evacuation. It is used for confirmed defecatory disorders.

A gastroenterologist evaluates possible causes, selects the necessary tests, and develops an individualized treatment plan.