Whether you feel constipated is likely based on what your normal bowel pattern is. However, "normal" bowel pattern can be quite variable. If you are constipated all your life, you may not think you are constipated (and likely would be less concerned about that). In general, normal bowel pattern refers to:

  • Having a bowel movement at least once every 3 days, but not more than 3 bowel movements per day.

  • Stool should pass easily and does not require straining

  • You should feel complete evacuation after your bowel movement

Normal bowel movement is a result of complex coordination of intestinal peristalsis and contraction and relaxation of the anorectal and pelvic floor muscle. These in turn are affected by the nerves, chemicals and hormones in your body. A problem with any one of the above may result in constipation.

Signs of constipation

Common signs you may already know include hard, lumpy or pebble-like stools, need to strain to pass stool, or not having a bowel movement in more than a few days. Other less-known signs include:

  • abdominal bloating or pressure sensation, or pain (due to stool back-up) that is usually relieved after a substantial bowel movement

  • reliance on laxatives (or other prescription medication for constipation) to have a bowel movement

  • sensation of not able to empty your bowel completely

  • sensation of (but no true) blockage or obstruction in the anus or rectum

  • need to use your finger or other manuvers to help pass stool

Causes and treatment of constipation

Here is a straightforward scheme of categorizing the cause of constipation and the corresponding treatment:

  • Constipation due to inadequate diet that is low in fiber and water intake and lack of exercise - the colon function and transit time are normal and there are no pathology or disease process. This is the most common reason and is easily correctable by increasing fiber and water intake and physical activity.

  1. Common medications: narcotic pain medication, anti-depressants, Parkinson's medication, psychiatric drugs

  2. Endocrine or metabolic disease: hypothyroidism (low thyroid function), diabetes

  3. Neurological disorders: Parkinson's disease, dementia, injury or disease involving the spinal cord, multiple sclerosis

  4. Psychosocial issues: depression, anxiety, stress, learned behavior (e.g. avoidance of public bathroom)

Sometimes, the cause is not obvious and more than one factor may be in play. A comprehsive evaluation is important for proper diagnosis and management.

When should you be concerned about your constipation

You should pay attention to any change in your usual bowel pattern, i.e. you were previously "normal" but recently more constipated. If your constipation comes with other symptoms such as blood in stool or when wiping, pain in the abdomen or anorectal region, abnormal discharge from anorectum, weakness or weight loss, you should seek medical attention promptly. Although it is always a good idea to increase your fiber and water intake and activity level to try to get your constipation better, when these are not working or when you just don't feel right about moving your bowel, it is time to bring it up to your doctor.

  1. Slow-transit constipation (colonic inertia)

  2. Pelvic floor dysfunction (such as anismus, rectocele)

  1. Cancer of the colon, rectum or anus

  2. Stricture due to diverticular disease

  3. Rectal prolapse or very large prolapsing hemorrhoids

  4. Stricture related to inflammatory bowel disease (Crohn's disease or ulcerative colitis), other previous severe inflammation of the anorectum (radiation or infectious proctitis), or anal surgery (e.g. post-hemorrhoidectomy)

  5. Severe acute inflammation causing swelling and narrowing of a segment of intestine

  • Constipation due to abnormal functioning of the colon, rectum, anus and/or pelvic floor - this is often less obvious and requires more investigation (ideally by a colorectal surgeon) and is more difficult to treat. Treatment may involve a combination of diet and bowel habit modification, judicious use of laxatives, biofeedback and pelvic floor physical therapy. Surgery is not necessary in the majority of cases:

  • Constipation due to a mechanical blockage of stool transit - this could occur in one of the following conditions, and require specific treatment of the underlying condition:

  • Constipation due to medications, endocrine or metabolic disease, neurological disorders, or psychosocial issues - these factors extrinsic to your intestinal tract may affect the nerve, chemical or hormonal function of your intestinal tract. When feasible, eliminate or minimize the effect of the following, or work with your healthcare provider to achieve better control of your disease can help with your constipation:

Helpful links:


*American Society of Colon and Rectal Surgeons