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What is constipation?

Dr. Lawrence S. Friedman, MD
Gastroenterologist

Constipation is the slow movement of feces through the large intestine, resulting in the difficult passage of dry, hard stool. It's one of the most common gastrointestinal complaints in the United States, responsible for more than 2.5 million visits to health providers each year. The National Institutes of Health says that more than four million Americans have frequent constipation. Constipation is more common in women than men, and more common among older people.

The hard, dry stool that defines constipation develops when the colon absorbs too much water. This may happen because the muscle contractions of the colon are too slow, so the stool moves along sluggishly. Or it can occur when the anal sphincter fails to relax when it should, causing an excessive amount of stool to be stored in the rectum. Constipation can also occur when you consciously slow the movement of stool through the colon to hold back a bowel movement. If you routinely override the urge to defecate by consciously constricting the external sphincter muscles that surround the anus, your reflex to defecate may be blunted, and accumulated stool may harden as a result, becoming even more difficult to pass.

Eventually, the colon tries to move the stool by squeezing down to push it along. This causes an uncomfortable pressure and cramping. If the stool is not eliminated, more hard stool accumulates. When the stool finally passes, it can cause extreme discomfort.

Constipation may mean hard, dry bowel movements, difficulty eliminating bowel movements, and/or infrequent bowel movements, sometimes preceded by cramping or bloating.

Many factors can contribute to constipation. Painful conditions of the anus can discourage regular bowel movements, which can result in large, hard, and painful bowel movements. Inadequate amounts of liquid or fiber in the diet can be partly responsible.

Some medications may be constipating. Poor habits, such as waiting too long to respond to the urge to move one's bowels, can be a factor. In other cases, poor muscle function of the intestine, resulting in slow movement of intestinal contents, is a factor.

Abnormal function of the anal muscles may also contribute to these conditions. Anatomic changes in the intestine, such as tumors, cancers, and other problems, can account for a change in the bowel habits. In many cases, no definite cause can be found.

While most people have bowel movements somewhere between three times daily and every three days, some may go a week or two between bowel movements without harmful effects. However, if pain, cramping or other discomfort develops, evaluation is suggested.

Constipation can mean different things to different patients. It could be not going to the bathroom for different amounts of time, or difficulty going.

Dr. Michael T. Murray, ND
Naturopathic Medicine Specialist

Constipation is the inability to defecate. The frequency of defecation and the consistency and volume of stools vary so greatly from one individual to another that it is difficult to determine normal function. In general, most nutritionally oriented physicians recommend at least one bowel movement a day.

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Constipation is a condition characterized by infrequent stools or difficulty with stool passage. Some people can have hard bowel movements, or have to strain to have a bowel movement. Others can have feelings of incomplete or unsatisfactory defecation. Also known as irregularity, constipation can include pain when having a bowel movement, an inability to “go” after trying for a prolonged period or having less than three bowel movements a week. Everyone’s habits and patterns are different, so what is considered “normal” varies from person to person.

Constipation is generally defined as having fewer than three bowel movements per week, having difficulty while passing a bowel movement or both. Signs and symptoms of constipation may include hard or lumpy stools, straining or incomplete bowel movements. Some people with constipation may also experience abdominal discomfort or bloating. Types #1 and #2 on the Bristol Stool Form Scale are in the constipation range for most people.

  • Type 1: stools that are separate, hard, nut-shaped lumps that are hard to pass
  • Type 2: stools that are sausage-shaped, but lumpy

Constipation that keeps coming back may indicate a chronic condition, such as chronic idiopathic constipation (CIC) or irritable bowel syndrome with constipation (IBS-C). CIC is chronic constipation with no known cause, and IBS-C is one of the three major subtypes of IBS.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.