• Less than three bowel movements in a week
• Hard stools
• Needing to strain to pass stool
• Blocked feeling in the rectum
• Needing to manually remove the stool from your rectum
• Abdominal bloating and pressure
• Grunting in children without passing stool

If you suffer from any of the above symptoms for longer than three months, you may have chronic constipation.

Anything that causes a loss of water or slows down the bowel as it traverses the intestinal tract can cause you to become constipated. If your bowel changes are sudden or accompanied by bloody stoolsyou should see your doctor as soon as possible. Physicians will usually group constipation into primary and secondary causes. A primary cause of constipation is usually related to a defect in colonic function or a malfunction of the defecation process. Secondary causes of constipation are usually related to lifestyle behaviors, diet, disease, or medications. These secondary causes include:

• Low dietary fiber intake
• Dehydration
• Sedentary lifestyle
• Lowthyroid levels
• Irritable bowel syndrome
• Pregnancy or post-partum
• Change of routines
• Stress
• Withholding stool (usually children)
• Medications (narcotics, iron supplements, anti-depressants, antacids)
• Nerve dysfunction (spina bifida, spinal cord injury, multiple sclerosis)

Less commonly, constipation can be caused by cancer in the colon.

Check with your doctor if you have these symptoms for three or more weeks. Let your doctor know about any medications you are taking, health conditions, and your dietary habits. Often, this will be enough to uncover the cause of your constipation. If there is no explanation, the doctor may order some of the following tests:

Abdominal x-ray. To check for constipation and any blockages in the bowel.

Sigmoidoscopy. This test uses a lighted scope to see the inside of the lower colon and rectum.

Colonoscopy. This test uses a lighted scope to see the inside of the entire colon.

Anorectal manometry. This checks how well the anal sphincter is working. It uses a small tube and balloon to measure how the muscles work to move the bowels through the anus.

Colonic transit study. The doctor will have you ingest radiographic material and then do x-rays over a few days to see the movement of food in your colon.

Defecography. You will have barium paste inserted into the rectum. The doctor will do an x-ray, and then have you pass the barium like a bowel movement. This can check the muscles in your colon and rectum.

Osmotic laxatives. These stimulate the bowels to move.

Stool softeners. Help bring water into the bowel making stools easier to pass.

Bowel training. You learn how to relax your pelvic floor muscles so you can have a bowel movement with ease. The therapist will insert a tube into the rectum to monitor muscle activity. You will then attempt to squeeze and then relax the muscles. Over time, you can retrain them to relax at will.

Surgery. Your doctor may send you for surgical intervention. These surgeries can repair things like strictures that hold up the stool, anal fissures, and rectoceles (herniation of the rectum).

Check with your doctor, but some natural and alternative remedies have shown to be helpful for constipation. These include:

Aloe vera. Aloe vera has a laxative effect when taken as a drink made from the aloe leaf. This has the possible side effect of severe cramping and is not recommended.

Flaxseed. This is a safe form of soluble fiber and works well when taken with liquids or sprinkled on cereal.

Senna. Senna is an over the counter laxative that causes the bowel muscles to contract. There may be some abdominal pain and cramping with use.

Keep in mind that herbal remedies may interact with other medications and have side effects.

Dietary changes. You will need to add more fiber to help bulk up the stool. Try to add more fruits, vegetables, and whole grains to your diet. It takes about 14 grams of fiber daily to keep the bowels working properly. Make sure you add fiber slowly to prevent gas and cramping.

Fiber supplementation. Adding a fiber supplement can help. These are powders that you mix into water or juice and help bulk up the stool.

Get moving. Getting more exercise can get the bowels moving. Exercise a little every day. Walking and swimming are good and easy forms of exercise.

Go when you feel the urge. If you feel the urge to have a bowel movement, go right away. If you hold it then you increase the risk for constipation.

Increase fluid intake. Try to drink more than the usual six to eight glasses of fluids daily. Go for ten to twelve glasses of non-caffeinated fluids. Caffeine can be more dehydrating. Drink lots of water, herbal tea, fruit juices, and sports drinks.

• Hemorrhoids– Swollen veins in your anus caused by straining
• Anal fissure – A large or hard stool can cause tiny tears around the anus
• Fecal impaction – Accumulation of hardened stool that gets stuck in the colon
• Rectal prolapse – Straining causes a part of the rectum to protrude from the anus

Andrews, C.N.(2011, October 25). The pathophysiology of chronic constipation. Canadian Journal of Gastroenterology, 26(Suppl B). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206564/

Cleveland Clinic. (2019, November 07). Constipation. Retrieved from Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/4059-constipation

Higgins, P., Johanson, J. F. (2004, April). Epidemiology of constipation in North America. American Journal of Gastroenterology. (pp 750-759).  Retrieved from: https://journals.lww.com/ajg/Abstract/2004/04000/Epidemiology_of_Constipation_in_North_America__A.30.aspx

Mayo Clinic. (2019). Constipation. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

Medline Plus. Constipation. (2020, November 17). Retrieved from Medline Plus: https://medlineplus.gov/constipation.html