Everyone's bowel habits are different. Some people go three times a day, others three times a week, and both can be normal. Constipation means your stools have become hard, difficult to pass, or less frequent than is normal for you. It is uncomfortable and it can wear you down, but it usually responds well to treatment. Dr. Pimienta helps adults across Los Angeles County with constipation that has not improved on its own.
What counts as constipation?
You may be constipated if you have one or more of these:
- Fewer than three bowel movements a week
- Hard, dry or lumpy stools
- Straining, or stools that are painful to pass
- A feeling that you have not fully emptied your bowels
- Needing to press on your belly or around the rectum to pass stool
Short-term constipation often follows travel, a change in routine, illness or a new medicine. Constipation is called chronic when it lasts for several weeks or longer. Chronic constipation that comes with belly pain may be part of irritable bowel syndrome with constipation (IBS-C).
What causes constipation?
Stool moves through the colon as the colon absorbs water from it. When stool moves too slowly, too much water is absorbed and it becomes hard. Common causes include:
- Diet and daily habits: too little fiber, not drinking enough, sitting for long periods, or often putting off the urge to go.
- Medicines: opioid pain medicines, iron pills, calcium supplements, antacids with aluminum or calcium, some blood pressure medicines, some antidepressants and allergy medicines, and others. Do not stop a prescribed medicine on your own; ask your doctor about options.
- Health conditions: an underactive thyroid (hypothyroidism), diabetes, Parkinson's disease, and pregnancy.
- Pelvic floor problems: the muscles that control bowel movements may tighten instead of relaxing when you push. Stool can be soft and still hard to pass. This is common, and it responds well to pelvic floor physical therapy with biofeedback.
- Less often, a narrowing or blockage in the colon, which is one reason new constipation in older adults deserves a look.
When should I see a GI doctor about constipation?
Make an appointment if constipation lasts more than a few weeks despite fiber and fluids, if you rely on laxatives most days, or if it keeps coming back. See a doctor promptly if you have any of these warning signs:
- New constipation or a lasting change in bowel habits after age 45
- Blood in or on your stool, or black stools
- Weight loss you cannot explain
- Anemia (a low blood count) or low iron
- A family history of colon cancer or inflammatory bowel disease
- Severe belly pain
Call 911 or go to the nearest emergency room if your belly is swollen and painful and you are vomiting and cannot pass gas or stool, which can mean a blockage, or if you have heavy rectal bleeding or bloody stools with dizziness.
How does Dr. Pimienta evaluate constipation?
He starts with your history: how long it has been going on, what your stools are like, your diet, activity and fluids, and every medicine and supplement you take. A physical exam, which may include a gentle rectal exam, can show whether the pelvic floor muscles are relaxing as they should. Many people need no more than that. When more is needed, tests are chosen to fit:
- Blood tests, such as a blood count, thyroid tests, and calcium and blood sugar levels.
- Other tests that may be arranged, such as tests of how the rectum and pelvic floor muscles work, when a pelvic floor problem is suspected.
- Colonoscopy when there are warning signs, or when you are due for colorectal cancer screening. Constipation alone, without warning signs, is not usually a reason for one.
Fiber, fluids and movement
For many people, daily habits make a big difference:
- Fiber: adults should get 22 to 34 grams a day, depending on age and sex. Good sources include beans, whole grains, vegetables, fruit, and nuts. Prunes and kiwifruit help some people. Add fiber slowly over a few weeks to limit gas.
- Fluids: drink water through the day, especially as you add fiber.
- Movement: regular activity, even a daily walk, helps the bowel move.
- Routine: try to go at the same time each day, often after breakfast, and do not ignore the urge.
- Position: resting your feet on a small stool so your knees are above your hips can make it easier to pass stool.
What do the different laxatives do?
Laxatives work in different ways, and the right one depends on your symptoms. Some also cause gas at first (see bloating and gas). In plain terms:
| Type | Examples | How it works |
|---|---|---|
| Bulk-forming (fiber) | Psyllium, methylcellulose | Adds bulk and holds water in stool. Take with plenty of water. Works over days. |
| Osmotic | Polyethylene glycol (PEG), magnesium, lactulose | Draws water into the bowel to soften stool. Usually works in one to three days. |
| Stimulant | Senna, bisacodyl | Makes the bowel muscles squeeze. Usually works overnight. |
| Stool softener | Docusate | Helps water mix into stool. Often weaker than the others. |
| Suppository or enema | Glycerin, bisacodyl | Works in the rectum, within minutes to an hour. For occasional use. |
| Prescription | Several types | Increase fluid in the bowel or help it move, when over-the-counter options are not enough. |
Magnesium products are not right for everyone, especially people with kidney disease. Used as directed, most laxatives are safe, and stimulant laxatives do not "wear out" the bowel the way many people fear. Your plan depends on your health. You and Dr. Pimienta decide together which approach fits, and follow-up visits make sure it is working.
Questions patients ask
Is it bad to take a laxative every day?
Not necessarily. Many people with chronic constipation take polyethylene glycol or another laxative daily, and it is generally safe when used as directed. It is still worth seeing a doctor to make sure there is no other cause and that you are on the right one.
How many bowel movements a day are normal?
Anywhere from three a day to three a week can be normal. What matters most is a change from your usual pattern, and whether stools are hard or difficult to pass.
Can my iron pills cause constipation?
Yes, iron is a common cause. Do not stop it on your own if you need it. Ask your doctor about taking it differently or adding a gentle laxative.
Do I need a colonoscopy for constipation?
Usually not for constipation alone. A colonoscopy is recommended if you have warning signs such as bleeding, weight loss or anemia, if constipation is new later in life, or if you are due for colorectal cancer screening.
Why do I feel I have not emptied completely?
This is common with a pelvic floor problem, when the muscles do not relax fully during a bowel movement. It is treatable, often with pelvic floor physical therapy. Dr. Pimienta will talk with you about whether more testing would help.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Constipation.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for Constipation.
- American Gastroenterological Association and American College of Gastroenterology. Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. American Journal of Gastroenterology, 2023.