How to Prevent and Treat Chronic Constipation

How to Prevent and Treat Chronic Constipation
14 October

Recognizing the symptoms that suggest chronic constipation, plus: a complete guide to getting regular

It’s normal to have an occasional bout of constipation. Uncomfortable as it may be, this usually resolves within a few days. But chronic constipation—which might require some action—is the issue if you have at least two of the following symptoms for at least three months:

• You have fewer than three bowel movements per week.
• You need to strain for at least a quarter of all your bowel movements.
• Stool is often hard or lumpy.
• Sometimes you feel like your bowels haven’t been fully emptied.

For relief, people with chronic constipation may turn to laxatives.

“Many older adults assume that constipation is just another inevitable part of aging, but it can be avoided through lifestyle [strategies and] occa­sion­ally medication,” says Christian Stevoff, MD, a gastroenterologist at Northwestern Medical Center in Chicago.

Know the Causes of Chronic Constipation

Chronic constipation might be more common in older adults, affecting about a quarter of women and 16 percent of men over age 65, and a third of women and a quarter of men older than 85, according to a study published in the journal Clinics in Geriatric Medicine in 2021.

“As we age, our gut and nervous system also age, and one of the consequences of that is the degeneration of nerves and muscles (that move waste along) so that they don’t function as well as they used to,” says Satish Rao, MD, chair of gastroenterology at Augusta University in Georgia.

But other factors, includ­ing insufficient fiber and too little physical activity, can also contribute. Medications such as opioids and certain antidepressants, blood pressure meds, and Parkinson’s disease drugs are all potential culprits, Stevoff says.

Some over-the-counter (OTC) pain relievers, like ibuprofen and naproxen, are also associated with constipation, and supplements that contain calcium or iron “can bind you up,” says William Chey, MD, a gastroenterologist at the University of Michigan in Ann Arbor.

Hypothyroidism or neurologic issues such as multiple sclerosis can lead to constipation, too, as can pelvic floor disorders—which affect the ability to coordinate muscles to push stool out, says David Poppers, MD, a gastroenterologist at NYU Langone Health in New York City.

Try These Lifestyle Steps

Lifestyle strategies can be quite effective if you continue them, but they can take several weeks to begin working. If you need immediate relief—say, you haven’t passed stool in several days—you might consider using an OTC osmotic laxative with polyethylene glycol (PEG), Stevoff says. (For some people, stimulant laxatives, such as senna and bisacodyl, may have harsher side effects than PEG-based medications.)

Always let your doctor know if you haven’t had a bowel movement in several days. For the long haul, try these strategies:

Increase your fiber. It helps bulk up stool, making it easier to pass. Research suggests that eating five or six prunes each day is as good for chronic constipation as some laxatives, Rao says. Or try eating two kiwi­fruits a day; research done by Chey has found that it relieves constipation in about half of people, without some of the side effects of prunes, such as abdominal pain, bloating, and gas.

Ramp up your fiber intake over a period of days to weeks to allow your body to get used to it, Chey says. If you find it hard to get enough fiber through food, consider taking an OTC fiber supplement. The best evidence is for those that contain psyllium, Poppers says.

Drink enough fluids. Try to drink around eight 8-ounce cups of fluid every day. A cup of coffee might also be helpful because it’s a mild gastro­­intestinal stimulant. Many older adults are perpetually dehydrated, which can worsen constipation, Chey says.

Pay attention to timing. Your bowels tend to be most active within about a half hour after a meal, so make sure you have access to a toilet then. It’s fine to spend about 5 to 10 minutes in the bathroom, but if nothing happens in that time, try later in the day, Poppers says.

Adopt the right posture. You want to keep your knees above your hips, which relaxes pelvic floor muscles that loop around the back of your rectum, says Carrie Pagliano, DPT, a spokesperson for the American Physical Therapy Association. “This way it provides a straight shot for BMs to go out,” she says. One option is to sit on the toilet with your feet on a small footstool, such as the Squatty Potty. And avoid straining­.

Exercise. “We think that it does release a number of gut hormones that can help get things moving again,” Rao says. A study published in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy in 2017 found that women with chronic constipation who walked on a treadmill for 60 minutes three times a week for 12 weeks reported an improvement compared with a control group.

If You Need Long-Term Help for Chronic Constipation

If you’ve tried lifestyle steps for three to four weeks and still experience some chronic constipation, see your doctor, Stevoff says. They can do blood work to rule out medical conditions, review your meds and supplements, and, if necessary, perform tests like a colonoscopy to check for an obstruction or a blockage. If your chronic constipation is caused or worsened by pelvic floor problems, your doctor may recommend pelvic floor physical therapy, where you’ll learn techniques such as abdominal massage that can help get things moving again.

When there’s no clear cause, prescription medications could be an option, Rao says—temporarily, or, in some cases, long-term. These may draw water into your intestines to speed up stool movement, directly help move stool through your ­colon, or, if your constipation is a side effect of opioid meds, help reverse this effect on your gastrointestinal system.

When Constipation Becomes Severe

If your constipation is unresolved for too long, it can lead to fecal impaction, where a lump of dry, hard stool becomes stuck in the rectum. While this can happen to anyone, it’s more common in older adults.

In addition to constipation, this can bring abdominal pain and a feeling of fullness that affects appetite. Fecal impaction can also lead to diarrhea, due to watery stool from higher up in the gastrointestinal tract passing around stuck stool, says Rao.

A doctor can diagnose fecal impaction with a digital rectal exam and X-rays. They may try to remove the impaction manually or administer a warm-water enema to flush it out. Once the stool is removed, they will recommend a laxative. If your impaction doesn’t respond to these measures, or if your doctor sees signs of a perforated colon, you might need emergency surgery.

You’ll be advised to take steps to prevent another impac­tion, such as increasing fiber intake and staying active. You’ll also want to talk to your doctor about medications that may contribute.

Thanks to Hallie Levine

Hallie Levine is an award-winning magazine and freelance writer who contributes to Consumer Reports on health and fitness topics. Her work has been published in Health, Prevention, Reader's Digest, and Parents, among others. She's a mom to three kids and a fat but feisty black Labrador retriever named Ivry. In her (nonexistent) spare time, she likes to read, swim, and run marathons.