Last Updated: November 3, 2022

Constipation occurs when the process of defecation is impaired to such a degree that a person can no longer easily pass stool.

Constipation falls under theGut Healthcategory.

What is constipation?

Constipation is a common gastrointestinal condition in which the ability to pass stool is impaired, resulting in difficulty with defecation, infrequent defecation, or both. Constipation in adults is considered chronic when symptoms persist for at least three months.

Constipation is commonly categorized as either primary or secondary. Primary (idiopathic) constipation has no obvious cause, while secondary constipation does have an identifiable cause, like a disease or medication side effect. In addition to being primary or secondary, constipation can be classified into subtypes based on certain characteristics (e.g., clinical features, apparent cause, etc.).

What are the main symptoms of constipation?

Common symptoms of constipation include:

  • Infrequent defecation
  • Difficulty passing stools
  • Excessive straining during defecation
  • The feeling of a blockage in the anus and/or rectum
  • Bloating
  • Abdominal pain.
How is constipation diagnosed?

A diagnosis of constipation is generally based on the patient’s weekly defecation frequency, ease of defecation, sensations felt during defecation, and stool characteristics. A clinician may also collect medical history, perform lab tests, and conduct examinations to look for an underlying cause of the constipation, although in most cases none will be identified.

Different criteria exist to determine what subtype of constipation is present. The Rome IV criteria can be used to diagnose several subtypes of constipation, these being functional (primary) constipation, irritable bowel syndrome with constipation (IBS-C), opioid-induced constipation, and functional defecation disorder.[1]

What are some of the main medical treatments for constipation?

Constipation is often treated with osmotic laxatives (which pull water into the colon), stimulant laxatives (which stimulate intestinal contractions), or stool softeners.[2][3] Commonly used osmotic laxatives are polyethylene glycol (PEG), lactulose, glycerin suppositories, and magnesium hydroxide. Commonly used stimulant laxatives are bisacodyl, senna, cascara, and sodium picosulfate. A commonly used stool softener is docusate. Docusate is often prescribed in an inpatient setting[4]; however, there is inadequate evidence for its ability to ease constipation.[5] Lastly, it is important to use laxatives as prescribed by a healthcare provider, as overuse can lead to diarrhea, dehydration, and electrolyte imbalances.

Other constipation treatments include increasing dietary fiber intake, certain medications, mineral oil, and enemas. In rare cases, surgery may be indicated.

Have any supplements been studied for constipation?

A number of different fiber supplements show evidence of benefit for constipation, with psyllium being perhaps the most well-established in this regard.[6]

Probiotics (taken via capsules or fermented foods) have sometimes been found to improve symptoms of constipation.[7][8] More research is needed to determine which probiotic strains are effective, although Bifidobacterium lactis specifically appears beneficial.

Senna, an herb sometimes taken in the form of tea, has a well-established laxative effect. Cascara (Frangula purshiana) bark is another herb often taken for its laxative properties; it contains the same active chemicals (anthraquinones) as senna.

Magnesium — usually in the form of magnesium oxide or magnesium citrate — can also act as a laxative when taken in high enough amounts. However, it is important to speak to your healthcare provider before taking magnesium, as the high doses often used for constipation can lead to a harmful elevation of blood magnesium levels, especially in people with impaired kidney function.[9]

How could diet affect constipation?

Lower fiber diets tend to be associated with a higher risk of constipation,[10][11][12] and increasing fiber intake can benefit constipation[13][6] More research is needed to better understand which fiber-rich foods are best in this regard.

Prunes, being high in sorbitol, can have a laxative effect and may therefore help with constipation.[14] However, sorbitol can provoke unpleasant GI symptoms (abdominal pain, bloating) in certain individuals.[15]

A few studies have found mineral water (not to be confused with mineral oil) can be helpful for constipation, possibly due to the magnesium, sulfate, and bicarbonate it contains.[16][17]

Kiwifruit seems to be beneficial for people with constipation.[18][19][20]

Are there any other treatments for constipation?

Assuming a squatting (rather than sitting) position, such that the knees are bent sharply, can improve the ease of defecation.[21][22][21]

Some studies have found that increasing physical activity is beneficial for constipation,[23][24] though other studies have reported no effect.[25][26]

In cases of constipation due to a functional defecation disorder, biofeedback therapy can train a person to coordinate the muscles involved in passing stool, improving outcomes.[27][28]

What causes constipation?

There are many possible causes of and contributors to constipation, which means the reason for constipation varies from person to person.

A number of health conditions can cause constipation, including hypothyroidism, diabetes, hypercalcemia, intestinal stricture, multiple sclerosis, and Parkinson’s disease. Constipation can also be caused by various medications, including opioids, iron supplements, nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, antacids, antihistamines, and diuretics.

Lifestyle factors that may increase the risk of constipation include a low fiber intake,[10][11][12][29] physical inactivity,[11][30][31][29] and a low fluid intake,[32][33][34][29] although conflicting evidence exists for each of these factors.

Supplements Demystified: Get Our Unbiased, Evidence-Based Guide

Examine Database: Constipation
What works and what doesn't?

Unlock the full potential of Examine

Get started

Don't miss out on the latest research

  1. ^Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén MAn approach to the diagnosis and management of Rome IV functional disorders of chronic constipation.Expert Rev Gastroenterol Hepatol.(2020-Jan)
  2. ^Bashir A, Sizar OLaxativesStatPearls.(2022-07)
  3. ^Basilisco G, Coletta MChronic constipation: a critical review.Dig Liver Dis.(2013-Nov)
  4. ^MacMillan TE, Kamali R, Cavalcanti RBMissed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients.Am J Med.(2016-Sep)
  5. ^Nguyen TThe Role of Docusate for Constipation in Older People.Sr Care Pharm.(2021-Oct-01)
  6. ^van der Schoot A, Drysdale C, Whelan K, Dimidi EThe effect of fiber supplementation on chronic constipation in adults: an updated systematic review and meta-analysis of randomized controlled trials.Am J Clin Nutr.(2022-Jul-11)
  7. ^Yong Wen, Jun Li, Qing Long, Chao-Chi Yue, Bing He, Xue-Gui TangThe efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trialsInt J Surg.(2020 Jul)
  8. ^Chengcheng Zhang, Jinchi Jiang, Fengwei Tian, Jianxin Zhao, Hao Zhang, Qixiao Zhai, Wei ChenMeta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adultsClin Nutr.(2020 Oct)
  9. ^Mori H, Suzuki H, Hirai Y, Okuzawa A, Kayashima A, Kubosawa Y, Kinoshita S, Fujimoto A, Nakazato Y, Nishizawa T, Kikuchi MClinical features of hypermagnesemia in patients with functional constipation taking daily magnesium oxide.J Clin Biochem Nutr.(2019-Jul)
  10. ^Shen L, Huang C, Lu X, Xu X, Jiang Z, Zhu CLower dietary fibre intake, but not total water consumption, is associated with constipation: a population-based analysis.J Hum Nutr Diet.(2019-08)
  11. ^Dukas L, Willett WC, Giovannucci ELAssociation between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women.Am J Gastroenterol.(2003-Aug)
  12. ^Morais MB, Vítolo MR, Aguirre AN, Fagundes-Neto UMeasurement of low dietary fiber intake as a risk factor for chronic constipation in children.J Pediatr Gastroenterol Nutr.(1999-Aug)
  13. ^Rijnaarts I, de Roos NM, Wang T, Zoetendal EG, Top J, Timmer M, Hogenelst K, Bouwman EP, Witteman B, de Wit NA high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults.J Nutr Sci.(2022)
  14. ^Attaluri A, Donahoe R, Valestin J, Brown K, Rao SSRandomised clinical trial: dried plums (prunes) vs. psyllium for constipation.Aliment Pharmacol Ther.(2011-Apr)
  15. ^Mack A, Bobardt JS, Haß A, Nichols KB, Schmid RM, Stein-Thoeringer CKChanges in gut microbial metagenomic pathways associated with clinical outcomes after the elimination of malabsorbed sugars in an IBS cohort.Gut Microbes.(2020-05-03)
  16. ^Dupont C, Hébert GMagnesium Sulfate-Rich Natural Mineral Waters in the Treatment of Functional Constipation-A Review.Nutrients.(2020-Jul-10)
  17. ^Anti M, Pignataro G, Armuzzi A, Valenti A, Iascone E, Marmo R, Lamazza A, Pretaroli AR, Pace V, Leo P, Castelli A, Gasbarrini GWater supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation.Hepatogastroenterology.(1998)
  18. ^Samuel W Chey, William D Chey, Kenya Jackson, Shanti EswaranExploratory Comparative Effectiveness Trial of Green Kiwifruit, Psyllium, or Prunes in US Patients With Chronic ConstipationAm J Gastroenterol.(2021 Jun 1)
  19. ^Udani JK, Bloom DWEffects of Kivia powder on gut health in patients with occasional constipation: a randomized, double-blind, placebo-controlled study.Nutr J.(2013-Jun-08)
  20. ^Eady SL, Wallace AJ, Butts CA, Hedderley D, Drummond L, Ansell J, Gearry RBThe effect of 'Zesy002' kiwifruit ( var. ) on gut health function: a randomised cross-over clinical trial.J Nutr Sci.(2019)
  21. ^Modi RM, Hinton A, Pinkhas D, Groce R, Meyer MM, Balasubramanian G, Levine E, Stanich PPImplementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects.J Clin Gastroenterol.(2019-03)
  22. ^Dov SikirovComparison of straining during defecation in three positions: results and implications for human healthDig Dis Sci.(2003 Jul)
  23. ^De Schryver AM, Keulemans YC, Peters HP, Akkermans LM, Smout AJ, De Vries WR, van Berge-Henegouwen GPEffects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation.Scand J Gastroenterol.(2005-Apr)
  24. ^Sayed A Tantawy, Dalia M Kamel, Walid Kamal Abdelbasset, Hany M ElgoharyEffects of a proposed physical activity and diet control to manage constipation in middle-aged obese womenDiabetes Metab Syndr Obes.(2017 Dec 14)
  25. ^Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson AEffects of regular exercise in management of chronic idiopathic constipation.Dig Dis Sci.(1998-Nov)
  26. ^Chin A Paw MJ, van Poppel MN, van Mechelen WEffects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial.BMC Geriatr.(2006-Jul-31)
  27. ^Rao SS, Patcharatrakul TDiagnosis and Treatment of Dyssynergic Defecation.J Neurogastroenterol Motil.(2016-Jul-30)
  28. ^Moore D, Young CJA systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults.Tech Coloproctol.(2020-09)
  29. ^Yurtdaş G, Acar-Tek N, Akbulut G, Cemali Ö, Arslan N, Beyaz Coşkun A, Zengin FHRisk Factors for Constipation in Adults: A Cross-Sectional Study.J Am Coll Nutr.(2020)
  30. ^Yamada M, Sekine M, Tatsuse TPsychological Stress, Family Environment, and Constipation in Japanese Children: The Toyama Birth Cohort Study.J Epidemiol.(2019-Jun-05)
  31. ^Paola Iovino, Giuseppe Chiarioni, Giancarlo Bilancio, Massimo Cirillo, Igor B Mekjavic, Rado Pisot, Carolina CiacciNew onset of constipation during long-term physical inactivity: a proof-of-concept study on the immobility-induced bowel changesPLoS One.(2013 Aug 20)
  32. ^Boilesen SN, Tahan S, Dias FC, Melli LCFL, de Morais MBWater and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence?J Pediatr (Rio J).(2017)
  33. ^Rey E, Balboa A, Mearin FChronic constipation, irritable bowel syndrome with constipation and constipation with pain/discomfort: similarities and differences.Am J Gastroenterol.(2014-Jun)
  34. ^Klauser AG, Beck A, Schindlbeck NE, Müller-Lissner SALow fluid intake lowers stool output in healthy male volunteers.Z Gastroenterol.(1990-Nov)
  35. ^Marieke H Schoemaker, Jeske H J Hageman, Dominique Ten Haaf, Anita Hartog, Petra A M J Scholtens, Jos Boekhorst, Arjen Nauta, Rolf BosPrebiotic Galacto-Oligosaccharides Impact Stool Frequency and Fecal Microbiota in Self-Reported Constipated Adults: A Randomized Clinical TrialNutrients.(2022 Jan 12)
  36. ^Ibarra A, Pelipyagina T, Rueffer M, Evans M, Ouwehand ACEfficacy of Polydextrose Supplementation on Colonic Transit Time, Bowel Movements, and Gastrointestinal Symptoms in Adults: A Double-Blind, Randomized, Placebo-Controlled Trial.Nutrients.(2019-Feb-20)
  37. ^Badiali D, Corazziari E, Habib FI, Tomei E, Bausano G, Magrini P, Anzini F, Torsoli AEffect of wheat bran in treatment of chronic nonorganic constipation. A double-blind controlled trial.Dig Dis Sci.(1995-Feb)
  38. ^Yang C, Liu S, Li H, Bai X, Shan S, Gao P, Dong XThe effects of psyllium husk on gut microbiota composition and function in chronically constipated women of reproductive age using 16S rRNA gene sequencing analysis.Aging (Albany NY).(2021-06-03)
  39. ^Fenn GC, Wilkinson PD, Lee CE, Akbar FAA general practice study of the efficacy of Regulan in functional constipation.Br J Clin Pract.(1986-May)
  40. ^Ashraf W, Park F, Lof J, Quigley EMEffects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation.Aliment Pharmacol Ther.(1995-Dec)
  41. ^Xu L, Yu W, Jiang J, Li NClinical benefits after soluble dietary fiber supplementation: a randomized clinical trial in adults with slow-transit constipation.Zhonghua Yi Xue Za Zhi.(2014-Dec-30)
  42. ^Soltanian N, Janghorbani MEffect of flaxseed or psyllium vs. placebo on management of constipation, weight, glycemia, and lipids: A randomized trial in constipated patients with type 2 diabetes.Clin Nutr ESPEN.(2019-02)
  43. ^Polymeros D, Beintaris I, Gaglia A, Karamanolis G, Papanikolaou IS, Dimitriadis G, Triantafyllou KPartially hydrolyzed guar gum accelerates colonic transit time and improves symptoms in adults with chronic constipation.Dig Dis Sci.(2014-Sep)
  44. ^Russo L, Andreozzi P, Zito FP, Vozzella L, Savino IG, Sarnelli G, Cuomo RPartially hydrolyzed guar gum in the treatment of irritable bowel syndrome with constipation: effects of gender, age, and body mass index.Saudi J Gastroenterol.(2015)
  45. ^Thomas Ms Wolever, Maike Rahn, ElHadji Dioum, Susan E Spruill, Adish Ezatagha, Janice E Campbell, Alexandra L Jenkins, YiFang ChuAn Oat β-Glucan Beverage Reduces LDL Cholesterol and Cardiovascular Disease Risk in Men and Women with Borderline High Cholesterol: A Double-Blind, Randomized, Controlled Clinical TrialJ Nutr.(2021 Jun 3)
  46. ^Sturtzel B, Elmadfa IIntervention with dietary fiber to treat constipation and reduce laxative use in residents of nursing homes.Ann Nutr Metab.(2008)
  47. ^Philippe Marteau, Heidi Jacobs, Murielle Cazaubiel, Cathy Signoret, Jean-Michel Prevel, Beatrice HousezEffects of chicory inulin in constipated elderly people: a double-blind controlled trialInt J Food Sci Nutr.(2011 Mar)
  48. ^Micka A, Siepelmeyer A, Holz A, Theis S, Schön CEffect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial.Int J Food Sci Nutr.(2017-Feb)
  49. ^Gill SK, Rossi M, Bajka B, Whelan KDietary fibre in gastrointestinal health and disease.Nat Rev Gastroenterol Hepatol.(2021-02)
  50. ^McRorie JW JrEvidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2: What to Look for and How to Recommend an Effective Fiber TherapyNutr Today.(2015 Mar)
  51. ^Yancy WS, Olsen MK, Guyton JR, Bakst RP, Westman ECA low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.Ann Intern Med.(2004-May-18)
  52. ^Baron JA, Schori A, Crow B, Carter R, Mann JIA randomized controlled trial of low carbohydrate and low fat/high fiber diets for weight loss.Am J Public Health.(1986-Nov)
  53. ^Laura R Saslow, Sarah Kim, Jennifer J Daubenmier, Judith T Moskowitz, Stephen D Phinney, Veronica Goldman, Elizabeth J Murphy, Rachel M Cox, Patricia Moran, Fredrick M HechtA randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetesPLoS One.(2014 Apr 9)
  54. ^Storz MA, Ronco ALNutrient intake in low-carbohydrate diets in comparison to the 2020-2025 Dietary Guidelines for Americans: a cross-sectional study.Br J Nutr.(2022-Jun-22)
  55. ^Martin-McGill KJ, Jackson CF, Bresnahan R, Levy RG, Cooper PNKetogenic diets for drug-resistant epilepsyCochrane Database Syst Rev.(2018 Nov 7)
Examine Database References
  1. Fecal Weight - Marlett JA, Kajs TM, Fischer MHAn unfermented gel component of psyllium seed husk promotes laxation as a lubricant in humansAm J Clin Nutr.(2000 Sep)
  2. Fecal Weight - Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano ALactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled studyJ Pediatr.(2010 Oct)
  3. Constipation Signs and Symptoms - İlker Turan, Özden Dedeli, Serhat Bor, Tankut İlterEffects of a kefir supplement on symptoms, colonic transit, and bowel satisfaction score in patients with chronic constipation: a pilot studyTurk J Gastroenterol.(2014 Dec)
  4. Constipation Signs and Symptoms - Kinnunen O, Winblad I, Koistinen P, Salokannel JSafety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patientsPharmacology.(1993 Oct)
  5. Constipation Signs and Symptoms - Naftali T, Feingelernt H, Lesin Y, Rauchwarger A, Konikoff FMZiziphus jujuba extract for the treatment of chronic idiopathic constipation: a controlled clinical trialDigestion.(2008)
  6. Constipation Signs and Symptoms - Morishita D, Tomita T, Mori S, Kimura T, Oshima T, Fukui H, Miwa HSenna Versus Magnesium Oxide for the Treatment of Chronic Constipation: A Randomized, Placebo-Controlled Trial.Am J Gastroenterol.(2021-Jan-01)
  7. Constipation Signs and Symptoms - Kubota M, Ito K, Tomimoto K, Kanazaki M, Tsukiyama K, Kubota A, Kuroki H, Fujita M, Vandenplas YLactobacillus reuteri DSM 17938 and Magnesium Oxide in Children with Functional Chronic Constipation: A Double-Blind and Randomized Clinical Trial.Nutrients.(2020-Jan-15)
  8. Constipation Signs and Symptoms - Mori S, Tomita T, Fujimura K, Asano H, Ogawa T, Yamasaki T, Kondo T, Kono T, Tozawa K, Oshima T, Fukui H, Kimura T, Watari J, Miwa HA Randomized Double-blind Placebo-controlled Trial on the Effect of Magnesium Oxide in Patients With Chronic Constipation.J Neurogastroenterol Motil.(2019-Oct-30)
  9. Constipation Signs and Symptoms - Collado Yurrita L, San Mauro Martín I, Ciudad-Cabañas MJ, Calle-Purón ME, Hernández Cabria MEffectiveness of inulin intake on indicators of chronic constipation; a meta-analysis of controlled randomized clinical trials.Nutr Hosp.(2014-Aug-01)