Constipation is one of the most common digestive complaints, affecting nearly everyone at some point in their lives. In North America, an estimated 12 percent to 19 percent of people experience chronic constipation.

At its core, constipation is characterized by infrequent bowel movements, hard or lumpy stools, straining during bathroom visits, or feeling like you haven’t completely emptied your bowels.

While many people dismiss constipation, thinking of it as a minor inconvenience, it can lead to serious complications.

Constipation looks different for everyone. For instance, what is normal for one person—such as having a bowel movement every other day—may indicate constipation for someone else.

Common Symptoms

Some frequently seen symptoms include:

• Infrequent bowel movements, such as passing stools less often than usual


• Straining or pain when passing stool


• Small, hard, pellet-like stools


• Leaking small amounts of watery stool


• Bloating and a firm or swollen abdomen


• Stomach pain or cramping


• Excessive gas or frequent burping


• Loss of appetite due to feeling uncomfortably full


• Pressure or fullness in the rectum


• Nausea or vomiting

When to See a Doctor

Some symptoms suggest a more serious problem and require medical attention, including:

• Blood in your stool, either bright red or dark


• Unintentional weight loss


• Fever above 100.4 degrees, which is unusual with constipation, and may signal a complication


• Persistent nausea or vomiting


• Signs of anemia, such as fatigue or weakness


• Abdominal pain that doesn’t improve after a bowel movement or wakes you from sleep


• Rectal pain


• Inability to pass gas


• Lower back pain caused by the stool pressing on nerves

Chronic Constipation Symptoms

You may have chronic constipation if constipation lasts for at least three months, and you experience two or more of the following symptoms:

• Straining during more than 25 percent of bowel movements


• Hard stools in more than 25 percent of cases


• A feeling of incomplete evacuation in more than 25 percent of cases


• Fewer than three bowel movements per week

Also, if lifestyle changes such as increasing fiber, exercise, and hydration don’t relieve constipation, it may be chronic.

In most people, as food waste travels through the colon, the colon gradually absorbs water and electrolytes, turning liquid digested material into soft, formed stool. Gentle muscle contractions then push the stool forward at a steady pace toward the rectum. By the time it reaches the rectum, most of the water has been absorbed, leaving the stool soft yet solid. Stretching of the rectum then triggers a strong, timely urge to go to the bathroom.

However, constipation happens when the stool lacks water or enough fiber to retain water, causing it to become harder and more difficult to pass, or when the stool moves too slowly, allowing excessive water absorption and causing the stool to become too dry.

Some constipation cases are caused by external factors—such as not eating enough fiber, not drinking enough water, or taking certain medications. These cases are called secondary constipation. In other cases, the bowel itself doesn’t function properly. This is called primary or functional constipation, which accounts for most constipation cases.

Additionally, some people with functional constipation develop pelvic floor dysfunction, a condition in which the muscles involved in bowel movements do not coordinate properly. Instead of relaxing, the pelvic floor or anal muscles may tighten during a bowel movement, making it difficult to pass stool even when the stool consistency is normal.

Meanwhile, most secondary constipation stems from everyday lifestyle factors, although medical conditions can also play a role.

Common Lifestyle Causes

These are the most frequent culprits behind constipation and the easiest to address:

• Bathroom Habits: Ignoring the urge to have a bowel movement or not maintaining a regular bathroom routine


• Diet: Eating too little fiber, drinking too little water, consuming too much coffee, tea, or alcohol, or eating too little overall


• Physical Activity: Living a sedentary lifestyle or not exercising regularly


• Lifestyle Changes: Traveling, which can disrupt normal routines


• Laxative Overuse: Using laxatives frequently, which can lead to dependence and make natural bowel movements more difficult

Emotional Factors

Your gut and brain are closely connected, and mental health significantly affects digestive health:

• Stress: Disrupts normal digestive function and can trigger constipation or diarrhea; often linked to anxiety from work or personal problems


• Depression: A common physical symptom of depression, as emotional state affects bowel function through the gut-brain connection

Medical Causes

When constipation isn’t related to lifestyle, it may stem from:

• Anatomic Causes: Structural abnormalities in the digestive tract, including anal stenosis or atresia, anal fissures, anteriorly displaced anus, imperforate anus, thrombosed hemorrhoids, intestinal strictures, obstructing tumors, and anal strictures.


• Abnormal Musculature: Disorders affecting muscle development or function, such as prune belly syndrome, gastroschisis, Down syndrome, and muscular dystrophy.


• Rectocele: A condition in which the rectum bulges into the weakened back wall of the vagina, especially during straining or bearing down.


• Hernia: An abdominal hernia that decreases effective intra-abdominal pressure, making bowel movements more difficult to pass.


• Hormonal and Metabolic Conditions: Hypothyroidism (underactive thyroid), diabetes, and imbalances in calcium or potassium levels.


• Digestive System Disorders: Irritable bowel syndrome, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, celiac disease, structural problems such as anal tears, hemorrhoids, intestinal narrowing, or tumors, and pelvic floor dysfunction.


• Disordered Defecation (Dyschezia): A condition in which the bowels cannot generate enough force to push stool out of the rectum, or the muscles around the rectum and external anal sphincter fail to relax properly during bowel movements.


• Neurological Conditions: Parkinson’s disease, multiple sclerosis, stroke, spinal cord injuries, or defects.


• Other Conditions: Certain cancers, including colon, rectal, ovarian, and brain cancers; chemotherapy treatment; cystic fibrosis; scleroderma (autoimmune disorder); and cow milk protein allergy, especially in children.


• Medications: Pain medications, particularly narcotics, and certain antidepressants, as well as many blood pressure medications and drugs used to manage Parkinson’s disease or seizures; antacids containing aluminum or calcium; nonsteroidal anti-inflammatory drugs such as ibuprofen; and dietary supplements including iron, calcium, or vitamin D taken in excessive amounts. Both very low and very high vitamin D levels may affect bowel function, with an imbalance in either direction contributing to constipation.

Other factors can include the following:

• Pregnancy: Hormonal changes, reduced physical activity, and pressure from the growing uterus on the intestines


• Advancing Age: Older people may experience decreased intestinal muscle activity and increased medication use

For most people, constipation can be recognized without testing—you generally know when you’re experiencing it. However, doctors may perform several tests, depending on how long you’ve had symptoms and how severe your condition is.

Your doctor will begin by reviewing factors such as your medical history and age, the presence of blood in your stool, changes in bowel habits, and any weight loss.

Your doctor may perform a complete physical exam, as well as a digital rectal exam, which involves checking whether the rectum is soft, blocked, enlarged, or contains blood. Stool amount, stool consistency, and sphincter function are also assessed.

Additional testing may include the following:

• Abdominal X-Ray: Shows whether the bowels are filled with stool or excess air, helping assess stool buildup or blockage


• Blood Tests: Check for conditions such as iron-deficiency anemia, which may indicate slow or hidden bleeding in the colon


• Lower Gastrointestinal Series (Barium Enema): Uses X-rays and a contrast liquid called barium to visualize the rectum and intestines and identify narrowing, blockages, or structural problems


• Defecogram: Assesses stool control and evacuation


• Colonoscopy: Examines the entire large intestine to detect abnormalities such as inflammation, ulcers, bleeding, or growths


• Sigmoidoscopy: Examines the lower part of the large intestine to help determine causes of constipation


• Colorectal Transit Study: Measures how long stool takes to move through the colon using X-ray-visible markers


• Anorectal Function Tests: Evaluate how well the anus and rectum function and whether constipation is related to muscle or coordination problems


• Fecal Immunochemical Test: Detects hidden blood in the stool

Most people with constipation can find relief using home remedies, including dietary and lifestyle modifications.

1. Dietary Fiber and ‘Natural Laxatives’

For decades, increasing dietary fiber has been a standard recommendation for relieving constipation. Most adults have been advised to eat at least 25 grams of fiber per day, depending on age and gender. Fiber comes in two forms—soluble and insoluble—both of which play roles in digestion. Soluble fiber absorbs water and forms a gel that can soften stool, while insoluble fiber adds bulk and helps stool move through the digestive tract.

However, more recent evidence-based dietary guidelines suggest that increasing fiber intake alone may not be sufficient. Current recommendations for chronic constipation incorporate a range of targeted strategies—such as specific types of fiber supplements, certain fruits like kiwifruit, rye bread, and high-mineral water—and place less emphasis on generic high-fiber diets than the past advice did.

Often referred to as “fruit lax,” dried fruit spread may help ease constipation. You can find various recipes for it online.

The following fruits and drinks are considered natural laxatives:

• Prunes: Eating prunes or drinking prune juice may help relieve constipation because they contain fiber and sorbitol, a natural sugar alcohol with mild laxative effects


• Apricots: Stewed apricots may help promote bowel movements when softened and eaten regularly


• Kiwis: Kiwis contain actinidin, an enzyme that helps speed digestion by breaking down proteins more efficiently


• Apple Juice: Apple juice contains smaller amounts of sorbitol and may be a helpful alternative for people who do not tolerate prunes


• Olive Oil: Taking a teaspoon of olive oil on an empty stomach in the morning may help lubricate the digestive tract and soften stool


• Hot Beverages: Drinking warm beverages, especially caffeinated drinks like coffee or tea, may stimulate bowel movements and speed digestion

The following foods and diets should be avoided:

• Very low-carbohydrate diets, such as the keto diet, are often high in fat and low in fiber


• Foods high in refined sugars, including heavy desserts, may increase the risk of constipation

2. Fiber Supplements

Dietary fiber offers many health benefits, but only a small percentage of people meet the recommended intake levels through food alone. For those with low-fiber diets, fiber supplements can help improve regularity. Fiber supplements generally work gradually and may cause gas or bloating, so adequate fluid intake is important.

3. Probiotics 

Probiotics are beneficial bacteria and yeast that help maintain a healthy balance of gut microbiomes. They may support regular bowel movements by improving stool consistency and promoting normal gut motility. Dietary sources include live-culture yogurt, kefir, and yogurt drinks.

4. Sufficient Liquids

Staying well-hydrated is essential for relieving and preventing constipation because fluids help fiber work effectively and keep stool soft and bulky by making it easier to pass.

Good fluid choices include water, naturally sweetened fruit juices, vegetable juices, clear soups, fortified soy beverages, smoothies, and broth, with water providing the majority of fluid intake.

5. Physical Activity

Regular exercise helps improve bowel motility by stimulating the natural contractions of intestinal muscles, allowing food to move through the colon more efficiently. Aerobic activities such as brisk walking or cycling are especially effective. Any amount of regular physical activity is beneficial, particularly for people with limited mobility.

6. Kegel Exercises

Pelvic floor, or Kegel, exercises help strengthen the muscles that support the bowel, rectum, and anus, which may improve bowel control and ease bowel movements.

7. Relaxation and Music Therapy

A May 2025 study involving more than 600 recruits found that short-term progressive muscle relaxation combined with music therapy may help improve gastrointestinal symptoms, including constipation.

If dietary and lifestyle changes do not provide relief, additional pharmaceutical and other treatment options for constipation are available.

1. Laxatives

Laxatives are medications that help promote bowel movements. They come in different types, each working in a distinct way on the digestive system. In some cases, different types of laxatives may be combined based on individual needs and response.

• Bulk-Forming Laxatives: Often the first laxative option recommended, these help stools retain water, making them softer and easier to pass and reducing the risk of fecal impaction. Common plant-based examples include ispaghula husk, sterculia, and methylcellulose.


• Osmotic Laxatives: Used when stools remain hard despite bulk-forming laxatives, these draw water into the bowel to soften stool and stimulate bowel movements. Common examples include lactulose and macrogols. There are four main types: saline laxatives, which work within 30 minutes to 3 hours; lactulose, which works over 6 hours to two days; polymer laxatives such as polyethylene glycol, which typically act within 6 hours; and glycerine suppositories, which soften stool and may also stimulate bowel movements.


• Stimulant Laxatives: Used when stools are soft but difficult to pass, these stimulate the muscles of the digestive tract to move stool through the colon more effectively. Common examples include senna, bisacodyl, and sodium picosulfate, and they typically act within 6 to 12 hours.


• Stool Softeners: Products such as docusate add moisture to stool to make it easier to pass.


• Lubricants: Lubricants such as mineral oil help stools pass more easily and may be useful for low bowel blockages, anal fissures, or painful hemorrhoids. However, they should not be used for more than one week, as prolonged use may lead to vitamin deficiencies or interfere with medications. Mineral oil is not recommended for pregnant women or for people who have difficulty swallowing, and oral mineral oil carries a risk of pneumonia if it enters the lungs.


• Fruit lax: Dried fruit spread may also help ease constipation. You can find various recipes for it online.

For short-term constipation, pharmacists usually advise stopping laxatives once stools are soft and easy to pass. For long-term use, laxatives are gradually reduced rather than stopped abruptly. When multiple laxatives are used, the dosage of each is typically tapered one at a time, which may take several months.

2. Suppositories 

Suppositories are small, solid medications that are inserted directly into the rectum, where they dissolve and work to relieve constipation. They may function as lubricants or stimulant laxatives by encouraging bowel muscles to contract and move stool along. Suppositories are often used for children or people who have difficulty swallowing oral medications and provide fast and targeted relief.

3. Other Medicines

Other medications may relieve constipation in different ways, including:

• Enterokinetics: Medications such as prucalopride work by stimulating serotonin (5-HT4) receptors in the digestive tract to increase intestinal muscle movement and improve bowel motility. Common side effects include nausea, diarrhea, abdominal pain, and headache.


• Guanylate Cyclase-C Agonists: Drugs such as linaclotide increase fluid secretion in the intestines, making stool easier to pass and improving related symptoms.


• Peripherally Acting Mu-Opioid Receptor Antagonists (PAMORAs): PAMORAs, such as methylnaltrexone, naloxegol, and naldemedine, treat opioid-induced constipation when other treatments haven’t worked. Alvimopan is another option, but it is used only short-term in hospitals to help treat postoperative ileus, a temporary slowing of the intestines after surgery.

4. Enemas

An enema involves inserting liquid, usually water, sometimes with salt, into the rectum through the anus. The liquid loosens stool and stretches the rectal walls, triggering muscle contractions that produce an urgent bowel movement.

5. Transanal Irrigation 

Transanal irrigation is a structured method for emptying the lower bowel using a catheter or specialized device to flush water into the rectum. Unlike a regular enema, transanal irrigation can empty the entire lower bowel, making it particularly useful for people with chronic constipation. Training from a health care professional is required to use the equipment safely.

6. Manual Defragmentation

Fecal impaction, in which hard stool becomes stuck in the rectum, is usually treated first with enemas, starting with tap water and then small amounts of specialized solutions. If this approach doesn’t work, a doctor may need to manually break up and remove the stool. This procedure can be painful, so local anesthetic creams or, in some cases, sedation may be used to reduce discomfort.

7. Sacral Nerve Stimulation

Sacral nerve stimulation has been used to treat constipation that does not respond to other treatments by helping regulate the nerve signals that control the large intestine. It has been shown to improve bowel movement frequency in some children with functional constipation, but in many patients, the benefits lasted less than six months.

8. Biofeedback

Biofeedback therapy trains people to better coordinate their rectal and abdominal muscles for more effective bowel emptying. Using gentle electrical signals, it helps increase awareness of muscle activity and improve control. Biofeedback is often used alongside dietary improvements to help relieve chronic constipation.

9. Cognitive Behavioral Therapy (CBT)

A 2022 study showed that combining CBT with biofeedback improved constipation symptoms, depression, and anxiety more effectively than biofeedback or standard treatment alone. About 67 percent of patients receiving both therapies were able to fully relax their bowel muscles during treatment, compared with none of those receiving only biofeedback or standard care therapy.

10. Surgery

Surgery is rarely used to treat constipation, but may be considered for specific conditions such as a large rectocele, in which the rectum bulges and traps stools, or rectal prolapse, when the rectum slips out of its normal position and interferes with bowel function. Pelvic floor surgery can help repair these issues, although some people may develop new symptoms afterward, including diarrhea, bowel obstruction, or incontinence.

11. Abdominal Massage Therapy

A 2023 meta-analysis found that abdominal massage therapy may increase bowel movement frequency, make stools easier to pass, improve stool consistency, and enhance quality of life for people with constipation.

A January 2025 meta-analysis showed that abdominal massage can also help relieve symptoms of chronic constipation, with effectiveness varying by type of constipation and massage technique.

12. Acupuncture

A 2020 meta-analysis suggested that acupuncture may be a safe and effective treatment for functional constipation, improving bowel movement frequency, stool consistency, symptoms, and quality of life, although more high-quality studies are needed.

Acupuncture has also shown benefits for opioid-induced constipation, including in clinical cancer care settings. In addition, acupressure on abdominal points may improve intestinal rhythm by stimulating the body’s “rest and digest” system, while essential oils may help relax abdominal muscles and support circulation. One commonly used acupoint is “Zhi Gou” (Branching Ditch), which has long been used in traditional Chinese medicine to support digestive health. A 2016 study found that electroacupuncture at Zhi Gou may reduce abdominal pain and bloating, improve bowel movements, shorten colon transit time, and decrease laxative use. An earlier study found that four weeks of electroacupuncture at the Zhi Gou acupoint relieved symptoms in 94.4 percent of constipation patients, while also improving colon transit time and reducing laxative use.

Mindset has a strong influence on constipation through the gut-brain connection. Your thoughts, emotions, and stress levels affect how the brain communicates with the digestive system.

A tense, anxious, or low mood can slow bowel movements, disrupt normal gut signaling, and interfere with pelvic floor muscle relaxation. A mindset of rushing, ignoring bodily cues, or worrying about bowel habits may also lead to delayed toilet use, making stools harder and more difficult to pass.

Many of the lifestyle approaches used to treat constipation can also help prevent it. Additional tips for healthy bowel habits include:

• Establish a Routine: Use the restroom at the same place and time each day, allow enough time, and respond promptly to the natural urge to have a bowel movement rather than delaying it.


• Change Posture: Place your feet on a low stool so your knees are higher than your hips, which can help straighten the rectum and make stools easier to pass.


• Time Meals: Eat small meals and snacks throughout the day to stimulate gut activity and promote more regular bowel movements.


• Track Habits: Keep a record of your food and drink intake, activity levels, and bowel movements to help identify patterns or triggers for constipation.

While some people worry that constipation may lead to cancer, there is no strong evidence linking long-term constipation to bowel cancer. However, untreated or persistent constipation can still cause medium- to long-term complications, including:

• Hemorrhoids: Repeated straining can damage the blood vessels in the rectum, causing swollen veins.


• Rectal Bleeding: Frequent straining leads to bleeding from hemorrhoids or anal fissures.


• Stercoral Ulcer: Impacted stool can wear away the lining of the lower bowel, potentially causing bleeding or bowel perforation.


• Rectal Prolapse: Persistent straining can push part of the rectum through the anus.


• Urinary Incontinence: Constant straining weakens the pelvic floor muscles and increases urine leakage, especially during coughing, laughing, or sneezing.


• Fecal Impaction: Stool becomes tightly packed in the colon or rectum, sometimes causing leakage around the blockage.