Understanding and Managing Constipation: A Patient Guide

Educational purposes only. Please contact your doctor if you have questions about your symptoms or care.

What Is Constipation?

Constipation means having fewer than three bowel movements per week. You may also notice hard stools, straining, a feeling that you can't fully empty your bowels, or needing to use your fingers to help pass stool.

When these symptoms have been present for at least six months, it's considered chronic constipation.

If this sounds familiar, you're not alone and there are many effective ways to find relief.

How Is It Diagnosed?

Your doctor will start by asking about your symptoms and performing a physical exam, which usually includes a rectal exam. Most people don't need extensive testing. Expect questions about:

• How often you have bowel movements

• Stool consistency (hard, soft, or watery)

• Whether you strain or feel pain

• Any blood in your stools

• Unintentional weight loss

• Medications you take

• Your diet and fluid intake

Additional testing may be recommended if you have warning signs like blood in your stools, unexplained weight loss, or anemia; if you're due for colon cancer screening; or if initial treatments aren't helping.

Treatment Options

Step 1: Lifestyle Changes

These are always the first place to start.

Diet: Gradually increase your fiber intake to 25–38 grams per day through foods like bran, fruits, vegetables, and nuts. Drink plenty of water, especially as you increase fiber. Prunes, kiwi, and mango have also been shown to help.

Bowel Habits: Try to go at the same time each day, especially after meals. Don't ignore the urge when it comes. Placing your feet on a small stool while sitting on the toilet can help straighten your bowel and make it easier to pass stool.

Physical Activity: Regular movement may help keep things moving, even if the evidence is modest.

Step 2: Over-the-Counter Medications

If lifestyle changes alone aren't enough, your doctor may suggest one of the following:

Fiber supplements (bulk laxatives): Examples include psyllium (Metamucil), methylcellulose, and polycarbophil. Start with a low dose and increase gradually to avoid bloating. Always drink plenty of water with these products.

Osmotic laxatives (usually recommended first): These work by drawing water into your intestines to soften stool. Options include polyethylene glycol (MiraLax), magnesium hydroxide (Milk of Magnesia), magnesium citrate, and lactulose. Polyethylene glycol is often the first recommended choice.

Stimulant laxatives (for short-term or rescue use): Examples include bisacodyl (Dulcolax) and senna. These work faster and are generally safe for occasional use.

Step 3: Prescription Medications

If over-the-counter options haven't done enough, your doctor may prescribe:

Secretagogues — medications that increase fluid in your intestines and may also help with abdominal pain. Options include lubiprostone (Amitiza), linaclotide (Linzess), and plecanatide (Trulance). The most common side effect is diarrhea in some people.

Prucalopride (Motegrity) — a prokinetic agent that helps move stool through your colon more quickly.

Step 4: Pelvic Floor Physical Therapy

If you have difficulty coordinating the muscles needed for a bowel movement, your doctor may refer you to a specialized physical therapist for pelvic floor therapy with biofeedback. This approach is highly effective for that particular type of constipation.

What to Expect

Most people improve with lifestyle changes and over-the-counter laxatives, though it may take some trial and error to find what works best for you. Treatment is usually a longer-term process, not a quick fix. If things aren't improving after several weeks, your doctor may refer you to a specialist for additional evaluation.

When to Call Your Doctor

Reach out promptly if you experience:

• Blood in your stools

• Unintentional weight loss

• Severe abdominal pain

• Constipation that suddenly gets much worse

• No improvement after trying recommended treatments

A Few Important Reminders

Daily bowel movements are not necessary for everyone — what's normal varies from person to person. Laxatives are generally safe when used as directed. Don't stop taking any prescribed medications without talking to your doctor first, as some can cause constipation as a side effect. And most importantly, be patient — finding the right approach takes time, and your doctor is your partner in that process.

This blog post is intended for educational purposes only and does not constitute medical advice. Please contact your doctor or healthcare provider if you have questions about your symptoms, medications, or treatment options.