What are the main causes of constipation?

What causes constipation? What are the symptoms? What symptoms can constipation cause? Most folks I work with think of the first question - the “why” to their symptoms. While most people know what constipation is (not being able to have a bowel movement), they often don’t know what healthy bowel habits are. 

What are healthy bowel habits?

• Daily bowel movement that is easy to pass

• No pain at all - with urgency to go, with having a bowel movement, or after

• Feeling completely empty when finished without needing to go again

• No straining to make a bowel movement happen

• Bowel movement happens without taking a laxative

• Texture of the stool should be like a cracked or smooth sausage

What are signs/symptoms of constipation?

• Multiple days of no bowel movement

• Difficulty initiating a bowel movement

• Needing to take a laxative to have a bowel movement

• Having a bowel movement, but is pebble-like or hard chunks of stool

What symptoms can constipation cause?

• Urinary system symptoms can be caused by constipation. The increased pressure on the bladder from the excess stool can make it harder for the bladder and pelvic floor to function properly

  • In school aged children, constipation is usually the culprit for bed wetting 

  • Urinary leakage with coughing, laughing, sneezing, jumping, etc

  • Bladder pain

• Back pain, hip pain, pelvis pain

• Hemorrhoids, which are varicose veins around the anus, are caused by excessive pressure in the area. Bearing down and straining to have a bowel movement creates that excessive pressure around the anus.

What are the causes of constipation?

• Diet - if you are lacking fiber (which most American adults are!), you will be more likely to be constipated

• Hydration - being dehydrated will make your stool firmer, making it harder to pass.

• Activity level - a generally sedentary lifestyle will negatively impact bowel health.

• Ignoring the urge to go to the bathroom - this will impact the reflexive loop that helps initiate having a bowel movement. Constantly doing this will cause the stool to spend more time in the colon, which sucks more water out, which makes the stool firmer, which makes it harder to pass.

• Medication side effects - the main side effect of opioid pain medications is constipation. There are other types of medications that do cause constipation as well.

• Changes in diet or lifestyle - often people will become more constipated with travel and vacation.

• Medical Conditions can cause constipation.

  • Digestive system disorders (Chron’s, Diverticulitis, Celiacs etc)

  • Endocrine conditions (Hypothyroidism, diabetes, etc)

  • Neurological conditions that impact the nerves around the bowels (spinal cord issues, MS, Parkinson’s etc)

  • For folks with Hypermobility Spectrum Disorders, slower transit time (amount of time it takes for food to pass through the digestive system) can lead to constipation as well.

• Hormonal Shifts can also cause constipation - progesterone slows digestion, so any phase where progesterone is higher it can lead to constipation

  • Pregnancy (especially earlier in pregnancy when progesterone rises the fastest)

  • Different points in menstrual cycle (often the luteal phase where progesterone is the highest)

  • Menopause (estrogen does play a role in gut motility, so the drop in estrogen can slow digestion)

Bristol Stool Chart:

One way to determine how healthy your bowel movements are is the Bristol Stool Chart. This is a relatively self explanatory chart, but a good way to track your progress. Types 1 and 2 are constipate. Types 3 and 4 are the ideal. Types 5-7 are diarrhea.

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About the author: Dr. Caitlyn Hauswirth-Varis, PT, DPT, OCS, CFMT, CF-L1

Caitlyn is a pelvic health expert and board certified orthopedic physical therapist. Beyond her PT degree and accolades, she is a Pregnancy and Postpartum Exercise Specialist, a CrossFit coach, and a running coach.

Disclaimer: This blog post is for informational purposes only and does not substitute for professional medical advice. Please consult with a qualified healthcare professional for personalized guidance.