Understanding Constipation
Constipation is a common digestive issue that can be categorized into two main types based on the duration and nature of your symptoms:
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Acute Constipation: This is a sudden, recent change in your normal bowel habits. According to American College of Gastroenterology (ACG) guidelines, a new or sudden onset of constipation should be evaluated by a healthcare professional to rule out acute causes, such as a bowel obstruction. Similarly, CDC health guidance encourages consulting a doctor if you experience persistent changes in bowel patterns to ensure timely and appropriate care.
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Chronic Constipation: This refers to long-term symptoms that have persisted for three months or longer. It often requires a systematic approach to identify the underlying cause and develop an effective management plan.
Common Forms of Chronic Constipation
Chronic constipation is frequently associated with specific conditions that affect how the digestive system functions:
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Functional Constipation: A disorder of gut-brain interaction where the bowel functions abnormally despite the absence of structural or metabolic disease. It is often characterized by chronic symptoms like straining, hard stools, or infrequent bowel movements.
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Irritable Bowel Syndrome with Constipation (IBS-C): A chronic condition involving a disruption in gut-brain communication, resulting in both constipation and recurrent abdominal pain or discomfort.
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Opioid-Induced Constipation (OIC): A specific type of constipation caused by the use of opioid pain medications, which slow down bowel motility and alter fluid dynamics in the gut.
Acute constipation
This is a sudden, recent change in your bowel habits. Because it happens quickly, it is important to pay attention to your body and consult a healthcare professional, as American College of Gastroenterology (ACG) guidelines recommend evaluating new or sudden symptoms to rule out issues like a bowel obstruction.
3 common symptoms:
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Sudden stop or significant drop in how often you have a bowel movement compared to your normal pattern.
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New, sharp abdominal pain or cramping that wasn't there before.
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A feeling of blockage or an inability to pass any gas or stool, which requires immediate attention.
Why it happens: Acute constipation is often triggered by a specific event, such as a sudden change in diet, starting a new medication, travel, or a physical obstruction in the gut that stops things from moving through.
Chronic constipation
This is defined as long-term, persistent symptoms that have lasted for three months or longer. It often involves a disruption in the communication between your gut and your brain, or issues with how the bowel muscles move stool.
3 common symptoms:
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Hard, dry, or lumpy stools (often looking like small pebbles or hard pellets), which are difficult and painful to pass.
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Straining or excessive pushing during most bowel movements, often feeling like you aren't "finished" even after you have gone.
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Infrequent bowel movements, typically fewer than three times per week.
Why it happens: Chronic constipation is often the result of long-term factors, such as Disorders of Gut-Brain Interaction (DGBI) where the gut and brain aren't communicating effectively, chronic use of certain medications (like opioids), or pelvic floor dysfunction.
Medications and Treatments
Prescription Medications
- Relistor (methylnaltrexone): Peripheral opioid antagonist used for opioid-induced constipation; can work quickly and is available as a pill or injection.
- Symproic (naldemedine): Peripheral opioid antagonist taken once daily by mouth to treat opioid-induced constipation.
- Entereg (alvimopan): Peripheral opioid antagonist used short-term in hospitals after surgery to help the bowels wake up; not for long-term home use.
- Amitiza (lubiprostone): Chloride channel activator that pulls fluid into the gut to soften stool; used for opioid-induced constipation and IBS with constipation.
- Linzess (linaclotide): GC-C agonist that increases fluid and movement in the intestines; used for IBS with constipation and chronic constipation.
- Trulance (plecanatide): GC-C agonist similar to Linzess that gently increases fluid and movement in the gut for chronic constipation and IBS with constipation.
Over-the-Counter & Non-Drug Options
- Fleet Enema (sodium phosphate): Hyperosmotic liquid enema that draws water into the colon for rapid relief, usually within 5–15 minutes.
- Fleet Mineral Oil Enema (mineral oil): Lubricating enema that coats and softens stool so it can pass more easily; slower onset than sodium phosphate enemas.
- Generic Saline Enema Kits (saline enemas): Gentler osmotic enemas that bring water into the rectum for mild constipation relief.
- Pedia-Lax Liquid Glycerin Suppositories (glycerin): Rectal suppositories that draw water into the rectum and lubricate stool; designed for children.
- Fleet Glycerin / Pedia-Lax Suppositories (glycerin): Osmotic suppositories that pull water into the rectum to help stool slide out more easily.
- Dulcolax / Fleet Bisacodyl Suppositories (bisacodyl): Stimulant suppositories that activate the nerves in the colon to trigger a bowel movement.
- Mineral Oil Suppositories (mineral oil): Rectal suppositories that lubricate the stool and rectal wall to ease passage; used less often.
- Squatty Potty (toilet stool): Non-drug tool that raises the feet to mimic a squatting position, straightening the anorectal angle and reducing straining during bowel movements.