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Causes of constipation

The following questions will help you to work out the reason for your constipation.

• Are you really constipated? (See questions in our section Are you constipated?)
• Are you taking enough fluids and fibre in your diet? In northern climates, dehydration is not usually a problem, but in hot climates, it can cause dry faeces that are difficult to pass.
• Do you take enough exercise?
• Are you taking any medicines that can cause constipation (see below)?
• Are you allowing enough lavatory time to defecate?
• Has there been any change in your lifestyle? Has your job or personal relationships become more demanding?
• Are you depressed? Nerves link the brain to the gut. Reduced activity of these nerves in depression affects the muscle activity of the bowel and results in constipation in some people.
• Do you have a frequent desire to defecate, then strain to pass a few small pellets and feel there is still more to come? This is typical of irritable bowel syndrome (see Useful contacts).
• After straining for some time, does the back passage seem to bulge as the stool comes halfway through? This feeling often occurs with piles (haemorrhoids).
• Do you have a painful condition, such as piles (haemorrhoids) or anal fissure? If passing faeces is painful, constipation is a likely result.
• If you are a woman, do you have to put a finger in your vagina to help pass the stool from the back passage? This probably means you have a rectocele, a weakness in the supporting tissues between the vagina and rectum.
• If you are a woman, did the constipation start after childbirth or after hysterectomy? Hysterectomy may sometimes damage the delicate nerve fibres connected to the bowel.
• Have you gained weight and tend to feel the cold, maybe with dry or thinning hair? You may have an underactive thyroid, which can also cause constipation.
• Do you have any other symptoms?
• Are you pregnant? About 1 in 3 pregnant women has constipation, probably because of the hormone progesterone. The best way to deal with it is to take extra fibre in your diet.
• Have you recently stopped smoking? Almost 1 in 10 quitters experience constipation for a while (Addiction 2003;98:1563–7).

Check your medicines. Many medicines can cause constipation. Common culprits are: 

• pain-killers or cough medicines containing codeine
• antacids (for indigestion) containing aluminium or calcium
• iron tablets
• some antidepressants (tricyclic and monoamine oxidase inhibitor types) and tranquillizers
• some drugs for Parkinson’s disease and for epilepsy (Parkinson’s disease can itself cause constipation)
• some diuretic drugs (for high blood pressure or heart failure)

Obviously, you should not stop a medicine that has been prescribed for you just because it is making you constipated – it could be an important medication for you, so discuss it with your family doctor.

 

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