Chronic constipation: causes, fixes, and when to see a doctor

Chronic constipation means you have hard, infrequent, or difficult bowel movements for weeks or months. Most people call it chronic when bowel movements happen fewer than three times a week or when you must strain often. It feels stubborn, but you can try practical steps that work for many people.

Start by checking habits. Low fiber, not drinking enough, and little movement are the top causes. Certain meds—like opioids, anticholinergics, some antidepressants, iron, and calcium supplements—often slow bowels. Medical issues such as hypothyroidism, diabetes, or pelvic floor problems can also cause long-term constipation. Noticing the cause helps pick the right fix.

Small daily changes pay off fast. Add fiber slowly: whole grains, beans, fruits, and vegetables help bulk the stool. If food changes alone don't work, try a fiber supplement like psyllium, but drink plenty of water. Aim to drink regularly throughout the day; dehydration makes stools harder. Move more—walking 20–30 minutes daily improves gut motility for many people.

Timing matters. Try to sit on the toilet 15–30 minutes after a meal to take advantage of your body's natural reflex to pass stool. Use a footstool to bend knees above hips—this simple squat position eases the outlet and shortens bathroom time. Avoid ignoring the urge to go; delaying can make constipation worse.

Over-the-counter options can help short term. Bulk-forming laxatives, osmotic laxatives (like polyethylene glycol), stool softeners, and occasional stimulant laxatives each have a role. Osmotic laxatives are often gentle and effective for chronic use, while stimulants work faster but are for short-term use unless advised by a doctor. Always follow package directions and check with your provider if you take other medicines.

If simple measures and OTC treatments don’t help, see a clinician. Bring a bowel diary: frequency, stool type, diet, medications, and any pain or bleeding. Your doctor may check for thyroid problems, blood tests, or recommend imaging. If pelvic floor dysfunction is suspected, pelvic floor physical therapy or biofeedback can be very effective.

Watch for warning signs: sudden, severe abdominal pain, blood in stool, unexplained weight loss, or a new change in bowel habits after age 50. These need prompt medical evaluation.

Living with chronic constipation can be frustrating, but most people find a workable plan. Start with diet, fluids, and routine, review your medications, and try safe OTC options if needed. If problems persist, ask for tests and referrals—getting the right diagnosis makes treatment much easier.

Fiber goals: aim for 20–35 grams per day; increase slowly to avoid gas. Some find that probiotic capsules or fermented foods help regularity; pick a common strain like Bifidobacterium or Lactobacillus and try for weeks to judge effect. Cut back on constipating foods—too much cheese, processed foods, or heavy red meat can worsen stool hardness. For opioid-induced constipation, ask your doctor about prescription options that target opioid receptors in the gut. Finally, be patient: bowel habits can take weeks to change, so stick with one plan for at least 2–4 weeks before switching. If unsure, get a second opinion. Always.