Chronic constipation is difficulty with bowel movements that lasts three months or more: fewer than three bowel movements a week, hard and dry stools, marked straining, a feeling of incomplete emptying or a need to help with the hand. Unlike passing constipation that appears when travelling, after a change in diet or in a stressful period, here the problem becomes part of daily life and affects appetite, mood and quality of life. Many people are embarrassed to talk about it and get by for years with over-the-counter laxatives without a work-up. It is worth seeing a gastroenterologist when constipation persists despite a change of habits, when it began recently after the age of fifty, when there is blood in the stool, unexplained weight loss, persistent abdominal pain or a sudden change in bowel habit.
How the bowel works and why constipation develops
The large bowel absorbs water from the food content that reaches it and moves it in wave-like contractions towards the rectum. The longer the content stays there, the more water is absorbed and the harder and drier the stool becomes. Constipation develops when the movement is too slow, when the pelvic floor and the muscles of the anus do not relax properly at the moment of passing stool, or when there is a mechanical obstruction, which is rarer. In many people it is a combination of several factors, which is why one solution does not help everyone.
Common causes of chronic constipation
- A diet low in fibre and too little to drink.
- Lack of movement, prolonged sitting and prolonged bed rest during illness.
- Regularly putting off the urge to go, at work or away from home, which dulls the natural reflex over time.
- Medicines: opioid painkillers, iron preparations, antacids containing aluminium, some medicines for blood pressure, depression, Parkinson’s disease and allergy. Do not stop a regular medicine without advice.
- An underactive thyroid, diabetes, high calcium levels or low potassium.
- Irritable bowel syndrome of the constipation-predominant type, in which abdominal pain and bloating join in.
- Pelvic floor dysfunction: the muscles contract instead of relaxing during the attempt to empty, sometimes after childbirth or surgery.
- An inherently slow transit of the bowel, which usually appears from a young age.
- Neurological diseases, pregnancy and older age.
- A narrowing or a tumour in the bowel, a rare cause but the one that matters to rule out when there are warning signs.
What you can do at home
A change of habits is the foundation of every treatment for constipation, even when medicines are needed:
- Gradually increase the amount of fibre in the diet: vegetables, fruit with the skin, pulses, whole grains, prunes and ground flaxseed. Increasing too fast causes gas and bloating.
- Drink enough throughout the day. Fibre without fluids makes constipation worse.
- Move: a daily half-hour walk speeds up bowel movement.
- Set a regular time to go, preferably in the morning after a meal, when the natural reflex is strongest, and do not rush.
- Do not put off the urge when it appears.
- Sit properly: a small footstool under the feet that raises the knees above the hips straightens the angle of the bowel and makes emptying easier.
- Avoid prolonged straining and breath-holding, which damage the pelvic floor and encourage hemorrhoids.
It is also worth noticing what happens around the bowel movement: stress, hurry, uncomfortable toilets away from home and irregular sleep affect the bowel more than people think. The bowel responds to routine, so regular sleep and meal times are part of the treatment, not a side note. A change in a supplement or a medicine that began around the time the constipation appeared also deserves a check.
When these habits are kept for three to four weeks and there is no improvement, it is time to seek advice rather than increase the dose of laxatives on your own.
When to see a gastroenterologist
It is worth booking a visit with a private gastroenterologist in Modi’in in these situations:
- Constipation that lasts more than three months despite a change of habits.
- Constipation that began recently, without a clear reason, especially after the age of fifty.
- Blood in the stool or on the toilet paper, even when you think it is hemorrhoids.
- Unexplained weight loss or loss of appetite.
- Persistent abdominal pain or bloating that worsens through the day.
- A sudden change in the thickness of the stool or alternating constipation and diarrhoea.
- A constant feeling of blockage or incomplete emptying, or a need to help with the hand.
- Anemia found on blood tests.
- A family history of bowel cancer or inflammatory bowel disease.
- Dependence on laxatives: a steadily rising dose is needed to produce a bowel movement.
An inability to pass stool or gas together with severe abdominal pain, a swollen, hard abdomen and vomiting is an emergency that needs an immediate visit to the emergency room.
What the gastroenterologist checks
The visit begins with a detailed conversation: when the constipation began, what the stools look like, whether there is straining or a feeling of blockage, what your diet and activity are, which medicines and supplements you take, and what your medical and family history is. A two-week bowel diary recording frequency, consistency and accompanying symptoms helps a great deal. The doctor examines the abdomen and sometimes the anal area, to assess muscle tone and the function of the pelvic floor.
As needed, the doctor refers you for blood tests, including a blood count, thyroid function, calcium and sugar. When there are warning signs, when the constipation is new after the age of fifty or when there is a family history, the doctor refers you for a colonoscopy, in which the whole large bowel is examined from the inside and a narrowing, polyps or a tumour are ruled out. In cases that resist treatment there are dedicated tests that measure the speed of transit through the bowel and the function of the pelvic floor muscles, and they determine the type of treatment.
How chronic constipation is treated
After the change of habits, the next step is fibre supplements or osmotic laxatives, which draw water into the bowel and soften the stool. These are safe for long-term use and do not create dependence, unlike stimulant laxatives, which suit short-term use only. When these are not enough, there are prescription medicines that increase fluid secretion in the bowel or speed up its movement, and the doctor matches them to the type of constipation.
When the work-up reveals pelvic floor dysfunction, medicines help little, and the effective treatment is retraining the muscles through dedicated pelvic floor physiotherapy and biofeedback. When the constipation is the result of a medicine, the doctor reviews an alternative or preventive treatment together with the treating physician. Surgery is very rare and reserved for exceptional cases of obstruction or extremely slow transit.
Why a work-up is better than settling for laxatives
Prolonged constipation leads to hemorrhoids, anal fissures and prolapse of the pelvic floor, and stimulant laxatives over years dull the bowel’s response. More importantly, new constipation or warning signs are sometimes the first sign of a disease that matters to find early. An orderly work-up identifies the type of constipation, matches it with focused treatment, and saves years of trial and error. If you are due for bowel screening, read our guide to colonoscopy in Israel.
At EliteMed in the Ayala 360 complex in Modi’in you can book a visit with a specialist gastroenterologist without a referral, and the consultation can be held in English. The information here is general and does not replace an examination and advice from a doctor.
Frequently asked questions
How many bowel movements a week are normal?
The normal range is wide, between three a day and three a week. Constipation is defined not only by frequency but also by stool consistency, straining and the feeling of emptying. Someone with fewer than three bowel movements a week, hard stools and straining for three months or more has chronic constipation and deserves a work-up.
Are over-the-counter laxatives dangerous for daily use?
Fibre supplements and osmotic laxatives are safe for long-term use in consultation with a doctor. Stimulant laxatives, which make the bowel contract, are meant for short-term use, and daily use over years can dull the bowel’s response and increase dependence. When a laxative is needed every day, it is a sign for a work-up, not for a higher dose.
Can constipation be a sign of a serious disease?
In most cases no, but constipation that began recently after the age of fifty, or constipation with blood in the stool, weight loss, anemia or persistent abdominal pain, can be the first sign of a narrowing or a tumour in the bowel, which is why in these situations the doctor refers you for a colonoscopy. Early detection changes the picture, so the work-up should not be put off.
What is pelvic floor dysfunction and how is it treated?
It is a condition in which the muscles of the pelvic floor and the anus contract instead of relaxing during the attempt to empty, so the stool does not come out despite straining, even when it is soft. The diagnosis is made by physical examination and dedicated tests, and the effective treatment is pelvic floor physiotherapy with biofeedback, which teaches the muscles to work properly.
Can regular medicines cause constipation?
Yes, it is one of the common causes in adults. Strong painkillers, iron preparations, some medicines for blood pressure, depression, allergy and Parkinson’s disease slow the bowel. Do not stop a medicine on your own, but bring the doctor a full list of your medicines and supplements so that an alternative or a preventive treatment can be considered.