“Stopped up.” “Bound up.” “Blocked up.” Constipation is not something that many people enjoy talking about (it’s not exactly a topic to discuss at the dinner table). But being constipated is nothing to be ashamed or embarrassed about. However, if you are (or think you are) constipated, it’s important to understand why and what you can do to prevent and treat it.
What is constipation?
Constipation is a condition in which you may have:
- Fewer than three bowel movements a week
- Stools that are hard, dry, and/or lumpy
- Stools that are difficult or painful to pass
- A feeling that not all stool has passed
How often you have bowel movements really can vary from person to person. Some people “go” several times a day while others may only go one or two times a week. You probably have your own unique pattern; it’s when you deviate from that pattern that can signal a problem.
Also, constipation is not a disease; rather, it’s a sign or symptom of a lifestyle or medical issue.
How common is constipation?
You might feel like you’re the only one suffering, but the reality is that constipation is pretty common. The American Gastroenterological Association estimates that about 16 out of 100 adults have constipation symptoms, and about 33 out of 100 adults ages 60 and older have symptoms. Millions of people seek medical attention for constipation every year.
Some research suggests that between 11% to 56% of people with diabetes have constipation. There’s a higher prevalence of constipation in people with diabetes compared to people without diabetes.
Who’s at risk of constipation?
Some people are more prone than others to constipation:
- Women, especially during pregnancy and childbirth
- Older adults
- People who don’t eat enough fiber
- People who take certain medications or dietary supplements
- People with certain health problems
What are causes of constipation?
There are many reasons for constipation, and you may be constipated for more than one reason at a time. Lifestyle factors and medications that can contribute to constipation include:
Diet
Not eating enough high-fiber foods (fruits, vegetables, whole grains, legumes), or eating high-fat meats and sugary foods can lead to constipation.
Not drinking enough fluids
Water is needed to help you stay “regular.” Eating a lot of fiber and not drinking enough fluids can lead to constipation.
Not getting enough physical activity
Good muscle tone in the muscles of the digestive tract helps to promote normal bowel movements. If muscles are weak, they can’t do their job as well.
Changes in your routine
Traveling, changes in your diet, ignoring the urge to have a bowel movement, and becoming pregnant can all lead to constipation.
Poor bowel habits
Constantly ignoring the “urge” to move your bowels, say, due to being at work or being too busy can lead to constipation.
Certain medications
Pain medications (narcotics), NSAIDS (ibuprofen, naproxen), antidepressants, antacids, antihistamines, some blood pressure medicines (verapamil, atenolol), antiseizure medicines (phenytoin, gabapentin), sedatives, and iron supplements can lead to constipation.
Certain health conditions
Some health conditions can also cause constipation. These include:
- Colorectal cancer
- Diverticular disease
- Irritable bowel syndrome
- Intestinal obstructions
- Pelvic floor muscle dysfunction
- Disorders that affect the brain and spine, such as Parkinson’s disease and multiple sclerosis
- Spinal cord or brain injuries
- Hypothyroidism
- Diabetes
- Stroke
- Mental health conditions
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Why might having diabetes cause constipation?
Constipation can occur in people who have diabetes (both type 1 and type 2) for several reasons. These include:
Diabetic neuropathy
Nerve damage that occurs in the digestive tract can affect the passage of food. Gastroparesis, or delayed gastric emptying, can also lead to constipation, sometimes with alternating episodes of diarrhea.
Eating little or no carbohydrate
People with diabetes following a low-carb or keto-style eating plan may be missing out on fiber from fruits, vegetables, and whole grains.
Co-existing conditions
Hypothyroid (low thyroid), celiac disease, and kidney disease are conditions that can occur in people with diabetes. All can lead to constipation.
Medications
Certain blood pressure medicines (calcium channel blockers, beta blockers, diuretics), and antidepressants can be culprits. Also, metformin, a common drug used to manage blood sugars, as well as the GLP-1 inhibitor class of medicines can cause constipation in some people.
How is constipation treated?
Many cases of constipation can be treated by making some changes in your daily routine:
- Drink plenty of water and other calorie-free beverages throughout the day.
- Include vegetables, fruit, whole grains, and legumes in your eating plan.
- Make a point to do some form of physical activity each day, such as walking.
- Talk with your doctor or dietitian about using a fiber supplement, such as Metamucil, Benefiber, or Citrucel. Be sure to drink plenty of water!
- Pay attention whenever you have the urge to have a bowel movement, and head for the bathroom!
If you’re not noticing any improvement, ask your doctor about using a stool softener (e.g., Colace, Dulcolax stool softener) or a mild laxative such as Milk of Magnesia or MiraLAX. Your doctor might also recommend a stronger laxative, like a stimulant (e.g., Dulcolax, Correctol) or an enema (e.g., Fleet).
In more severe cases of constipation, your doctor might recommend prescription medications:
- Lubiprostone (brand name Amitiza)
- Linaclotide (Linzess)
- Prucalopride (Prudac, Motegrity)
- Plecanatide (Trulance)
Surgery might be indicated if you have a blockage in your large intestine, an anal fissure, or rectal prolapse.
The lifestyle suggestions listed above are the best ways to prevent constipation in the first place. Also, remember that aiming to keep your blood sugars in your target range can help, as well.
Want to learn more about diabetes and digestive disorders? Read “Treating Gastroparesis” and “What to Eat If You Have Gastroparesis.”
