Constipation is a common medical problem that is characterized by going to the toilet less often than normal to pass stool or passing painful or hard stools. The cause of constipation may be not drinking enough liquids or not eating sufficient amounts of fiber. It can also be an adverse effect of some medicines or due to an underlying medical illness. In many cases, the cause is unclear .

Signs and Symptoms of Constipation

There is no an exact number of bowel movements you should have a day or a week. Generally having a bowel movement three times a day or three times a week is considered within the healthy range. It is different for each person. However, constipation is characterized by passing fewer than 3 bowel movements in a week. If you are wondering how do I know if I’m constipated? The following signs and symptoms may help you remove your doubt:

  • Passing hard, lumpy, dry stool with difficulty

  • Straining for a bowel movement

  • Feeling like you have not completely evacuated your bowels or you still feel the need to go again

  • Feeling of blockage in the rectum or intestine

  • Bloating or pain in the abdomen

  • Decreased appetite

  • Feeling of lethargy or sluggishness

Long term constipation can cause some complications such as hemorrhoids, anal fissures (tearing of the skin around the anus) and prolapse of the rectum.

Diagnosis of Constipation

The doctor will do a general physical exam and a rectal exam. Apart from these, the following procedures and tests are used to diagnose constipation and to answer your question how do I know if I'm constipated:

Blood Tests

Blood tests will be done to diagnose diseases such as hypothyroidism (low thyroid).


In this procedure, a lighted, flexible tube is inserted into your anus to examine the rectum and the lower part of your colon.


In this procedure, a flexible tube equipped with camera is inserted into your anus to examine your entire colon.

Anorectal Manometry

By using this method, the function of the anal sphincter muscle is evaluated. A narrow, flexible tube is inserted into your anus and rectum and then an inflated small balloon is attached at the tip of the tube. The tube is then pulled back via the sphincter muscle. This procedure helps the doctor measure the coordination of the sphincter muscles.

Balloon Expulsion Test

In this procedure, the speed of the anal sphincter muscle is evaluated. This test is often done along with anal manometry. It measures the time you take to push out a balloon filled with water placed in your rectum.

Colonic Transit Study

This test evaluates the movement of food through your colon. You are made to swallow a capsule that contains either a wireless recording device or a radiopaque marker. The progress of the ingested capsule through the colon is recorded over several days and be visible on X-rays.


In this procedure, a soft paste made of barium is inserted into your rectum. You are asked to pass the barium paste as you would pass stool. The barium is visible on X-rays and can show a prolapse or problems with muscle coordination or muscle function.

MRI Defecography

In this procedure, a contrast gel is inserted into your rectum. You are asked to pass the gel. The MRI scanner will see and assess the coordination and function of defecation muscles. The problems of rectal prolapse or rectocele can also be diagnosed by this procedure.

Causes of Constipation

After getting answers to question how do I know if I'm constipated, let us discuss some of the causes of constipation:

Diet and Constipation

  • Poor diet: Constipation can be caused by eating foods rich in refined sugar or animal fats such as meats, dairy products and eggs but low in fiber such as fruits, vegetables and whole grains.

  • Low intake of fluids: Hard dry stools can occur due to drinking insufficient quantity of water as the large intestine absorbs fluids and in such people without enough water may not pass into the intestine to keep the stools soft.

  • Alcohol and caffeine: Both of these cause increased urination, thereby leading to relative dehydration and less amount of fluid in the intestine to keep the stools soft.

Poor Bowel Habits and Constipation

A cycle of constipation may be initiated by ignoring the desire to pass stools. After some time the person may not feel the desire to the pass stool. This results in progressive constipation. For instance, some people ignore going to washroom because they are too busy or they avoid going in public washrooms.

Some Medicines

Some of the medicines that may result in constipation include antacids containing calcium carbonate and aluminum hydroxide; antispasmodic drugs, iron tablets, antidepressants, diuretics, anticonvulsant drugs and painkillers and narcotic containing drugs.

Less Physical Activity

Constipation can occur as a result of lack of physical activity. For instance, it can occur in individuals who are less active due to health problems, sedentary lifestyle, or long time of staying in bed because of an illness or an accident.

Changes in Daily Routine or Life Changes

Constipation can occur when there are changes in your daily routine. For instance, your bowel movement can change when you travel, get older.

Certain Medical Illnesses

Some medical illnesses can slow the movement of stools through your colon, rectum or anus, leading to constipation. Some of these are: diabetes, disorders affecting spine and brain such as Parkinson’s disease, hypothyroidism and brain or spinal cord injuries.

Problems of the Gastrointestinal (GI) Tract

Problems in your GI tract that narrow or compress your rectum and colon can result in constipation. Some of these problems are tumors, swelling or inflammation such as inflammatory bowel disease or diverticulitis.

Functional Gastrointestinal Disorders

A functional GI disorder occurs when your gastrointestinal tract behaves in an abnormal manner without any pathology. For instance, Irritable bowel syndrome (IBS) is a common functional GI disorder and constipation can be one of the symptoms of IBS.

Pregnancy and Constipation

One of the common symptom during pregnancy is constipation and it can occur due to several reasons:

  • Mechanical pressure on the intestine by the growing uterus

  • Slowing of the intestinal movement due to hormonal changes

  • Changes in fluid and food intake

  • Anal fissure (tearing of the skin around anus)

What to Do When You Are Constipated

How do I know if I’m constipated is a question that need to find out an exact answer, as it makes you feel terrible. Therefore, once you have found that you are constipated, follow these steps to make yourself feel better:

  • Drink 2-4 extra glasses of fluids/water per day.

  • Drink warm fluids, especially in the morning.

  • Eat more vegetables and fruits.

  • Eat bran cereal and prunes.

  • If required, use a very mild OTC stool softener such as docusate or a laxative such as magnesium hydroxide. Don’t take laxatives for more than 2 weeks without consulting your doctor. Your symptoms may become worse if you overdo it.


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