Chronic Constipation

If fiber and laxatives have not solved it, there is usually a reason worth finding.

Constipation means more than infrequent bowel movements. Straining, hard stools, a sense of incomplete emptying, bloating, and needing to help things along manually all count, and someone can have several of these while still going most days. It becomes chronic when it persists for months, and at that point self-treatment often stops working.

Why It Happens

Diet and hydration matter, but they are rarely the whole story in someone who has already tried adjusting them. Chronic constipation generally falls into a few patterns, and treatment depends on which one you have.

• Slow transit — the colon simply moves contents through too slowly
• Pelvic floor dysfunction — the muscles that should relax during a bowel movement tighten instead, so stool cannot pass normally no matter how soft it is
• Constipation-predominant IBS — constipation alongside abdominal pain and bloating
• Secondary causes — medications, thyroid disease, diabetes, neurological conditions, or a structural blockage

The pelvic floor pattern is the one most often missed. Patients pile on fiber and laxatives for years without improvement, because the problem is coordination rather than stool consistency. It does not respond to more fiber. It responds to retraining, and it is treatable once identified.

When to Be Seen

Get evaluated if constipation has persisted for months despite over-the-counter treatment, if you are relying on laxatives regularly, or if it is affecting daily life. Some features need prompt attention regardless of duration: rectal bleeding, unintended weight loss, anemia, a new change in bowel habits after age 45, vomiting, or a family history of colorectal cancer.

How We Evaluate It

We start with your history, medication list, and an examination, which frequently points to the answer on its own. Bloodwork can identify secondary causes. Anorectal manometry, performed in our office, measures how the pelvic floor and anal sphincter muscles work during a simulated bowel movement, and it is what confirms or excludes the pelvic floor pattern. Colonoscopy is used when structural disease needs ruling out or when you are due for screening anyway.

Treatment

Treatment follows the cause. Fiber and fluid intake are worth optimizing, though the type of fiber matters and more is not always better. Where medication is needed, several classes work differently and choosing the right one matters more than escalating doses of the wrong one. For pelvic floor dysfunction, biofeedback retraining is the most effective treatment and works well for most patients who have it. Where a medication or another medical condition is contributing, addressing that often resolves the problem.