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Constipation and diuretics: The Associations of Diuretics and Laxatives Use with Cardiovascular Mortality. An Individual Patient-Data Meta-analysis of Two Large Cohort Studies

13 Surprising Causes of Constipation

Everyone is affected by constipation now and then — your diet, travel, and a lack of activity can all trigger a brief bout.

But you might be surprised by the conditions and other factors that can be responsible for longer term or chronic constipation. The list is wide-ranging, from pregnancy constipation to a side effect of antidepressants.

Some of these causes of constipation can be handled at home with an over-the-counter product or changes in your medicine cabinet, but serious constipation warrants a prompt doctor’s visit.

“Constipation that’s new, different, associated with bleeding or weight loss, and lasts a couple of days may be a sign of colon cancer,” says gastroenterologist Benjamin Krevsky, MD, associate chief of the section of gastroenterology at Temple University in Philadelphia, Pa.

But since there are several more common causes of constipation that aren’t as serious, don’t worry too much. Your doctor can help you determine what’s really behind your constipation.

Sneaky Causes of Constipation

Here’s an overview of some of the conditions that may be to blame for your discomfort:

  • Hypothyroidism. “The thyroid is a general regulator and affects organs all over the body,” explains Dr. Krevsky. This includes the bowel. Your family doctor might miss this, but a gastroenterologist who sees this effect several times a year will probably test you for hyperthyroidism and can treat it to relieve your chronic constipation.
  • Hyperparathyroidism. Less common than hypothyroidism, an overactive parathyroid — a gland close to the thyroid — can also be a cause of constipation. Simple testing and treatment will also bring relief.
  • Prescription painkillers. Opioids — not over-the-counter pain relievers — can cause constipation. For people recovering from surgery or managing chronic pain, this side effect can be an obstacle to quality of life (or possibly, hospital discharge). Solutions include taking different pain medications or adding a laxative. Krevsky explains that research in this area is progressing and within the next several years doctors might have new medications to treat pain without causing constipation.
  • Laxatives. Ironically, the laxative you are taking could ultimately lead to chronic constipation. Your body builds up a tolerance to medications that act as stimulant laxatives, such as castor oil. Technically, says Krevsky, they aren’t causing constipation so much as failing to ease it. A better bet for laxatives that won’t lead to tolerance is milk of magnesia or polyethylene glycol (Miralax).
  • Antidepressants. Constipation was one of the unpleasant side effects of an older class of antidepressants called tricyclics. “That’s because they interfere with the transmission of nerves that stimulate the bowel to move,” says Krevsky. Constipation is a much less common but still possible side effect of the more modern SSRI antidepressants. Talk to your doctor about whether you should take a different antidepressant or add a laxative.
  • Antacids. So you have heartburn and now, to add to your misery, constipation sets in. Antacids that contain aluminum are the likely culprit, says Krevsky. Read the ingredient list and make a switch if necessary. Try an over-the-counter acid controller medication, or better yet, talk to your doctor. If you take antacids often enough to get chronic constipation, you should probably be tested for gastroesophageal reflux disease (GERD).
  • High blood pressure medications. Chronic constipation is a side effect of an older class of high blood pressure medications called diuretics, which act on the salt in your body to control fluid levels. “You get dehydrated and your body steals moisture from the stool,” says Krevsky. You cannot compensate by drinking more water than you need — you’ll just lose it through urination. The solution is to talk to your doctor about a switch in blood pressure medication or adding a laxative.
  • Irritable bowel disease (IBD). Though diarrhea is more associated with IBD, some people with Crohn’s disease that affects the small bowel will get chronic constipation. In this case, you need more aggressive therapy for the IBD or surgery, says Krevsky.
  • Pregnancy. Pregnancy constipation is a common problem. Early in pregnancy, constipation may be caused by changing hormones or your diet; in later months, the pressure that the baby is putting on your organs becomes the culprit. Don’t strain, warns Krevsky, because this can cause hemorrhoids, which will just make you more uncomfortable. And don’t take a laxative without talking to your ob-gyn first.
  • Diabetes. People who have diabetes face a number of potential health problems, including chronic constipation. “This is in large part due to the nerve inflammation that goes along with being a diabetic,” Krevsky says. Solutions include getting better control of diabetes to prevent more damage and talking to your doctor about medication to fight constipation.
  • Heavy metal poisoning. Many family doctors don’t think about lead poisoning as a cause of constipation, but a work-up occasionally reveals significant exposure to lead, which can come from chipping old paint and other sources of exposure at home. Nerve damage is one of the outcomes of heavy metal poisoning, and this can affect the normal function of the bowels.
  • Supplements. Calcium supplements and iron supplements both can cause constipation. If you suspect either one, get a recommendation from your doctor for a better way to supplement if you are truly deficient.
  • Diseases of the colon. Any painful colon problem, such as an anal fissure or hemorrhoids, can cause chronic constipation because people avoid bowel movements and “detrain their bowel to work properly,” Krevsky explains. Treating the underlying cause can end this type of constipation.

Finally, Krevsky suggests, it’s possible that you don’t actually have constipation at all. He explains that while many people have a bowel movement regularly, such as once or twice a day, there are others who only do so two or three times a week — and they are just fine. Call this a hazard of pharmaceutical and food product advertising, but Krevsky says he occasionally has patients who are convinced they are constipated because they have seen ads promoting daily regularity. But as long as you’re being regular, you’re probably fine, as long as this doesn’t change and you don’t feel any discomfort.

If you are constipated and worried about the cause, check in with your doctor. Ending your chronic constipation could be as simple as choosing a better over-the-counter laxative or getting better control over a chronic health problem.

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How to Treat Constipation Caused by Your Medications

 You can treat this type of constipation with laxatives that you can buy at a drug store or supermarket. You do not need a prescription for these laxatives.

Laxatives work in two ways:

  • Stimulant laxatives help stool move along your bowel or
  • Osmotic laxatives help liquid stay in your bowel so stool does not become dry and hard.

Just as you need to eat every day, you must take laxatives every day for them to work.  


The first laxative you should try is the stimulant type called
sennosides. It is mild and works for most people. You can buy sennosides in pills or in liquid. 


If you have a history of frequent bowel cramps (also known as “Irritable Bowel Syndrome”), you may want to try an osmotic laxative first, such as

Steps to treat constipation that is caused by your medication:

Each person has a different bowel pattern. What is “normal” for you will be different than what is “normal” for another person. However, having a bowel movement should not be uncomfortable. You should not have to push too hard and your stool should be soft, but formed.

It is important to tailor your laxative doses based on your bowel pattern and goal. A treatment that is tailored for you is called a protocol. 

Look at the diagram below. 

here to enlarge diagram. 

Each step up the protocol has a higher dose so you can work up to the level you need to maintain a comfortable bowel pattern. If you move up the protocol as shown, you will not risk over-treatment, which could cause diarrhea.

You should start EITHER the sennosides protocol OR the PEG protocol. Do not start both at the same time

Most people find the sennosides protocol to be the easiest to take. Sennosides cost less than PEG but PEG works just as well. 

Whichever protocol you choose, start at step 1. Wait 24 hours. If you have a bowel movement within 24 hours that is soft and comfortable to pass, stay at step 1.

If you do not have a comfortable bowel movement within 24 hours, go to the next step in the protocol.

Only go to the next step if you are still feeling constipated after 24hrs. 

Keep moving up a step every 24 hours until you feel your bowel pattern is good for you.

If you have diarrhea, stop taking laxatives until you have a normal bowel movement. Restart the protocol at a lower step than you were on when the diarrhea happened.
Do not take pills for diarrhea.

If you have very bad stomach cramps, stop taking sennosides and call your health care team.

Call your health care team if you:
  • Feel the protocol is not working for you. You may need an osmotic laxative call lactulose syrup. This is sometimes necessary when you have reached the highest step on your protocol and you are still constipated.

  • Are not sure how much laxative to take or when you should move to the next step of the protocol.
  • Are still constipated after getting to the top step of the protocol. You may need a combination of laxatives or a change in medication or pain management. 
  • Start having watery stools after a period of being constipated. There may be hard stool stuck in your rectum. If this happens, do not take pills for diarrhea.

Medicines can cause constipation

Constipation is a bowel disorder. Its characteristic features are a reduction in the number of bowel movements (2 times a week), increased hardness of feces, a feeling of incomplete emptying of the intestine after a bowel movement.


There are two types of constipation: sluggish bowel and defecation disorder. While sluggish bowel is characterized by slow intestinal transit of stool, when bowel movements are impaired, incomplete bowel emptying occurs.

Constipation usually has many causes. Often these are the features of human nutrition, and sometimes we will take medications. Many medications directly affect bowel function and can interfere with digestion.

Cardiovascular drugs

The active substances of various drugs can affect bowel function. So, many patients who regularly take cardiovascular drugs suffer from constipation. These drugs include beta-blockers and ACE inhibitors, which lower blood pressure.

Diuretics cause sluggish bowel movements

People with heart failure and high blood pressure are often prescribed diuretics (diuretics). These drugs remove excess fluid from the body, thereby reducing the load on the heart. However, along with the liquid, minerals, such as potassium, are also excreted from the body. This can cause the stool to become harder and difficult to pass.

Painkillers can cause constipation

Pain therapy often consists of opioid analgesics such as morphine and codeine. One of the most common side effects of opioids is constipation. Opioids suppress the activity of nerve cells in the gastrointestinal tract and slow down intestinal motility. In this case, constipation can be avoided by adjusting the dose of drugs or by parallel administration of drugs that improve digestion.

Antidepressants reduce intestinal activity

Many antidepressants have a calming and relaxing effect. As a result, the intestines often become sluggish and digestion slows down. There is constipation.

Iron supplements interfere with bowel function

Iron supplements have to be taken because of low hemoglobin. These medications often cause digestive problems. Stomach pain, diarrhea, and constipation are possible side effects because iron can irritate the lining of the stomach and intestines.

Massage can stimulate the intestines

For constipation, a light abdominal massage is often recommended. Experts say that it helps to improve peristalsis by stimulating nerve connections in the intestines. Massage should be done for 10-15 minutes before going to the toilet, making circular and stroking movements. Abdominal breathing will be equally effective: deep breaths increase pressure on the intestines, making bowel movements easier.

You may also be interested in:

  • Why constipation occurs and how to deal with it?
  • 9 easy ways to improve digestion
  • The 13 Most Common Bowel Diseases: Symptoms and Treatments

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    Treating constipation in adults and children

    For most people, the normal frequency of bowel movements is between three times a day and three times a week. Some people may not have a bowel movement for a week or more and experience no discomfort. The frequency of bowel movements directly depends on the diet. The daily diet of the average person contains 12-15 g of fiber. And for the normal functioning of the intestines, you should consume at least 25-30 g of fiber and 1. 5-2 liters of fluid per day. Sufficient physical activity is also necessary to maintain normal bowel function.

    To ensure you get enough fiber in your diet, include fiber-rich foods such as bran, whole grains, whole grain breads, and certain fruits and vegetables in your daily diet.

    About 80% of people suffer from constipation at some point in their lives, and such short periods of constipation are quite normal. The diagnosis of “constipation” is made with a frequency of bowel movements less than three per week. The common belief that everyone should have a bowel movement every day has led to the overuse and dependence of many people on laxatives.

    What causes constipation?

    There are several reasons for the development of constipation, including insufficient intake of fiber and fluids, a sedentary lifestyle and a change in the usual environment. Travel, pregnancy, or dietary changes can lead to constipation. In some people, constipation may occur following repeated volitional refusal to defecate when the urge to defecate appears.

    More serious causes of constipation may be neoplasms or areas of narrowing of the intestinal lumen. Therefore, with persistent, not amenable to self-correction, constipation, you should consult a coloproctologist. In rare cases, such serious diseases as scleroderma, lupus, disorders of the nervous and endocrine systems: thyroid disease, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injury can lead to the development of constipation.

    Can medications cause constipation?

    Yes, many medications, including pain relievers, antidepressants, tranquilizers and other psychiatric medications, blood pressure medications, diuretics, iron supplements, calcium supplements, and aluminum-containing antacids, can cause or worsen constipation.

    Moreover, some people who do not experience constipation in normal life may become dependent on the laxatives they take to achieve daily bowel movements. For many of them, the constant use of laxatives brings significant harm.

    When should I see a doctor about constipation?

    Any long-term bowel dysfunction, such as increased or decreased frequency or volume of stools, or difficulty passing stools, should be treated by a specialist. If symptoms of constipation persist for more than three weeks, see a physician. If traces of blood appear in the stool, you should immediately contact a coloproctologist.

    How can I determine the cause of constipation?

    Constipation can be caused by a variety of causes and it is important to identify them in order to prescribe the correct and most effective treatment. The attending physician will definitely prescribe special studies to exclude the anatomical causes of constipation, such as tumors and areas of narrowing of the intestinal lumen.

    A digital examination of the rectum is often used as the first examination method. This method is simple and can answer many questions about the causes of constipation. Examining the bowel with a flexible illuminated instrument or using a barium x-ray can help pinpoint the cause of constipation and rule out serious conditions such as polyps, tumors, or diverticular disease.

    Other research methods help to determine the functional state of the intestine. For example, to conduct a marker study, the patient swallows capsules containing certain biological markers that are visible on x-ray examination performed a few days later. The results of the study show the presence or absence of violations of the muscular apparatus of the intestine. Other studies are aimed at assessing the condition of the anal canal and rectum. These include examining the reflexes of the anal sphincter muscles, which controls the defecation process, using a small plastic canister, as well as x-rays during defecation.

    In most cases, neither anatomical nor functional disorders of the bowel can be detected and the causes of constipation are considered non-specific. Conducting an adequate study is a very important point, especially when the cause of constipation is: a decrease in the speed of food moving through the intestine, difficulty in evacuating feces, or other conditions.

    Treatment of constipation

    Most patients with constipation can be successfully treated by adding fiber-rich foods such as bran, whole grains, whole grain bread, vegetables and fruits, and sufficient fluids to the daily diet. Your doctor may also recommend lifestyle changes. The use of foods containing non-digestible dietary fiber in the intestine, such as bran, has a positive effect not only on constipation, but also on digestion in general. With their regular use, the level of cholesterol in the blood decreases, the risk of developing polyps and colon cancer decreases, and the development of hemorrhoids is prevented.

    Adequate fiber should be consumed for several weeks, possibly months, to achieve the full effect. However, its constant use does not form dependence, unlike stimulant laxatives. Other types of laxatives, enemas, and suppositories should only be used as directed by a physician and under the supervision of a coloproctologist.

    For some patients, it may be helpful to set a daily time of day for bowel movements.