What are the surprising causes of constipation? How do diuretics and laxatives affect cardiovascular mortality? Get the answers in this comprehensive article.

Uncovering the Surprising Causes of Constipation

Constipation is a common issue that can be triggered by a variety of factors, from diet and lifestyle to underlying medical conditions. While occasional constipation is not uncommon, longer-term or chronic constipation may be a sign of more serious underlying problems. In this article, we’ll explore some of the surprising causes of constipation and how they may be associated with cardiovascular mortality.

Thyroid Disorders and Constipation

One of the lesser-known causes of constipation is hypothyroidism, or an underactive thyroid gland. As gastroenterologist Benjamin Krevsky explains, “The thyroid is a general regulator and affects organs all over the body,” including the bowel. While a family doctor may miss this connection, a gastroenterologist who frequently sees this effect can test for and treat hypothyroidism to help relieve chronic constipation.

Parathyroid Dysfunction and Constipation

Another endocrine disorder that can contribute to constipation is hyperparathyroidism, or an overactive parathyroid gland. This less common condition can also lead to chronic constipation, but simple testing and treatment can provide relief.

Medications and Constipation

Certain medications, including prescription painkillers and antidepressants, can also cause constipation as a side effect. Opioid painkillers, in particular, can be a significant obstacle for people recovering from surgery or managing chronic pain. Solutions may include switching to different medications or adding a laxative. Researchers are also working on new pain medications that do not cause constipation.

Laxative Dependence and Constipation

Ironically, the very laxatives used to treat constipation can sometimes lead to chronic constipation. Certain types of laxatives, such as stimulant laxatives like castor oil, can cause the body to build up a tolerance, ultimately failing to provide the desired relief. Krevsky recommends considering laxatives that are less likely to lead to tolerance, such as milk of magnesia or polyethylene glycol (Miralax).

Other Causes of Constipation

Additional conditions that can contribute to constipation include irritable bowel disease (IBD), pregnancy, diabetes, and even some common medications like antacids and blood pressure medications. In the case of IBD, constipation may be more associated with Crohn’s disease affecting the small bowel, rather than the more typical diarrhea. Pregnancy constipation can be caused by changing hormones, diet, or the baby’s pressure on the organs, and should be discussed with an obstetrician.

The Associations of Diuretics and Laxatives with Cardiovascular Mortality

In addition to understanding the various causes of constipation, it’s also important to consider the potential associations between constipation, diuretics, laxatives, and cardiovascular mortality. A recent meta-analysis of two large cohort studies explored these connections, providing valuable insights for both healthcare professionals and patients.

The study found that the use of diuretics, a class of medications commonly prescribed for high blood pressure, was associated with an increased risk of cardiovascular mortality. This is likely due to the dehydrating effect of diuretics, which can lead to reduced moisture in the stool and chronic constipation.

Similarly, the use of laxatives was also found to be associated with an increased risk of cardiovascular mortality. While laxatives are often used to alleviate constipation, the study suggests that their long-term use may be indicative of underlying health issues that contribute to a higher risk of cardiovascular events.

These findings highlight the importance of considering the potential cardiovascular implications of constipation and the medications used to manage it. Healthcare providers should be vigilant in monitoring patients who are prescribed diuretics or using laxatives long-term, and work to address the underlying causes of constipation to minimize the risk of adverse cardiovascular outcomes.

Conclusion

Constipation is a common issue that can have a wide range of underlying causes, from thyroid disorders and medication side effects to pregnancy and diabetes. Understanding these diverse factors is crucial for healthcare providers to accurately diagnose and effectively treat constipation.

Additionally, the associations between constipation, diuretics, laxatives, and cardiovascular mortality underscore the importance of carefully managing constipation and its treatment. By addressing the root causes of constipation and considering the potential cardiovascular implications, healthcare providers can help patients improve their overall health and well-being.

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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Water, Constipation, Dehydration, and Other Fluids

Written by Debra Fulghum Bruce, PhD

• What Causes Chronic Constipation?
• How Can I Prevent Dehydration?
• Will Drinking Water and Other Fluids Cure Constipation?
• How Much Fluid Is Enough to Ease Chronic Constipation?
• Besides Water, What Other Fluids Can Help Keep Me Hydrated?
• Are There Fluids I Should Avoid?
• More

If you’re looking for a simple way to ease chronic constipation, drink plenty of fluids every day. Staying well-hydrated can be a key part of your plan to “get things moving” again.

Water is important for your digestion. It keeps the food you eat moving through your intestines, and it keeps your intestines smooth and flexible, too.

Dehydration is one of the most common causes of chronic constipation. The food you eat makes its way from your stomach to the large intestine, or colon. If you don’t have enough water in your body already, the large intestine soaks up water from your food waste. This makes you have hard stools that are difficult to pass.

There are other causes of chronic constipation too, including what you eat, traveling, medicines, irritable bowel syndrome, and pregnancy.

Watch the amount of fluid you drink, listen to your body, and drink more liquids during exercise and hot weather.

You get dehydrated when your body gets rid of more fluids — usually through sweating or going to the bathroom more than normal — than it takes in. Drinking too little water during exercise, hot weather, or daily activities can also cause your body to use up its stored water.

Extra fluids help keep the stool soft and easy to pass, but drinking more liquids does not cure constipation.

When it comes to thirst, most experts say you should let your body be your guide. The Institute of Medicine’s Food and Nutrition Board suggests that women get 91 ounces of water each day from foods and drinks and men should get 125 ounces. Remember, this recommendation includes the fluids that you take in from your food.

In general, for healthy, average people, 8 cups a day is a good goal. Talk to your doctor about how much water is good for you.

People with some medical conditions may need to drink less than that. Others may need more than 8 cups a day.

Vegetable juices, clear soups, and herbal teas are also good sources of fluids. Fruit juices, while hydrating, contain a lot of unneeded sugars

Stay away from alcohol. It is a diuretic, which gets rid of water from your body and leads to dehydration. Caffeinated drinks like coffee, tea, and colas are also diuretics, but as long as you drink moderate amounts, they probably won’t cause dehydration.

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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.

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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.