What causes constipation? 13 factors you shouldn’t ignore

If you have constipation – less than three bowel movements a week, dry or lumpy stool, and/or stool that is hard to pass – you should know that you’re by no means alone. This common problem can be caused by anything from depression to low-carb diets. Here are some of the many factors that might cause constipation.

When figuring out what causes constipation, the answers may be surprising. Our modern sedentary lifestyle is bad for more than just your waistline, says Dr Atif Iqbal, a gastroenterologist. Staying in a sitting position for long periods of time kinks up your colon, discouraging stool from passing through and causing constipation. Take regular breaks to stand up and move around. Walking and deep squats, in particular, are two movements that are particularly effective for producing a bowel movement. If constipation is a chronic problem and you don’t feel like squatting on top of your toilet, many have found relief using a “squatty potty,” which elevates the legs to a more natural pooping position.

Cheeseheads, take note: Eating a lot of this melty, delicious food is one of the main explanations for constipation, says Dr Iqbal. While all dairy products have the potential to stop you up, cheese seems to be the biggest digestive troublemaker – not because it’s inherently constipating but because many people eat it instead of healthier fibre-filled foods like whole grains, fruits and veggies. If you’re eating pizza, for example, you’re probably not eating a salad. Make sure that you save room in your stomach for fibre-filled fare. A review of studies published in 2018 in The American Journal of Clinical Nutrition suggests that eating a high-fibre diet reduces your risk for cardiovascular disease, stroke, type 2 diabetes and several cancers (including pancreatic, gastric, colon and breast). Generally, this is most often an issue for children.

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If a bout of depression has you gaining weight or feeling constipated, there’s a reason for that. “Depression slows your overall metabolism,” Dr Iqbal explains. Worse, the medications most commonly prescribed to treat depression are also constipating. A review of studies in BMJ Open shows that there are many non-pharmaceutical therapies for depression, some of which have been shown to be as effective as meds. These include cognitive behavioural therapy, exercise and meditation.

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One of the biggest complaints people have after embarking on a low-carb/high-protein diet is constipation. And for good reason: Eating a diet that focuses on meat, eggs and fat leaves little room for plant fibre, says Dr Iqbal. Even worse, many people consciously avoid fibre-filled foods like whole grains, fruits and vegetables because they are high in carbohydrates. Remember, all carbohydrates are not created equal. Focus on just eliminating highly processed carbs or foods with a high glycaemic index, like sugary treats and white bread. To keep your colon healthy and prevent constipation, make sure you get at least five servings of fruits and veggies a day. (The one exception: bananas, which can be constipating on their own.)

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How can fibre, a go-to constipation treatment also be the cause of constipation? Here’s how: Overdosing on fibre can desensitise your stomach lining, making it less responsive to signals to evacuate, Dr Iqbal explains. This is especially true when people are getting mega doses of fibre from supplements like pills or powders rather than from whole food sources. Skip the fibre pills. Not only is there little scientific evidence to show they work, but they may be working against you, at least in the poop department. A review of studies published in 2017 in the Journal of the American Association of Nurse Practitioners shows that although fibre supplements can appear to be a healthy way to increase fibre intake, most don’t provide any of the health benefits associated with a high‐fibre diet. Still backed up? Your doctor may even temporarily recommend removing fibrous foods from your diet to give your gut a chance to reset.

Not the best news for those with a sweet tooth: Chocolate can be constipating, although the effect appears to vary from person to person. Research is limited, but one study in the European Journal of Gastroenterology & Hepatology found that chocolate is a major offender. When patients were asked which foods or beverages caused constipation, chocolate was mentioned most often (followed by white bread and bananas). There’s no way to tell if chocolate is contributing to your constipation problem unless you completely eliminate it from your diet for a period of time. Start with two weeks and if your constipation improves, then limit the sweet stuff to special occasions.

If you’re painfully constipated, taking a laxative may seem like the best solution. Unfortunately, this could just make your problem worse, Dr Iqbal explains. Laxatives are meant to be used only on a short-term basis, for a week at most. Any longer and you risk making your bowels dependent, which can start a vicious cycle of constipation and diarrhoea. Before you turn to medication for constipation, it’s always best to identify what causes constipation for you and treat that first, he says. Evaluate your lifestyle, dietary habits, exercise and medications to see what’s causing the problem before popping a laxative.

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All medications have side effects. And a surprising number list constipation as one of them. Antidepressants (particularly SSRIs like Prozac), anti-anxiety drugs, heartburn medications and blood pressure pills are the most common offenders, Dr Iqbal says. There might be another prescription medication option, Dr Iqbal explains. “You just need to be clear with your doctor about what problems you’re experiencing.” For instance, he says the calcium in many heartburn medications can cause constipation so instead opt for ones that rely on magnesium to work. Or if you’re on a calcium-channel blocker for high blood pressure, you can try a beta-blocker instead. Of course, any changes to your medications should be done under medical supervision.

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Vitamins with high levels of calcium and iron can be extremely constipating, Dr Iqbal says, and yet many people don’t realise this and take one every day. “Certain minerals, especially in amounts over the recommended daily dosing, can slow down digestion in the large bowel,” he explains. Only people known to have a medical issue that requires supplemental iron, such as iron-deficient anaemia, should use supplemental iron, and then only if recommended to do so by their doctor.