Constipation

Digestive Health & Nutrition Care
Written By Jennifer Tang

Overview

Constipation can mean having hard or difficult-to-pass stools, straining, feeling that you have not completely emptied your bowels, or having bowel movements less often than is normal for you.¹˒² Some people naturally have bowel movements several times a day while others go only a few times per week, so frequency alone does not determine whether someone is constipated.

At Tangible Health, we take an individualized approach to constipation by looking at your bowel patterns, diet, fibre and fluid intake, medications and supplements, movement, stress, digestive symptoms, and overall health. Care focuses on identifying factors that may be slowing or making bowel movements difficult while supporting comfortable, sustainable regularity.

What Is Constipation?

Constipation is a change in bowel function where stool moves more slowly, becomes harder to pass, or is not emptied comfortably or completely. It can be short-term, such as during travel, illness, medication changes, or a shift in routine, or it can become chronic and persist over time.¹˒²

There is no single “normal” number of bowel movements that applies to everyone. Constipation is better understood by looking at stool consistency, ease of passing stool, bowel frequency, and whether you feel fully emptied, rather than simply whether you have a bowel movement every day.¹˒²

Different types of constipation can involve slower movement through the colon, difficulty coordinating the pelvic-floor muscles during a bowel movement, or constipation associated with conditions such as IBS. Understanding the pattern can help guide the most appropriate treatment.²˒⁵

Common Symptoms of Constipation

Common symptoms may include:¹˒²

  • Hard, dry, or pellet-like stools

  • Straining during bowel movements

  • Fewer bowel movements than is normal for you

  • Feeling that you have not completely emptied

  • Feeling blocked or unable to pass stool easily

  • Bloating or abdominal fullness

  • Abdominal discomfort

  • Increased gas

  • Spending a long time on the toilet

  • Feeling the urge to go but having difficulty passing stool

Persistent constipation can also contribute to complications such as hemorrhoids, anal fissures, or fecal impaction in some people.

Causes & Contributing Factors

Constipation can have many possible causes, and several factors may occur together.

Fibre, Fluids & Eating Patterns
Not getting enough dietary fibre may contribute to constipation. Fibre helps add bulk and retain water in stool, while adequate fluid intake helps fibre work effectively.¹˒⁴ Increasing fibre too quickly can sometimes worsen bloating or discomfort, so changes may need to be gradual and individualized.

Movement & Bowel Habits
Regular physical activity can support bowel function. Ignoring the urge to have a bowel movement, changes in routine, travel, and difficulty establishing consistent bathroom habits may also contribute.³

Medications & Supplements
Constipation can be caused or worsened by certain medications and supplements, including some pain medications, iron supplements, antidepressants, antacids, and other treatments.²˒³ Medication-related constipation should be addressed with the prescribing healthcare provider rather than stopping a necessary medication without guidance.

IBS & Gut Motility
Constipation may occur as part of constipation-predominant irritable bowel syndrome (IBS-C) or chronic idiopathic constipation. In these conditions, changes in intestinal movement and gut-brain signalling can contribute to symptoms.⁵˒⁶

Pelvic Floor & Difficult Evacuation
For some people, stool reaches the rectum normally, but the pelvic-floor and anal muscles do not coordinate effectively during a bowel movement. This can cause significant straining, incomplete evacuation, or a feeling of blockage.

Underlying Health Conditions
Thyroid disorders, diabetes, neurological conditions, pregnancy, structural concerns, and other medical conditions may contribute to constipation in some people.²

Our Approach to Constipation

At Tangible Health, we focus on understanding your bowel pattern and what may be making stool difficult to pass, rather than assuming every case of constipation has the same cause.

Your Bowel & Digestive Patterns
We look at how often you have bowel movements, stool consistency, straining, incomplete evacuation, bloating, abdominal discomfort, and whether symptoms change with meals, travel, stress, menstrual cycles, or other factors.

Your Diet, Lifestyle & Contributing Factors
We review fibre and fluid intake, meal patterns, physical activity, medications and supplements, bathroom habits, stress, sleep, and existing digestive or medical conditions. If your symptoms suggest IBS, pelvic-floor dysfunction, a medication effect, or another medical condition, this can guide whether additional investigation or referral is appropriate.

Your Goals
Your priorities may include having softer and easier bowel movements, reducing straining or bloating, improving bowel regularity, understanding whether certain foods or medications are contributing, or reducing reliance on unnecessary restrictive diets or supplements. Your care plan is developed around the outcomes that matter most to you.

Treatments That May Be Included

Your individualized constipation care plan may include:

  • Clinical Nutrition to gradually optimize fibre intake, support adequate fluids and nutrition, and identify dietary patterns relevant to your symptoms

  • Lifestyle Medicine to support physical activity, bowel routines, meal timing, hydration, sleep, and other habits that influence bowel function

  • Nutraceuticals & Supplements when there is a specific indication, which may include selected fibre or magnesium preparations when appropriate

  • Botanical Medicine when clinically appropriate, with consideration of safety, medications, duration of use, and the type of constipation

  • Naturopathic Counselling when stress, gut-brain interactions, or behavioural patterns are contributing to digestive symptoms

Increasing fibre is helpful for many people but is not the answer for every type of constipation. Significant bloating, slow-transit constipation, or difficulty emptying the rectum may require a different strategy.

What to Expect

Initial Assessment
We start with a detailed review of your bowel habits, stool consistency, straining or incomplete evacuation, abdominal symptoms, diet and fibre intake, hydration, physical activity, medications and supplements, stress, previous digestive conditions, and overall health.

Bowel Patterns & Contributing Factors
From there, we look for patterns that may help explain your constipation. This may include fibre or fluid intake, medication effects, IBS-C, slowed bowel movement, changes in routine, or signs that pelvic-floor coordination may be contributing. Most constipation can initially be assessed from your history and physical examination. Additional bloodwork, imaging, colonoscopy, or specialized bowel-function testing is selected based on your symptoms and medical history rather than routinely performed for everyone.⁷

Personalized Plan
You’ll receive a personalized care plan designed around your bowel pattern, likely contributors, health history, current treatments, and goals. Changes may be introduced gradually so we can determine which strategies genuinely improve your bowel function without unnecessarily worsening bloating or restricting your diet.

Ongoing Support
Follow-up allows us to monitor stool consistency, bowel frequency, straining, bloating, and overall digestive comfort. Your plan can be adjusted over time, and persistent constipation that does not respond as expected can be referred for further medical or pelvic-floor assessment when appropriate.

When to Seek Support for Constipation

Consider speaking with a healthcare provider if you experience:

  • Constipation that persists or frequently returns

  • Hard or painful bowel movements

  • Regular straining

  • Persistent incomplete evacuation

  • Significant bloating or abdominal discomfort

  • A noticeable change from your usual bowel pattern

  • Constipation that begins after starting a new medication or supplement

  • Symptoms that do not improve with reasonable dietary and lifestyle changes

Seek prompt medical assessment if constipation occurs with:

  • Blood in your stool or rectal bleeding

  • Persistent or severe abdominal pain

  • Inability to pass gas

  • Persistent vomiting

  • Fever

  • Unintentional weight loss

  • Significant abdominal swelling

  • New or rapidly worsening bowel symptoms²

A persistent or unexplained change in bowel habits should not automatically be attributed to diet, stress, or “slow digestion.”

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Frequently Asked Questions

  • There is no single normal frequency for everyone. Some people have bowel movements several times per day while others may go only a few times per week. Constipation is more about difficulty passing stool, hard stools, straining, or a change from your normal pattern than hitting a specific daily number.¹˒²

  • Common contributors include low fibre intake, inadequate fluids, changes in routine, inactivity, medications, IBS-C, slowed bowel movement, and difficulty coordinating the pelvic-floor muscles. Certain medical conditions can also contribute.²˒³

  • Not always. Fibre can be helpful, particularly when intake is low, but increasing it too quickly can worsen bloating for some people. The type and amount of fibre should be tailored to your symptoms.¹˒⁴

  • Foods containing fibre are generally encouraged, and psyllium is one fibre supplement with evidence for chronic constipation. Fibre should usually be increased gradually and taken with adequate fluid.⁴˒⁶

  • Stress can influence gut-brain communication and bowel patterns, but it is only one possible contributor. Persistent constipation should not automatically be attributed to stress without considering diet, medications, bowel function, and other medical causes.

  • Incomplete evacuation can occur with constipation and may sometimes suggest difficulty coordinating the pelvic-floor muscles during a bowel movement. Persistent symptoms may benefit from further assessment.

  • Several laxatives have good evidence for constipation and may be used appropriately. The best option depends on the type and duration of constipation, other health conditions, and medications. PEG, for example, has strong guideline support for chronic idiopathic constipation.⁶

  • Naturopathic care can help assess fibre and fluid intake, bowel habits, medications and supplements, lifestyle factors, digestive symptoms, and other possible contributors while developing an individualized plan and identifying when medical or pelvic-floor assessment may be appropriate.

 

Related Care

Constipation may overlap with several areas of health. You may also benefit from:

Jennifer Tang
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