Constipation

Everyone is different, but women normally have bowel movements at least every other day and no
more than twice daily. Having a bowel movement fewer than three times per week, along with straining
to produce a hard bowel movement, is called constipation.

About Constipation MEDICINES AND SUPPLEMENTS

Constipation affects about one in three women. Constipation may be a side effect of many medicines
Symptoms of constipation vary. They may include: and supplements. Medicines that treat bladder urgency,
depression, blood pressure and pain affect bowel
• Pain or abdominal discomfort movements. Iron and calcium supplements can cause
• Blood in the stools constipation.
• Gas Talk with your medical provider about the side effects of
• Bloating your medicines. Ask about alternative medicines without
• Straining constipating effects.
• Hard/firm stool NERVE OR MUSCLE PROBLEMS
• Lumpy or hard stool For some women with constipation, the cause is due to
•A sense that the rectum does not completely a problem with the nerves or muscles in the colon. This
empty after having a bowel movement slows bowel movements as they travel through the colon.
PELVIC FLOOR DISORDERS
Type 1 Separate hard lumps, Pelvic pain may prevent relaxation of pelvic floor
like nuts, hard to pass muscles, leading to problems having bowel movements.
Straining excessively with bowel movements may lead
Type 2 Sausage-shaped, but lumpy to pelvic floor disorders such as pelvic organ prolapse.
Prolapse, including rectoceles and rectal prolapse, can
Type 3 make constipation worse. Rectoceles do not cause
Ideal Stool Types

Like a sausage, but with

cracks on its surface constipation.
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Type 4 Like a sausage or a snake, OTHER HEALTH PROBLEMS

smooth and soft
Other medical conditions that can impact the bowels
Type 5 Soft blobs with clear-cut include irritable bowel syndrome, kidney disease, colitis,
edges, passed easily thyroid disorders, neurological condition cord injuries)
and cancer. Talk to your provider if you have these
Type 6 Fluffy pieces with ragged
conditions or are concerned about them.
edges, a mushy stool

Type 7 Watery, no solid pieces. Learn the terms

Entirely liquid
Constipation: Having a bowel movement fewer than
three times a week, along with straining to produce a
hard bowel movement.
Causes Pelvic floor disorders (PFDs): Conditions that affect the
There are many reasons for constipation. Diet is only muscles of the bottom of the pelvis (called the pelvic
one of them. Changes in nerve or pelvic floor muscle floor), including pelvic organ prolapse (POP), urinary
functioning can affect the bowels. Lifestyle choices, incontinence, and bowel control difficulties.
medicines and supplements, pelvic floor disorders,
and other health problems may also impact bowel Pelvic organ prolapse (POP): Dropping of the pelvic
movements. organs, such as the bladder, uterus and rectum, caused
by a loss of vaginal support.
LIFESTYLE FACTORS
A common cause of constipation is not eating enough Perineum: The space between the vagina and the anus.
fiber or drinking enough fluids. This can cause bowel Rectum: Portion of the bowel near the outlet (anus) that
movements to become hard or irregular. The typical stores bowel movements before they are evacuated.
American diet is low in fiber, usually without enough
servings of fruits and vegetables. Foods like white Rectocele (posterior vaginal wall prolapse): Rectum
rice, pasta, or white bread are more likely to lead to bulges upward into the vagina because of a weakened
constipation. Not drinking enough water results in vaginal wall and perineum.
hard bowel movements.
Rectal prolapse: Rectal tissue protrudes from the anal
Additionally, an inactive lifestyle may contribute to opening.
irregular bowel movements.
Accidental bowel leakage: Leakage of stool (fecal
incontinence) or leakage of stool and gas (anal
incontinence).

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Constipation
Diagnosis aim for 25 to 38 grams of fiber daily

It is normal to feel embarrassed to discuss bowel Examples of High Fiber Foods Serving Size Grams of
Fiber
problems with your medical provider. Consider
talking about bowel problems with your primary BREADS AND CEREALS
medical doctor or your urogyn specialist. This Oat or wheat bran (raw) 1 ounce 12
All Bran Cereal 1/2 cup 10
includes constipation and trouble controlling the Bran Buds 1/2 cup 8
stools (accidental bowel leakage). Your provider may Oatmeal (cooked) 1 cup 4
ask you to describe your bowel movements, by using Whole wheat pasta 1 cup 4
a bowel diary or with the Bristol Stool Scale (see Air-popped Popcorn 1 cup 2 1/2
Whole-grain breads 1 slice 2
image on first page).
LEGUMES, COOKED
A pelvic exam can assess if the pelvic floor is among Pinto beans 1 cup 15
the causes for your irregularity. You may need to Baked beans 1 cup 14
see a specialist, such as a gastroenterologist (GI) Lima beans 1 cup 13
Navy beans 1/2 cup 9 1/2
or colorectal surgeon. If you have red blood in White beans 1/2 cup 9 1/2
your stools, you should have a colonoscopy. This Lentils 1/2 cup 8
is a procedure in which the bowels are examined Kidney beans 1/2 cup 8
with a small camera to look for polyps, cancer and SEEDS AND NUTS
hemorrhoids, among other things. Flaxseed 1 ounce 8
Almonds 1 ounce 4
Treatment VEGETABLES
Artichoke, boiled 1 med 6
Lifestyle changes include increasing dietary fiber, Pumpkin, canned 1/2 cup 5
fluid intake, and activity level. For example, eating Potato, baked with skin 1 med 5
whole grains, legumes, fruits, and vegetables helps Acorn squash 1/2 cup 4 1/2
Green peas 1/2 cup 4
you get enough fiber. Your goal should be 25 to 38 Leafy greens 1 cup 4
grams of fiber a day. This may require a supplement.
FRUITS
Gradually increase fiber to keep bloating at a low Dates 1/2 cup 6.5
level. As you increase fiber, you also need to increase Pears 1 med 4
your water intake. Also, get out there and get Raspberries 1/2 cup 4
moving! Even just a short walk can help your bowels Blackberries 1/2 cup 4
Blueberries 1/2 cup 4
move better. Apples with skin 1 med 4
Oranges 1 med 4
Changing your position when you sit on a toilet can Prunes (dried) 1/4 cup 3
make a difference. Put your feet on a small stool at
the base of the toilet. This position helps to relax the
pelvic floor muscles and make it easier for a bowel helpful to press on the perineum or inside the vagina
movement to pass from the body. to help get all the stool out.
Ask your provider if pelvic floor physical therapy You may require a constipation medicine called a
would help. Physical therapists can teach you how laxative. These drugs soften stool and stimulate
to relax your muscles using massage techniques that bowel movements. There are many different types.
help release bowel movements. Some women find it Ask which one is best for you.

Sitting Squatting
Position with footrest
Puborectalis Puborectalis Three Takeaways
muscle muscle fully
only partially relaxed allows 1. C
 onstipation means straining to pass hard,
relaxed stool to pass
more easily
lumpy stools less than 3 times a week.
2. S
 imple changes can help. Eat high-fiber
foods,drink plenty of water,and get
moving. Ask your provider about
medicines that might be part of the
problem.
3. T
 alk to your provider about your
symptoms and ask about medicines
© Alila Medical Media or tests that might help.

© 2023 American Urogynecologic Society. All rights reserved.