What should I do if I’m always constipated?

If you're experiencing chronic constipation—defined as infrequent bowel movements (typically fewer than three per week), straining during defecation, a sensation of incomplete evacuation, a feeling of anorectal obstruction, a sensation of abdominal bloating or fullness, or a perception of hard or lumpy stools—it's important to approach management systematically. First, rule out secondary causes: medications (e.g., opioids, anticholinergics, calcium channel blockers, iron supplements), metabolic disorders (e.g., hypothyroidism, hypercalcemia, diabetes mellitus), neurological conditions (e.g., Parkinson disease, multiple sclerosis, spinal cord injury), and structural abnormalities (e.g., colorectal cancer, strictures, rectocele). A thorough history, physical examination—including digital rectal exam—and targeted investigations (such as thyroid function tests, serum calcium, and age- and risk-appropriate colorectal cancer screening) may be warranted.

First-line management focuses on lifestyle and behavioral modifications. Increase dietary fiber gradually to 25–30 g/day from whole grains, legumes, fruits, and vegetables—paired with adequate fluid intake (1.5–2 L of water daily)—to avoid bloating or worsening symptoms. Regular physical activity (e.g., brisk walking for 30 minutes most days) supports colonic motility. Establish consistent toileting habits: respond promptly to the urge to defecate and consider adopting a forward-leaning posture with feet supported on a stool (the “squatty potty” position) to optimize pelvic floor relaxation and anorectal angle.

If conservative measures fail after 4–6 weeks, pharmacologic options may be considered under medical guidance. Osmotic laxatives (e.g., polyethylene glycol 3350) are first-line due to their safety profile and efficacy. Stimulant laxatives (e.g., senna, bisacodyl) should be used short-term only, as prolonged use may lead to tolerance or electrolyte disturbances. For select patients with chronic idiopathic constipation or irritable bowel syndrome with constipation (IBS-C), prescription agents such as lubiprostone, linaclotide, plecanatide, or prucalopride may be appropriate after careful risk–benefit assessment.

Importantly, persistent new-onset constipation in individuals over age 50—or constipation accompanied by red-flag symptoms such as unintentional weight loss, rectal bleeding, iron-deficiency anemia, nocturnal symptoms, or a family history of colorectal cancer—requires prompt gastroenterological evaluation to exclude serious underlying pathology.