How long can you go without pooping? It is a frequent question. This article tells how to distinguish constipation from a severe condition.
People, that suffer from acute or chronic constipation often ask themselves: how long can I go without pooping? This article will respond to this question, along with many others concerning constipation. According to the official definition, constipation is when bowel movements (pooping) happen fewer than three times a week and/or are difficult to pass.
Bowel habits vary a lot from person to person, and what may seem frequent to some can appear infrequent to others. Some people have three bowel movements a day, others one a day, while others go two times a week. However, the consensus is that going three days without pooping is too long; after that, feces become more challenging to pass.
Constipation (particularly chronic constipation) is one of the most common digestive tract symptoms worldwide. In the United States, approximately 15% of the population suffers from chronic constipation. Annual medical visits due to constipation can reach more than 5 million in a normal year.
Worldwide, chronic constipation affects more than 50 million people. Apparently, the condition is more frequent in America than in the European continent (probably due to differences in the two regions’ diet). Although constipation can occur at any age (infant constipation is a common complaint), it is more frequent as age increases. Besides, constipation is three times more frequent in women.
Is constipation a disease?
Constipation is not a disease; it is a symptom. This symptom can occur due to many different conditions. Some of them are mild and easy to treat, and others are complicated and dangerous. It is your physician’s job to determine the cause of your constipation.
How long can you go without pooping before you need to worry?
As previously stated, the broad definition of constipation has fewer than three bowel movements a week. The problem with this definition is that bowel habits vary a lot from person to person. For example, a person with three bowel movements a day will probably feel constipated if he or she goes two days without pooping.
For this latter reason, the most prominent gastroenterologists in the world meet every few years to release new diagnostic criteria to define and diagnose constipation. The name of this criteria is the Roma criteria.
According to Roma IV criteria, a patient must have presented at least two of the following symptoms for at least three months in a row to be diagnosed with constipation:
- Less than three bowel movements a week
- Straining for at least a quarter of all pooping attempts
- Hard or lumpy stools in a quarter of pooping attempts
- A sensation of blockage or obstruction while pooping in at least a quarter of defecations
- The sense of incomplete defecations in a quarter of pooping attempts
- Needing manual maneuvering in at least a quarter of pooping attempts
What are the causes of constipation?
Depending on the cause, there are two different kinds of constipation. Each one with other implications when it comes to treatment.
Primary constipation or functional constipation arises due to problems in colonic function. In many cases of primary constipation, lack of pooping is due to an intrinsic neuromuscular disorder in the large intestine that slows down intestinal transit. These patients usually exhibit decreased urgency to evacuate.
Other patients have constipation due to anatomical or functional abnormalities in the pelvis or the anal sphincter; these patients typically complain of increased straining while pooping (frequently having to recur to manual maneuvers) and a feeling of incomplete defecation. However, most patients with primary constipation don’t have any abnormalities in large intestine transit, perineal wall, or anal sphincter. These patients fall into the category of normal transit constipation. They may exhibit abdominal discomfort, mild bloating and frequently benefit from a high fiber diet. Patients with normal intestinal traffic and no other abnormalities often turn out to have irritable bowel syndrome.
Secondary constipation refers to constipation cases due to issues outside the digestive tract that end up in constipation or to diseases that cause constipation as just one of the symptoms. Some causes of secondary constipation include:
- Dietary issues: Low fiber diets and overuse of coffee, tea, alcohol are proved causes of constipation.
- Low exercise
- Structural causes: Refers to physical obstructions that lead to constipation; some include things like tumors (colon cancer), anal fissures, thrombosed hemorrhoids, impacted feces, volvulus, and idiopathic megacolon.
- Metabolic disorders: Having electrolyte imbalances (for whatever reason) such as too little potassium, too little chloride, too much calcium, among others, can lead to constipation.
- Endocrine disorders: Constipation is a common symptom of hypothyroidism or hyperparathyroidism.
- Neurologic disorders: Parkinson’s disease, multiple sclerosis, spinal cord injury, stroke.
Can certain medications cause constipation?
Several many medications can cause fewer bowel movements and constipation; these include:
- Opioids (codeine, morphine, oxycodone)
- Ibuprofen and diclofenac
- Several others.
What are the symptoms of a constipated person? (Besides few bowel movements)
Many constipated patients do not notice being constipated, and they usually accept constipation as their normal way of life. Several studies show that directly asking patients if they are constipated or not leads to misdiagnosis and underreporting constipation. Many constipated patients don’t have any other symptoms and simply don’t notice it. However, depending on the cause, constipated patients may also exhibit symptoms such as:
- Painful defecation
- Diarrhea (many patients suffer from chronic constipation alternated with short episodes of diarrhea)
- Lower back pain
- Rectal bleeding
- Tenesmus (cramping rectal pain- the feeling of needing to have another bowel movement despite that just had one)
When should you go to the ER for constipation?
Several alarm symptoms suggest your constipation might be due to a severe and potentially life-threatening condition. Some of these alarm symptoms include:
- Blood in the stool: Related to cancer, inflammatory bowel disease, and diverticulosis.
- New-onset constipation in patients over the age of 50: Colon cancer becomes an important consideration.
- Weight loss: A sign of colon cancer but might also be present in inflammatory bowel disease.
- Iron deficiency anemia: Very common in colon cancer.
- Signs of bowel obstruction: Include colicky abdominal pain that evolves into constant and severe pain, vomiting (sometimes with a fecal appearance), distended abdomen, abdominal tenderness.
The presence of any of these should prompt your health care provider to refer you to a subspecialist for more in-depth evaluation.
What is the difference between constipation and bowel obstruction?
Unlike constipation, which tends to be a chronic or subacute condition that can be present for weeks, months, even years, bowel obstruction is an acute medical emergency that requires urgent care. It has intense, unbearable abdominal pain, vomiting, inability to pass gas, and severe cramping. Most patients with bowel obstruction require urgent surgery to prevent intestinal necrosis, perforation, and peritonitis.
Moreover, the causes of intestinal obstruction are quite different from those of constipation. The three most common causes of intestinal obstruction are postoperative complications, hernias, and tumors, in that order, respectively.
How is constipation in babies?
Constipation is also very prevalent in small children and babies. In babies, constipation has different causes than in adults because their digestive system is a little bit different. Formula-fed babies tend to have more constipation than those that receive breast milk. Besides, children could be born with genetic problems in their colon that cause them constipation, like Hirschsprung disease, among others.
Should you push when constipated?
The quick answer is no. Excessive straining while pooping can cause many of the complications described in the next section. Modifying your pooping position can help a lot and decrease the need for pushing. Leaning forward while pooping and using a footstool to elevate your thighs above your hips makes it easier for your body to poop. Taking deep breaths while pooping increases abdominal pressure due to the diaphragm’s contraction, making it easier to poop.
What are the complications of going too long without pooping?
Although many patients go on months and years with constipation without attributing any importance to it, chronic constipation can lead to complications such as:
- Hemorrhoids: Swollen (and painful) veins in the lower rectum result from the constant friction of those veins with a hard stool. Severe cases might even require some form of surgery.
- Anal fissures: Tears of skin around the anus that causes severe pain during a bowel movement. This causes a vicious cycle in which the patient begins to dread pooping, which leads to more severe constipation, harder poop, and more pain with each bowel movement. Many cases of annal fissuring require surgical intervention.
- Rectal prolapse: Due to constant pressure while pushing, the large intestine detaches itself from its original site and goes out through the rectum.
- Fecal impaction: Accumulated poop in the rectum hardens. Impacted feces make it harder for other feces to be evacuated, leading to a vicious cycle of obstruction.
What are laboratory tests required for constipation?
The diagnostic testing your doctor chooses to do depends greatly on the magnitude of your symptoms (if there are any alarm symptoms or not). Some useful diagnostic laboratory tests your doctor might order when you consult for constipation include:
- Complete Blood Cell Count: Helps detect anemia, which is a critical alarm symptom.
- Thyroid tests: Helps ruling out hypothyroidism as a cause of secondary constipation.
- Blood chemistry: Helps to detect electrolyte imbalances.
What imaging studies are useful in constipation?
Suppose the patient presents with severe acute abdominal pain, fever, or a high white blood cell count. In that case, your doctor might choose to do certain imaging studies to rule out any intrabdominal problems. These include:
- Abdominal X-ray: It may reveal a colon full of poop in patients with fecal impaction.
- Abdominal computed tomography: Very useful when the doctor suspects bowel obstruction.
- Air-contrast barium enema: This is useful in diagnosing obstructive colon cancer or any other colonic stricture.
- Defecography: Involves filling up the rectum with barium contrast to fluoroscopically observe the act of defecation. It helps in detecting pelvic abnormalities.
What patients should get a colonoscopy?
Colonoscopy can be a very useful diagnostic study in the context of chronic constipation, but not every patient requires it. Gastroenterologists prefer to perform the procedure only in patients that present constipation along with alarm symptoms like anemia, blood in the stool, a family history of cancer, or recent and unexplained weight loss.
What is the treatment for constipation?
Nowadays, medical therapy focuses mostly on addressing the underlying problem rather than treating the symptom. Diet and lifestyle modifications are the mainstay of treatment and are useful in most cases of primary constipation. The treatment for secondary constipation varies a lot depending on the cause.
The key to primary constipation treatment is assessing and correcting the patient’s dietary habits. In short, it includes increasing the consumption of fiber while decreasing or eliminating the consumption of foods and beverages that favor constipation. Some products patients with constipation should avoid having:
- Dairy products: Including milk and all types of cheese
Although fiber is readily available in a great variety of fruits, vegetables, and cereals, several studies show that many constipated patients do not improve with diet alone; many of them also need fiber supplements. The most common supplements contain wheat, psyllium, or methylcellulose.
Hight water consumption (at least a liter and half a day) is vital in treating constipation. Weekly exercise helps the digestive system to move and makes pooping easier. Some foods with high fiber content include:
- Whole-grain rye bread
- Chia seeds
- Sweet potatoes
- Spinach and other greens
- Prune juice
What medications are useful in constipation?
Many medications have proven different grades of efficacy when dietary fiber and lifestyle changes change; here are some of them:
- Bulk-forming agents: This is another name for fiber supplements. They make the stool softer and bulkier, making it easy to pass through. They are safe for long term use. Metamucil is the most famous example of a bulking laxative.
- Lubricant laxatives: These medications build a coat around the stool, making it easier to pass through. They start working just a few hours after taking them. However, they are not good for long term use because they cause a vitamin deficit. Mineral oil is the most common example. It comes as an enema, and it can cause dependence making it hard to have a regular bowel movement without the drug.
- Osmotic laxatives: These laxatives help keep water inside the intestines, which softens the stool causing more frequent bowel movements. They come both as suppositories and oral presentations.
- Stimulant laxatives: They stimulate the large intestine to contract. They are for very short term use in severe constipation Senokot is the most popular stimulant laxative.
- Stool softeners: The group adds fat and water into the stool, which results in softer bowel movements. Milax is the most famous stool softener.
Do you have this symptom, or do you have problems with your bowel movements?
This tool is a Constipation Symptoms Checker. It gathers the most symptoms and risk factors for constipation. Therefore, the tool will tell anybody who uses it the likelihood that their symptoms are because of constipation. Using the tool is free and would only take a few minutes.