Constipation may come and go and can cause pain and discomfort. But when it happens for weeks, months, or years, you may have chronic constipation. Chronic constipation can affect the quality of your life. But you can work with your doctor to learn how to manage it with different treatments.

What causes it?

Some people have trouble with constipation for weeks, months, or years. Or it may come and go over long periods of time.

The cause of chronic constipation is often related to two problems with your digestive system. It may be because your intestines don't move stool along well. Or, when the stool gets to the rectum, maybe you can't pass it out of your body easily. These problems can be caused by:

• Diet, especially if you don't eat enough fruits, vegetables, and fiber.
• Not drinking enough fluids.
• Drinking too much coffee or alcohol, which can act like diuretics that remove water from the stool and make it harder to pass.
• Not getting enough physical activity.
• Medicines, such as antidepressants, water pills (diuretics), iron, and pain medicines.
• Changes in your daily routines from travel or changes in your school or job. This may affect how often you have time to have a bowel movement.
• Getting older. As people age, the digestive system can slow down.
• Stress.
• A history of emotional, physical, or sexual abuse.
• Problems relaxing the anus or pelvic floor muscles.

Sometimes, no cause is found. In that case, your doctor may diagnose you with a type of irritable bowel syndrome.

What are the symptoms?

The symptoms include having less than three bowel movements a week. You may also feel like you strain to pass stool, or you have hard stools that are painful to pass. Some people may have bleeding from hemorrhoids when they pass stools. Or you may feel that you don't completely empty your bowels.

How is it treated?

There are many ways to treat chronic constipation, depending on what's causing it. Many people need to combine treatments. You may have already tried increasing activity or changing your diet.

Your doctor may also suggest some of these treatments.

• Fiber. Fiber helps keep water in your stool, making it softer and easier to pass.
• Drinking more water. Your body needs water to be able to pass stool.
• Laxatives. Some foods have a natural laxative effect, like prunes. There are also laxative medicines. One type (osmotic) holds water in the intestine to make it easier to pass stool. The other type (stimulant) increases movement in the intestine.
• Stool softeners. These keep stool soft so it is easier to pass.
• Medicines. Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some medicines may help with your bowels. But others can make constipation worse. You may be able to switch to a different medicine that will not cause constipation.
• Biofeedback. This can help retrain your pelvic floor muscles to know when to relax and when to push so passing stool is easier.