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Chronic constipation means bowel movements are infrequent, hard to pass, or leave a feeling that the bowel has not emptied, and that this has been going on for months rather than days. It is not defined by a single number of bowel movements a week, because what is normal varies widely between people. In some people the bowel moves too slowly. In others the pelvic floor muscles do not relax properly when they try to have a bowel movement.
There is no correct number of bowel movements. Anywhere from three times a day to three times a week can be normal, and what matters more is a change from your own usual pattern, and whether stools have become hard or difficult to pass. Occasional constipation after travel, a change in diet or a new medicine is a different thing from the ongoing pattern described on this page.
It is also not always a fibre problem. Two quite different mechanisms produce similar symptoms: slow movement through the colon, and a pelvic floor that tightens instead of relaxing during a bowel movement. The second will not improve with more fibre alone, and it is one of the reasons an assessment can change what is offered.
Symptoms differ between people and change over time, often with diet, activity, illness or a new prescription. Chronic constipation is also a recognised contributor to other problems, including haemorrhoids, anal fissures, diverticular disease, rectal bleeding and rectal prolapse.
Some risk factors cannot be changed:
Others can often be worked on, usually with support from a health care team:
Chronic constipation is diagnosed clinically, using the Rome IV criteria, which look for several typical features present in a substantial share of bowel movements over a sustained period. Doctors add blood tests to check the thyroid, calcium and for anaemia, and use a rectal examination to assess how the pelvic floor is working. Sigmoidoscopy or colonoscopy is arranged when there are alarm features, or when a person is due for colorectal cancer screening anyway. Specialist centres may add anorectal manometry, a balloon expulsion test, or a colonic transit study, which are the tests that separate a slow moving colon from a pelvic floor that is not relaxing.
Care in Canada usually starts with diet, fluid, activity and toileting habits, and moves on to medicines or physiotherapy when those are not enough. Depending on what your assessment showed and what you have already tried, a health care team may discuss:
Different laxatives work in different ways, and some are intended for regular use while others are meant for occasional use, which is worth going through with a pharmacist or doctor. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.
Constipation is common and often incompletely managed, and there is no agreed way to tell early on whether slow bowel transit, pelvic floor dysfunction, or both are responsible. That matters, because the treatments differ. Studies now underway are testing new prokinetic and secretory medicines, therapies for constipation related to opioid pain relievers, biofeedback and pelvic floor physiotherapy protocols, dietary fibre and microbiome interventions, and devices including sacral neuromodulation and vibrating capsules. Researchers are also working on simpler office based tests of pelvic floor function, so that people can be matched to the right treatment sooner.
Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up the care you have now, and no one can say in advance whether a study will help you personally.
This page is written in plain language for people considering clinical research. It is general health information, not medical advice, and it does not replace a conversation with your own doctor or nurse practitioner.
There is no single right number. Anywhere from three times a day to three times a week can be normal, and what matters more is a change from your own usual pattern, and whether stools are hard or difficult to pass. The Rome IV criteria doctors use include having fewer than three spontaneous bowel movements a week as one of several features.
Different laxatives work in different ways, and some are intended for regular use while others are meant for occasional use. The Gastrointestinal Society lists chronic laxative use among the contributors to ongoing constipation, so it is worth reviewing what you are taking with a pharmacist or doctor rather than continuing indefinitely on your own.
For some people the difficulty is not slow bowel movement but muscles around the anus that tighten instead of relaxing when they try to go. Pelvic floor physiotherapists retrain that coordination, often using biofeedback. Your doctor can tell you whether testing suggests this is part of your picture.
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