It is normal to have a bowel movement (defecate) anywhere from three times a day to three times a week, as long as the stool (fecal matter) is soft and comfortable to pass. A person experiencing constipation has hard or lumpy stool, which is difficult to pass. Chronic constipation affects 15-30% of people, and is commonly found in young children and the elderly, occurring more frequently in females than in males.
Transit time is the duration between when food enters the mouth and when leftover waste finally passes out as stool. A meal could take anywhere from 12-72 hours to travel through the digestive tract. Each person is unique; a normal bowel movement pattern for one person may be very different from those of family members or friends. Some individuals have an irregular pattern, never knowing what to expect. Usually, before food enters the colon, most of the nutrients have been absorbed into the body and the colon’s role is to remove water. If someone has a long transit time, meaning food passes slowly through the colon, then too much water is absorbed, hardening the stool.
Causes of Hard Stools
To understand what causes hard stools, you must first be acquainted with how your digestive system works. Once most of the nutrients from the food we eat are absorbed by the small intestine, the small intestine then releases the remaining liquid and fiber into the large intestine, where these substances undergo the process of being formed into a stool.
As fecal matter makes its way through the large intestine, much of the liquid is drawn out, forming a stool that’s ready to be evacuated during a bowel movement. When fecal matter takes too long to go through the lower part of the large intestine, even more, liquid may be drawn out, resulting in forming hard, dry stools.
Medication-related causes
Sometimes hard stool is due to something you did (or didn’t) eat as well as medications you take. Examples include:
- aluminum- and calcium-containing antacids
- anticholinergics
- anticonvulsants to prevent seizures
- antispasmodics
- calcium channel blockers
- diuretics
- iron supplements
- medications used to treat depression
- medications used to treat Parkinson’s disease
- narcotic pain medicines
Diet- and lifestyle-related causes
Diet-related causes of hard stools include dehydration (not drinking enough water) and a low-fiber diet. Some potential lifestyle-related causes of hard stool include:
- changes to one’s diet
- changing medications
- not engaging in regular physical activity
- traveling
If a person frequently ignores the urge to have a bowel movement, this can cause stool to become harder to pass. This is because holding back bowel movements can make changes to the brain that affect the future urge to have a bowel movement.
Your stool can build up inside the digestive tract and become harder to pass.
Medical causes
Sometimes, an underlying medical condition can cause hard stools. Examples of these conditions include:
- aging
- anatomic problems with the digestive tract
- brain injuries
- celiac disease
- diverticulitis
- hormone-related conditions, such as hypothyroidism
- intestinal obstructions
- intestinal tumors
- Parkinson’s disease
- pregnancy
- proctitis, an inflammation of the prostate gland
- spinal cord injuries
Some of these conditions, such as an intestinal obstruction, can be a medical emergency. Because stool can’t get out, a person can experience life-threatening complications if the bowel leaks into the intestinal lining.
Hard stool treatment
Medication Therapy
If constipation does not improve with diet and lifestyle changes, then there are supplements and medications available.
Bulk Forming Agents: These are made of indigestible fibre, which absorbs and retains fluid and helps to form a soft, bulky stool (e.g., Metamucil®, Prodiem®). While not quick-acting, they are safe for long-term use. Add these to your diet gradually and increase your fluid intake at the same time.
Enemas: An enema involves insertion of a liquid, usually water, into the rectum via the anus. Typically, after holding the liquid in place for a few minutes, there is an intense urgency to move the bowels.
Stool Softeners: These products work by holding water in the stool (e.g., Colace®). They are safe for long-term use and for pregnant women and the elderly.
Lubricants: Lubricant laxatives coat the colon and stool in a waterproof film, allowing it to remain soft and slip easily through the intestine, usually within 6-8 hours. Don’t use these products for longer than a week, as some have been shown to cause vitamin deficiencies and medication interactions. An example of a lubricant laxative is mineral oil. Not recommended for pregnant women or for persons who have difficulty swallowing.
Stimulants: These laxatives increase muscle contractions to move food along the digestive tract more quickly (e.g., Ex-lax®, Dulcolax®, castor oil, senna tea, and Senokot®). Stimulants are typically recommended for short-term use. However, in some individuals, constipation does not resolve with dietary adjustments, exercise, or short-term laxative use. For those with persistent or difficult constipation, physicians might suggest long-term laxative use. These are not recommended for pregnant women.
Hyperosmotics: Osmotic laxatives encourage bowel movements by drawing water into the bowel from nearby tissue (intestinal lumen), thereby softening stool. Some of these laxatives can cause electrolyte imbalances if they draw out too many nutrients and other substances with the water. They can increase thirst and dehydration. There are four main types of hyperosmotics:
Saline laxatives are salts dissolved in liquid; they rapidly empty all contents of the bowel, usually working within 30 minutes to 3 hours. Examples of saline laxatives are citrate salts (e.g., Royvac®), magnesium preparations (e.g., Phillips’® Milk of Magnesia), sulfate salts, and sodium phosphate. Not intended for long-term use or for pregnant women.
Lactulose laxatives are sugar-like agents that work similarly to saline laxatives but at a much slower rate, and are sometimes used to treat chronic constipation. They take 6 hours to 2 days to produce results.
Polymer laxatives consist of large molecules that cause the stool to hold and retain water. They are usually non-gritty, tasteless, and are well tolerated for occasional constipation. Results can be expected within 6 hours, but it can take longer depending on the dose. An example of a polymer laxative is polyethylene glycol (e.g., PegaLAX®).
Glycerine is available as a suppository and mainly has a hyperosmotic effect, but it may also have a stimulant effect from the sodium stearate used in the preparation. Glycerine is available through several manufacturers.
Enterokinetic: Prucalopride succinate (Resotran®) works by targeting the serotonin (5-HT4) receptors in the digestive tract to stimulate motility (muscle movement) and has Health Canada approval for the treatment of chronic idiopathic constipation in women for whom laxative treatment has failed to provide relief. Resotran® usually produces a bowel movement within 2-3 hours and then spontaneous complete bowel movements typically begin occurring within 4-5 days of starting treatment. Side effects may include nausea, diarrhea, abdominal pain, and headache, mostly following the initial dose and then subsiding with ongoing treatment.
Guanylate cyclase-C agonist: Linaclotide (Constella®) works by increasing intestinal fluid secretion, which helps ease the passage of stool through the digestive tract, relieving associated symptoms and has Health Canada approval for the treatment of chronic idiopathic constipation in men and women. In clinical trials, Constella® showed a statistically significant improvement compared with placebo for complete spontaneous bowel movements. The results occurred within the first week, often on the first day, of dosing and were sustained over the 12-week treatment period. Diarrhea is the most commonly noted side effect.
Hard poop medical treatment
Examples of medications a doctor may prescribe or recommend include:
Bulk-forming agents. Examples include Citrucel or FiberCon. These medications help to add bulk to stool, making it easier to pass.
Osmotic agents. Examples include MiraLAX. These medications attract water to the stool, making it easier to pass.
Stool softeners.Examples include docusate sodium (Colace). This helps to soften hard stool so it isn’t so hard to pass.
Ideally, these methods are a short-term solution. If your hard stool causes significant medical problems, such as an intestinal blockage or rectal prolapse, you may require surgery. That is usually a last attempt to correct an underlying problem.
Prevent or Relieve Hard Stools
You can use these tips to help relieve occasional occurrences of hard stools. If your problems are ongoing, you should see your doctor. These tips will cover hard stools both with and without constipation.
Treat Your Constipation: Infrequent bowel movements are often a major contributor to the experience of hard stools. If you experience constipation on a regular basis, it is essential to see your doctor to find exactly what may be causing the problem. An accurate diagnosis is essential in developing a treatment strategy. If constipation is confirmed as the problem, learn self-care for constipation and how chronic constipation is treated.
Add Fiber to Your Diet: Although research on dietary fiber and hard stools is not conclusive, there are some indications that increasing soluble fiber may be helpful. Soluble fiber dissolves in water, therefore softening the stool. Soluble fiber can be found in many fruits, vegetables, beans, and grains. Flaxseed, chia seeds, and psyllium are also excellent sources of soluble fiber. Learn simple rules for adding fiber to your diet, the best foods to eat when you are constipated, and the foods to avoid when you are constipated.
Drink More Water: If you do not hydrate fully, your body will get the water that it needs by drawing more liquid out of your stools. This can be a prime cause of hard stools. One of the easiest things you can do to keep your stool soft is to drink adequate amounts of water throughout the day.
In your effort toward a softer stool, you may also have to make a change in what you are drinking. Alcohol and caffeine are both dehydrating, so you may need to cut back on your coffee, cocktails, and soda consumption. If you do choose a dehydrating drink, make sure you compensate by following up with a nice, tall glass of water. See more about when you need to drink more water.
Pay Attention to Urges to Go: Many people have a tendency to try to put off bowel movements, preferring to wait until they are in the comfort of their own home, or until there is a more convenient time.
Takeaway:
Hard stools are a sign that the stool is spending too much time in the colon.
It is essential that you tune into your body’s needs and make your way to a bathroom when your body is signaling that it is ready for an evacuation. Strategies for bowel retraining may also be helpful.
When Necessary, Use a Stool Softener: Stool softeners are over-the-counter products that serve to soften the stool and help to initiate a bowel movement. They reduce the amount of fluid that the intestines absorb, leaving more water in the stool. They trigger a bowel movement in 12 to 72 hours.
The primary active ingredient in over-the-counter stool softener products is docusate, and common brand names include Colace, Correctol, Diocto, Doxinate, Ex-Lax Stool Softener, Fleet Sof-Lax, Modane Soft, Phillips’ Stool Softener, and Surfak. Stool softeners differ from suppositories, which are a form of stimulant laxative. Stool softeners are generally considered a safer alternative, but only for short-term use. Always check with a physician before taking any over-the-counter product.
Try Massage, Biofeedback, and Alternative Therapies: Abdominal self-massage has been studied as a treatment for constipation. It may stimulate the muscles involved in producing bowel movements and reduce stress. Biofeedback has also been explored to help people with constipation. Use of probiotics may help. Alternative therapies that don’t have proven effects include acupuncture and acupressure. Medical experts warn against using natural products marketed as laxatives as the dosage and purity cannot be assured and there may be interactions with other medications you are taking.
Seek Medical Treatment From Your Doctor: It is good to work with your doctor when your symptoms persist, and you can also be more assured that these won’t interfere with any other medications you are taking. Your doctor can recommend stool softeners and various types of laxatives, both over-the-counter and by prescription. There are other medications your doctor can prescribe, including Amitiza (lubiprostone) and Linzess (linaclotide) that draw water into your intestines.
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