Common Causes of Constipation

Article by: Dr. Heah Hsin Tak

28 September 2022

Abdominal complaints and conditions form the most common reasons people seek doctors’ consults. The symptoms are wide and vary in severity, with multiple causative factors. In this multipart series, we discuss a variety of abdominal intestinal symptoms in small digestible portions.

Constipation, is one of the most annoying experiences. The sensation of unable to pass motion, coupled by waves of colicky abdominal pain and repeated but unsuccessful trips to the toilet can be distressing. Unfortunately, everyone will definitely experience this condition one time or another in their lifetime. More often than not, the symptoms are temporary and relieved by over the counter or traditional medications. However, constipation when recurring and non-resolving, can signify a genuine underlying medical condition. In this article we look into the risks and various “forms” of the complaint.


The most common cause of constipation is dietary. As our society becomes more affluent and Westernised, our diet also tend to trend towards more and more “modern” features. Surveys have showed that we consumed more meats and sugar, rather than the traditional vegetables and fruits. That means, consumption of vegetable fibers has reduced as well. Lack of dietary fiber leads to slower passage of stools in the intestines.

A lifestyle that is generally “unhealthy” can have the intestines complaining and refuse to work. Modern hectic city life usually means a high stress environment, very little exercise and insufficient water intake. On a hectic dehydrated day, stools that form will be bulky and harder. As a result, combined with a lack of fibers and fluids, the lethargic intestinal muscles will find it difficult to propel hard stools along the long tunnel towards the exit.

Being of the female gender, there are additional risks of developing constipation. Various life events coupled with aging can cause weakening of pelvic floor muscles by repeated stretching an already wider pelvis. As the muscles sag, the pelvic organs shift from their original suspended positions. The impaired coordination of nerves to the muscles also contribute to ineffective efforts during defecation.

We heard it all the time: the muscles weaken as one ages. That holds true for muscles of the intestines as well. It is an unavoidable phenomenon. However, there are ways to delay the progression of the condition. Regular exercise during the younger age will condition the body’s muscles and theoretically delay the

Various bowel diseases can manifest as constipation via different mechanisms. The primary concern is always colorectal cancer. The tumour that has formed, can block the intestines to various degrees and cause constipation symptoms. Other primary bowel diseases such as diverticular disease and previous its inflammations, irritable bowel syndromes are very well known to cause constipation. Inflammatory bowel disease such as Crohn’s disease can lead to structural defects in the intestines like fistula and strictures. Lazy bowel syndromes where the colon contracts poorly will lead to stools retention.

Chronic medical conditions can also have constipation as one of their symptoms. Endocrine problems such as an underactive thyroid, diabetes, uraemia in kidney diseases, hypercalcaemia can cause paucity of bowel movements. Various neurological conditions also affect bowel motion, such as spinal cord injuries, multiple sclerosis, Parkinson’s disease and stroke. Systemic diseases with multiorgan involvement such as lupus and scleroderma are the rarer causes.

Many drugs come with constipation as a known side effect. This non-exhaustive list features the common suspects:

  • Strong pain killers
  • Antidepressants
  • Iron pills
  • Certain blood pressure medications
  • Psychiatric medications
  • Anti seizure drugs
  • Anti nausea medications

Lastly, a supposedly joyous physiological event such as pregnancy also commonly causes constipation! The good news is, it’s only temporary.

As we have discussed, the list of causes of constipation is very long. Some are temporary and self limiting, however, many can be life threatening. Always seek a doctor’s appointment early for an early diagnosis.  In the next chapter, we will discuss what to expect during the appointment with your doctor.



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