How do you know if you’re constipated? Is it just based on how many times a week you have a bowel movement?

There are lots of different criteria for diagnosing constipation. Most are based on the number of stools you’re having—fewer than three per week being the standard textbook definition. But the fact is you can have a bowel movement every single day and still be constipated. I see patients who move their bowels regularly but still feel full and uncomfortable afterwards, and when I examine them I can feel distended loops of bowel that are filled with stool—a clear sign that they’re having incomplete evacuation. So while there’s an official guideline for diagnosis, how you feel before, during, and after a bowel movement is an important part of getting to the right solution. Sometimes people who are squeezing out a stingy stool every day may not even realize they’re constipated until they come to me for problems with bloating—and are pleasantly surprised when a constipation fix also solves their bloating woes. 

Constipation is a symptom, not a disease, and there’s always at least one explanation (and sometimes three or four!) for why it’s happening. That’s why I’m prone to badgering people with questions about size, shape, consistency, ease of passage, and even the odor of their bowel movements. They’re all important clues about why things aren’t moving: small pebbly stool might mean diverticulosis; toothpaste-thin stool could be a sign of colon cancer but also occurs commonly with diverticulosis; layered concretions that look like they’ve been deposited at different times could suggest a problem with contractility of the colon; painful passage with bleeding could be a fissure; a foul smell could mean a parasite or bacterial overgrowth—both conditions that typically cause loose stools but can also have the opposite effect. Figuring out the underlying reasons for your constipation and coming up with the right remedy may take a bit of detective work, but when your bowels start to function like the well-oiled machine they’re meant to be, it’s a wonderful feeling. If you’re struggling with bowel movements, check out a free sample of our Getting Regular course.