The Elephant in the Room: Why Constipation Matters
The Elephant in the Room: Why Constipation Matters
Joy Stepinski, MSN, RN-BC
June 18, 2026
Constipation can be the elephant in the room. Often, the topic of bowel movements can be uncomfortable, embarrassing, and feel too private. Yet constipation is all too common. As a bedside nurse, I routinely asked patients about their bowel habits. A surprisingly common answer was “I move my bowels once or twice per week.” As I teach students about patient care, one of the most frequent questions I receive is how to develop healthy bowel habits themselves. The good news is that regular bowel function does not have to be complicated. As we will see, consistent lifestyle habits, including nutrition, hydration, mobility, and daily routines, can promote optimal gut health and support healthy bowel function.
How is constipation defined? Although definitions vary across publications, constipation is generally described as infrequent bowel movements, hard or dry stool, and straining during defecation [1]. In clinical practice, standardized criteria, such as the Rome III criteria, are used to support identification and diagnosis. Even with these criteria, constipation remains a highly individual experience. Diet, medications, activity level, and emotional health influence symptoms, and personal perception contributes to how bowel habits are experienced.
According to the National Institute of Diabetes and Digestive and Kidney Diseases [2], constipation is common throughout the lifespan. Although it can occur at any time, constipation becomes more common with age. The organization estimates that 16 in 100 of American adults (about 16%) experience constipation, and 33 in 100 older adults over age 60 (about 33%). One survey of 557 participants [3] reported that symptoms may be physical, including straining, bloating, abdominal pain, nausea, and hard stools. Frequently, constipation causes a diminished quality of life, disrupting work or school responsibilities, and social activities.
In a cross-sectional study [4], researchers examined psychological components of functional constipation among 593 participants. Functional constipation refers to to constipation without an identifiable underlying cause. Among the participants, 46.9% experienced sleep disorders, while 56.6% reported mental health concerns, including depression, anxiety, and somatic symptoms. Additional challenges included peer, work, and relationship stressors, as well as exposures to traumatic events, such as physical or sexual abuse [5].
The impact of constipation on older adults can be substantial, although many of these challenges are experienced across all age groups. Daily activities may require constant adjustment around bowel habits and symptoms, and many individuals become preoccupied with bowel function. Because bowel health is often viewed as a private matter, discussing concerns may feel uncomfortable. As a result, some people experience social isolation, reduced participation in activities, and negative mood [6].
Constipation among children has a global prevalence of approximately 30% [7]. One-quarter of physician referrals to a pediatric gastroenterologist are related to this issue. The signs and symptoms of constipation may include infrequent bowel movements, hard stools, straining, abdominal discomfort, and stool-withholding behaviors. Children may exhibit unusual behaviors, such as rocking back and forth or hiding when attempting to suppress the urge to defecate. Repeated suppression of this urge can diminish normal rectal sensation, while continued water absorption in the colon leads to firmer stools. Stool then accumulates in the rectum, contributing to abdominal pain, loss of appetite, and nausea. Over time, postponing bowel movements may become an established behavioral pattern that persists into adolescence. As a result, children may experience a range of emotional challenges, including shame, depression, social withdrawal, interpersonal difficulties, and somatic symptoms.
Constipation can have serious health consequences. For example, studies reported a higher prevalence of colorectal cancer among people with constipation, with a greater risk among those with more severe symptoms [8]. Constipation has also been linked to other gastrointestinal disorders, including gastric cancer, ischemic colitis, diverticulitis [9], and gastroesophageal reflux disease (GERD) [10]. In addition, poor bowel function has been associated with cognitive decline [11].
One of the most serious complications is fecal impaction, which occurs when stool becomes lodged in the rectum and cannot be expelled. Without treatment, fecal impaction may lead to a bowel obstruction and other potentially life-threatening complications, including perforation, sepsis, or tissue damage [12].
Because constipation is a widespread concern with consequences that can affect physical, emotional, and social well-being, understanding lifestyle factors is essential. Next month, we will take a closer look at the role of nutrition, hydration, physical activity, and daily routines in supporting healthy bowel habits and gastrointestinal health.
References
Munch, L., Tvistholm, N., Trosborg, I., & Konradsen, H. (2016). Living with constipation—older people's experiences and strategies with constipation before and during hospitalization. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 30732.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Definition & facts for constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts
Johanson, J. F., & Kralstein, J. (2007). Chronic constipation: a survey of the patient perspective. Alimentary Pharmacology & Therapeutics, 25(5), 599-608.
Zhao, Z., Bai, B., Wang, S., Zhou, Y., Yu, P., Zhao, Q., & Yang. B. (2024). Physical and psychological correlates of somatic symptoms in patients with functional constipation: A cross-sectional study. BMC Psychiatry, 24(1), 134.
Rao, S. S., & Meduri, K. (2011). What is necessary to diagnose constipation?. Best Practice & Research Clinical Gastroenterology, 25(1), 127-140.
Mulhem, E., Khondoker, F., & Kandiah, S. (2022). Constipation in children and adolescents: Evaluation and treatment. American Family Physician, 105(5), 469-478. https://www.aafp.org/afp/2022/0500/p469.pdf
Guérin, A., Mody, R., Fok, B., Lasch, K. L., Zhou, Z., Wu, E. Q., ... & Talley, N. J. (2014). Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation. Alimentary Pharmacology & Therapeutics, 40(1), 83-92
Osterweil, N. (2015). Chronic constipation a warning sign for GI disorders. Medscape. https://www.medscape.com/viewarticle/853239
Momma, E., Koeda, M., Tanabe, T., Hoshikawa, Y., Hoshino, S., Kawami, N., ... & Iwakiri, K. (2021). Relationship between gastroesophageal reflux disease (GERD) and constipation: laxative use is common in GERD patients. Esophagus, 18, 152-155. https://doi.org/10.1007/s10388-020-00770-5
Brooks, M. (2023). Chronic constipation linked to cognitive decline. Medscape. https://www.medscape.com/viewarticle/994551?form=fpf
Arnaud, M. J. (2003). Mild dehydration: a risk factor of constipation?. European Journal of Clinical Nutrition, 57(2), S88-S95.