This page gives an exhaustive list of the different constipation symptoms you, as a sufferer, may experience.
During my practice as a clinical herbalist, I came to realize the following: we are all different, and we will likely express this condition in different ways.
But there is one common endeavor we all seek. We want the ability to prevent a crisis. In order to do this, we need to sharpen our senses and deeply listen to ourselves. Any constipation symptom arising in your body is a chance to react early in the cycle.
As you will see, some symptoms are not directly related to gastro-intestinal health, but are very important as well. They may give us a clue that constipation is brewing in the background.
The Merriam Webster dictionary gives the following definition for "symptom":
So the definition is fairly broad, and I feel that we should not restrain ourselves to the narrow medical list of constipation symptoms, which is purely gut-related and will not include signs like “varicose veins getting worse”.
Some will argue that certain symptoms I list on this page are not symptoms per-se, but are more complications of constipation.
Are varicose veins a possible complication of constipation? Yes.But once varicose veins are installed, is “varicose veins getting worse” a possible constipation symptom? Yes again, due to abdominal congestion.
Whatever existing condition you have that is aggravated by constipation should, in my opinion, be considered as a symptom, even if it is not directly bowel-related.
Keeping a broad, all-inclusive view can only be beneficial. The more we know about those broad symptoms, the earlier we can react. Going back to varicose veins, if you have both varicose veins and constipation, and you feel your legs becoming heavier and slightly painful, it might be an early sign that stools are starting to back-up in your colon. It could very well give you an advance warning, to be heeded and acted upon.
Doctors need a classification, a way to diagnose precisely a condition in a repeatable manner, and that is understandable. They tend to use the ROME III criteria, which gives a consistent view of constipation symptoms that all doctors and specialists can agree upon.
The Rome Foundation is an independent not-for-profit organization specialized in the treatment of functional gastrointestinal disorders. The foundation has been “bringing together scientists and clinicians from around the world to classify and critically appraise the science of gastrointestinal function and dysfunction"(1).
The criteria, which is in its third revision (thus “Rome III”), tells us a constipation diagnosis can be made if two or more of the following symptoms show-up:
Also, according to the criteria, loose stools are rarely present without the use of laxatives.
The description of those symptoms is too narrow and quantitative, and will not fit everyone of us. Some people may not be constipated with “fewer than three defecations per week” for instance, and others will start to back-up if they do not go everyday.
Let us loosen-up that strict numerical view a bit, and expand on those symptoms a little more.
Straining and pushing more than usual
The defecation process is efficient enough to expel the feces mostly through an involuntary wave, with a little pushing on our part to get process started. Involuntary means we have little control over the process. Once triggered by our first push, most of the evacuation should happen on its own.
When we are chronically constipated, we tend to forget that during normal defection, there is barely any straining or forcing required.
If you have to push hard from beginning to end, and your stools come out moist and fairly normal, it gives you a clue that you lack pelvic muscle tone. Even if this just happens once in a while, less than 25% of the time. You may benefit from doing pelvic floor exercises.
Stools are hard, lumpy, feeling spiky and hard
When this starts to happen, it is a sign that constipation might be looming. Sometimes the harshness creates what feels like a scratch, or a small tear in the anal mucosa. The very first part of the evacuation might feel this way, then once this first plug is evacuated, the rest of the stools come out moist.
If you are prone to hemorrhoids, you will know when this happens (it hurts!). Take action immediately, at the first sign of hard stools, even if constipation has not begun (yet).
Pushing too hard, for too long, over periods of time, means we run the risk to develop the dreaded hemorrhoids. Even though they are truly a complication of constipation, once developed their aggravation becomes a symptom.
Aggravation of hemorrhoids may very well be a sign of constipation about to begin. By aggravation, I mean for instance, they were “inside” not bothering you, and now there is a bit “coming out” and being inflamed.
Sensation of incomplete defecation
This is a bit more subtle. Even after a bowel evacuation, there is still a sensation of distention, of a mass in the abdomen. This mass can often be palpated, and is often located in the transverse and descending colon (see picture on the definition of constipation page).
This distension may sometimes be felt before constipation begins.
Sensation of obstruction
This is an evolution of the previous symptom, a condition called fecal impaction, happening when the mass in the abdomen is not moving anymore and forming a plug.
Most of the time, the plug seems to be right there, behind the anus muscle, but is too big, hard and dry and cannot be evacuated. Some may have gotten into the habit of inserting a finger to help break and move the plug, or self-administer an enema.
Those who have experienced constipation on a regular basis know that bleeding as a constipation symptom is not unusual. Hard and abrasive feces lead to scratches in the fragile mucosa of the colon. Those small fissures have a tendency to bleed.
If there is fresh blood (bright red) on the toilet paper, but there does not seem to be blood intermixed with the stools, the blood is likely coming from a small tear or hemorrhoid.
If there is blood intermixed with the stools, it might be due to polyps or inflammatory bowel disease, and needs to be checked by a doctor. If the blood is not bright red but of a darker color (giving the stools a blackish appearance), it is likely coming from higher up in your gastrointestinal tract.
Bleeding can hide a more serious condition, so consult your doctor when this happens.
Gaz and bloating
For some reason, this constipation symptom does not show-up in the Rome criteria. And yet, it manifests itself in a lot of patients. Stagnation of fecal matter means more bacterial fermentation, and thus more gas.
The overall digestion may also slow down during constipation, which will also create fermentation higher up in the intestine and stomach.
Any change in digestive patterns
Let us take a broad view. Whenever you notice a change in digestion for the worse, it gives you a clue that your system is starting to rebel.
It could be acid reflux, more gases, waking up in the wee hours of the night (liver issues), trouble digesting fats (i.e. lack of bile), etc. Pay attention to any change that might forecast constipation trouble a few days down the road. A herbal body cleanse might be appropriate at this stage.
The constipation symptoms listed in the previous section are still purely related to bowel health. As discussed before, we need to expand that view to include the other organs system that may be impacted by constipation.
These are some of the accompanying signs that I heard from people coming to my clinic. You may never encounter those. On the other hand, you may have experienced one of those without making the connection to constipation.
Aggravation of varicose veins
Constipation is classified as a risk factor for developing varicose veins(2). If you suffer from varicose veins, this condition may worsen when you get constipated. When your abdominal area gets congested, venous blood moving from the legs toward the heart is meeting resistance in the middle. This may worsen the sensation of fullness in your legs. Your varicose veins may also look worse, more blue/black, and more swollen, with fluid retention around the ankles.
Having a sensation of fullness in your legs may be an advance warning that things are starting to back-up in your colon.
For some sufferers, one of the symptoms of constipation is a headache that gets worse as days go by without a bowel movement. The typical over the counter anti-inflammatory drugs (aspirin, ibuprofen, etc) will not bring relief. Relief is only obtained after a successful bowel movement.
Having a beginning of a headache may be a warning sign that constipation is developing.
You may feel a pressure on your bladder with a sensation that you need to urinate even after you have emptied your bladder. This may be a sign that your colon is backing up.
Some sufferers are less and less hungry as the days go by, and some experience mild nausea. The intra-abdominal pressure caused by fecal stagnation may trigger that symptom.
Pimples appearing on your buttock may be a sign of abdominal, and particularly liver congestion. This may precede, or appear during constipation.
Stools backing-up and exerting pressure in your colon may express itself as “referred pain” in the lower back. Referred pain means the pain is felt at a location other than the location of the stimulus. In our case, the stimulus is in the bowel, but the nervous system and brain is expressing it in the lower-back.
Constipation and back pain is covered in details in the following article:
This is obviously not a term or condition recognized by the medical profession. But it is nonetheless a condition mentioned and experienced by some constipation sufferers, so it deserves a place here.
It is described as an inability to think clearly, a state of confusion. The brain seems to be stalling to perform the most simple calculations or projections. The person may become forgetful. Some individuals coming to my clinic voiced this as “I think I am becoming dumb”. This may sometimes evolve into depressive states.
Loosing your ability to think clearly may be an early sign of stool backing up in your colon, and may serve as a warning sign.
Knowing the different constipation symptoms is an opportunity to react early and vigorously.
Constipation symptoms are like a barometer: always keeping a eye on them, at all time, gives us an opportunity to take action quickly and efficiently.
We have unfortunately lost the ability to listen to ourselves. A lot of us run like headless chickens during the day, then crash in front of the TV at night, too exhausted to pay attention to what is happening in our own “temple”.
The old doctors knew better. They always asked their patients to describe how their stools looked like. We do not have doctors asking us today, so we need to take this back into our own hands.
The key to solving any chronic condition is the ability to intervene right at the beginning of the crisis and nip it in the bud. Migraine sufferers know that. Constipation sufferers should know this as well.
So let’s cut all that noise coming from the outside and learn to sharpen our senses and listen to what is happening inside our own body.
(1) Rome Foundation web-site at http://www.romecriteria.org/ (go to the "Rome III Disorders and Criteria" page and open the PDF for a list of constipation symptoms).
(2) Jones RH, Carek PJ. "Management of varicose veins". Am Fam Physician. 2008 Dec 1;78(11):1289-94. Review.