Stress and Constipation: What’s the Link?

Most people will experience constipation at some point in their lifetime. Sometimes it can be traced to dietary changes or other lifestyle factors. But you may also notice that your bowel habits change when you’re under stress. 

Is there a link between stress and constipation?

Research shows a strong connection between the brain and the bowels (gut). Mood changes can lead to symptoms in the bowels. And bowel changes can lead to changes in your mood. This is called the “gut-brain axis.” 

Stressful events, regardless of the cause, can lead to constipation. This includes physical and emotional stress. Anxiety and physical stress like sleep deprivation can both lead to constipation. 

How can stress cause constipation?

The digestive tract is one of the most complex systems in the body. Muscles, nerves, bacteria, and other cells have to work together for the bowels to function properly. The bowels have almost as many nerve cells as the brain. And the same neurotransmitters that send signals to nerves in the brain affect the nerves in the bowels.

What the brain perceives as stress is also perceived as stress by the bowels. Stress can cause changes in the release and action of the neurotransmitters in the bowel. These stress-related changes can directly affect your bowel function. This can result in constipation or loose stools.

How do you know if stress is causing constipation?

There’s no single test to find out if stress is the cause of your constipation. But stress can affect more than just the bowel. So if you’re constipated and having other symptoms of stress, it’s reasonable to think that stress could be causing your constipation too. Common symptoms of stress to look for are:

• Fatigue

• Insomnia

• Indigestion

• Changes in appetite

• Rapid heart rate

• Feeling of nervousness

• Low sex drive

• Trouble concentrating 

How to relieve constipation when you’re dealing with stress   

Even under stress, the bowels usually respond to conservative therapies. Ideally, the first step is to reduce your level of stress. Here are some ways to reduce stress:

• Use your support system

• Exercise regularly

• Practice mindfulness and meditation

• Interact with animals

• Practice yoga and deep-breathing exercises

But it’s not always possible to reduce stress in the short term. Fortunately, there are other effective treatment options to relieve your symptoms of constipation.

Dietary changes

A change in diet is often a great way to address constipation. For example, dehydration can lead to constipation. So increasing your water intake often helps. Water can help to soften your stools, making them easier to pass. If you’re constipated, your provider can give you guidance on how much water you should be drinking daily.

A low-fiber diet can also lead to constipation. You can try increasing your fiber intake in different ways. This can be in the form of a high-fiber food or a supplement. The average person only gets about 16 g of fiber per day. Women should aim for at least 25 g of fiber, and men should get about 38 g of fiber. 

Fiber and water work together to treat constipation. An increase in fiber without an increase in water can make constipation, bloating, or abdominal pain worse.  

Medications

Laxatives help to loosen stool so you can pass it. They may bring additional relief if adding more fiber to your diet doesn’t work. There are several different laxative options, including:

• Osmotic agents: These medications — like Miralax (polyethylene glycol 3350) — pull water into the bowels, making the stool softer.

• Stool softeners: Docusate and other stool softeners work by drawing water and fat into the stool. The softer stool can pass through the bowels easier.

• Lubricants: Mineral oil and other lubricants coat the stool and make it slippery. This allows for easier passage out of the body.

• Stimulants: Medications (like bisacodyl) stimulate the muscles of the bowels into action. 

Laxatives can give rapid results. So it’s possible to get dependent on them if you use them for a long time. People generally tolerate them well, but they can cause a few side effects. Common side effects include nausea or vomiting, persistent diarrhea, and abdominal pain. 

Other causes of constipation

Besides stress, there are other important causes of constipation. That’s why it’s important to let your healthcare provider know if you’re struggling with constipation. Since there’s no specific test for stress-related constipation, your provider will often first make sure there are no other potential causes of your constipation. 

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common digestive disorder that can cause changes in your bowel movements. Depending on your subtype, you may experience frequent loose or watery stools (IBS-D), or you may have constipation (IBS-C).

In addition to changes in the appearance of your stool, IBS also causes symptoms like:

• Abdominal pain

• Nausea

• Gas or bloating

• Stools with mucus

Inflammatory bowel disease

Inflammation in the bowels from conditions like Crohn’s disease and ulcerative colitis can lead to constipation. Complications of inflammatory bowel disease (IBD) can cause changes in the physical structure of the bowel wall. This can dramatically slow the movement of stool through the bowels, resulting in constipation.  

Medication

If you’re taking medications regularly, it’s a good idea to make sure your constipation isn’t due to your prescriptions. There are many medications that can cause constipation. These can include:

• Pain medications (like oxycodone and tramadol)

• Antihistamines (like diphenhydramine and cetirizine)

• Iron supplements

• Blood pressure medications (like amlodipine and propranolol)

• Antidepressants (like amitriptyline)

Bowel obstruction

Any blockage that narrows the diameter of the bowel can lead to constipation. A bowel obstruction may come from something on the outside that compresses the bowel. It can also be from something inside that blocks the flow of stool. This type of constipation does not respond well to conservative therapies and needs a medical evaluation. 

Causes of a bowel obstruction can include:

• Previous abdominal surgery: Scar tissue from previous surgery can result in  narrowing of the bowel.  

• Cancer: Tumors or other abnormal growths can physically block or narrow the bowels from both inside and outside the bowel. 

• Abdominal hernias: These are holes in the wall of the abdomen. Bowel can get trapped in these holes and block the flow of stool.

• Volvulus: This is where the bowel twists on itself, which can cut off the flow of material through it.

Nerve damage 

There are a lot of nerves in the bowels. So damage to the nerves may impair how the bowel works and result in constipation. Constipation can be a common issue if you have a neurologic disorder like:

• Multiple sclerosis (MS)

• Parkinson’s disease

• Spinal cord injury

Endocrine dysfunction 

An endocrine disorder is when there’s an issue with one or more of your hormones. Many different hormones help to regulate the bowels. So having too much or too little of a hormone can lead to constipation. 

Common hormone disorders that can cause constipation include:

• Hyperparathyroidism: An overactive parathyroid gland can lead to too much calcium. This can cause constipation. 

• Hypothyroidism: An underactive thyroid gland can slow your bowel function and lead to constipation.

• Hyperglycemia (high blood sugar): A high blood sugar level from poorly controlled diabetes can lead to nerve dysfunction. This can prevent the bowel from working properly and lead to constipation.

When to see a healthcare provider for constipation

If you have symptoms of constipation that don’t get better with simple remedies, you need to seek medical attention. That’s because constipation may be serious or due to an underlying medical problem.

Let your provider know right away if you have symptoms of: 

• Abdominal pain

• Increasing belly size

• Weight loss

• Fever

• Chills

• Nausea and vomiting

• Severe headache

• Weakness

• Blood in the stool

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Written by:

Patrick Massey, MD, PhD

Dr. Patrick Massey earned his medical degree from Rush Medical College and his PhD in immunology from Northwestern University Feinberg School of Medicine. He went on to complete an integrative medicine fellowship at the University of Arizona’s Andrew Weil Center for Integrative Medicine.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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