Constipation: what is normal, what causes it and what works — Reclaim Power Telehealth patient library

Constipation: What Is Normal, What Causes It, and What Works

Gut Health
September 20, 2026
Reclaim Power TelehealthReclaim PowerTELEHEALTH

Gut health · Bowel habits

Common, fixable, and usually more than one thing at once.

Written for my patients. If you are not one, read "call me" as "call your own clinician", and take the questions here to them.

What counts as normal

Normal ranges from three times a day to three times a week. How often matters less than how it goes. The goal is a soft, formed stool that passes without straining and leaves you feeling empty.

Constipation means one or more of these, most of the time, for at least three months: hard or lumpy stools, straining, feeling like you did not finish, needing to press or help it out, or fewer than three bowel movements a week.

Call me before trying anything here if you have

Blood in your stool or black, tarry stools; weight loss you cannot explain; low iron or anemia; constipation that started recently after age 45; a family history of colon cancer or inflammatory bowel disease; or severe belly pain, vomiting, or not passing gas. These need to be checked, and that may include a colonoscopy.

What usually causes it

Food and fluidToo little fiber, too little fluid, or a sudden change in routine or travel.
MedicationsOpioids, iron, calcium, some blood pressure pills (amlodipine, verapamil), anticholinergics including some bladder and allergy medicines, and some antidepressants.
Body changesLow thyroid, diabetes, pregnancy, and autonomic problems like POTS can all slow the gut.
Pelvic floorSome people's pelvic floor muscles tighten instead of relaxing when they push. It is common in long-standing constipation, laxatives do not fix it, and pelvic floor physical therapy with biofeedback does.
Gut microbesSome gut microbes produce methane gas, which is linked to slower transit. A breath test can check for it.
HabitIgnoring the urge because the timing is bad trains the signal to fade.

Start here

  • Build fiber slowly over two to three weeks. Soluble fiber (psyllium, oats, kiwi, beans) softens stool. Large amounts of bran can make bloating worse.
  • Try two green kiwifruit a day, peeled. In a trial across three countries, they added about 1.5 complete bowel movements a week, a bit more than psyllium, with less bloating. The study was funded by a kiwi company; the result still fits earlier trials. Prunes are a good alternative.
  • Drink enough. Extra water helps most if you are running low or adding fiber.
  • Use your gut's natural timing. The colon is most active after waking and after meals. Sit for a few minutes after breakfast even if you do not feel much urge.
  • Put your feet on a stool so your knees sit above your hips. In a study of healthy adults, a footstool shortened time on the toilet and cut straining.
  • Do not strain and do not scroll. If nothing happens in 5 to 10 minutes, get up and try later.
  • Walk every day. Movement helps the gut move.
  • Coffee gets the colon going in some people. That is fine to use.

If that is not enough: what the guideline says

The 2023 joint guideline from the two largest U.S. gastroenterology societies rated each treatment. A strong rating means the evidence is good and most people should consider it; conditional means it may help, and the choice depends on you.

Conditional recommendation, and my first pick

Magnesium oxideIt pulls water into the colon, it is inexpensive and gentle, and the trials behind it are positive, though smaller and fewer than for MiraLAX, which is why the guideline rates it conditional. Doses in studies were around 1 to 1.5 grams a day; we usually start lower. Not for you if you have kidney disease. Take it at least 2 hours apart from thyroid medicine, iron, and some antibiotics.

Strong recommendation

Polyethylene glycolMiraLAX and generics. Draws water into the stool. Gentle and safe for daily long-term use. My next step if magnesium is not enough or is not right for you.
Bisacodyl, picosulfateStimulant laxatives. Best for short-term use or as a rescue when you are stuck.

Conditional recommendation

Fiber supplementPsyllium is the best studied. Start small and increase slowly.
SennaA plant-based stimulant laxative. Fine for occasional or regular use.
LactuloseA prescription sugar solution. Works, but causes more gas and bloating.

If over-the-counter options do not work, there are prescription medicines with strong recommendations: linaclotide, plecanatide, and prucalopride. Lubiprostone is another option. If nothing works, the next step is testing how your pelvic floor and colon are moving, not a stronger laxative.

Myths worth letting go

"Pounds of old stool"The idea that your colon holds pounds of old waste stuck to its walls is not supported. Colonoscopies do not find it. You do not need a cleanse.
"Laxatives ruin your colon"Studies have not shown that normal use of stimulant laxatives damages the colon. Using one beats being miserable.
"It has to be every day"Three times a week can be perfectly normal if it is easy.

I wrote this for my patients, and it reads the same for everyone: general information, not a plan. If you would like your own numbers read against your own story, that is what a Lab Second Look is for. If you are not sure where to start, the free intro call is fifteen minutes.

Read next: Which magnesium · Iron and ferritin · Your thyroid

A note on how to use this. General information for my patients, not individualized advice. Check with your clinician before combining laxatives or using magnesium if you have kidney disease.

  1. Chang L et al. AGA–ACG clinical practice guideline: pharmacological management of chronic idiopathic constipation. Gastroenterology 2023;164(7):1086–1106.
  2. Gearry R et al. Consumption of 2 green kiwifruits daily improves constipation and abdominal comfort. Am J Gastroenterol 2023;118(6):1058–68.
  3. Modi RM et al. Implementation of a defecation posture modification device. J Clin Gastroenterol 2019;53(3):216–9.
  4. Heaton KW et al. Defecation frequency and timing, and stool form in the general population. Gut 1992;33(6):818–24.

Trang Ca Laube, FNP-BC, FMACP · Reclaim Power Telehealth · Updated September 2026

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Trang Ca Laube, FNP-BC, FMACP

Board-certified Family Nurse Practitioner and Functional Medicine Certified Practitioner. Founder of Reclaim Power Telehealth, seeing adults in Indiana, Colorado, Utah, Washington and Arizona. Author of The Safety Switch. These handouts are general information written for my patients, not individualized advice.

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