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Types of Constipation - 7 Primary Categories and Subtypes
- Written by: Sebastian Dan, Senior Editor
- Medically reviewed by: Horia Marculescu, MD
- Last medically reviewed on: December 23, 2025
Constipation is a condition marked by challenging and infrequent bowel movements, occurring typically four or fewer times a week. This symptom is one of the most frequent gastrointestinal complaints in the United States and is a common reason for visits to colorectal surgeons and gastroenterologists.
This prevalent issue often goes unnoticed until the patient experiences complications like anorectal disorders.
The medical literature identifies seven primary categories of constipation, each containing distinct clinical subtypes. Almost all the types of constipation share similar characteristics and specific causes. It is essential to learn and to recognize them for long-term relief and prevention.
1. Chronic Constipation
Chronic constipation is the most common gastrointestinal disorder out of all the types of constipation, persisting for at least three months, and is characterized by:
- Infrequent bowel movements
- Difficult stool passage
- A sensation of incomplete evacuation
This condition has a profound influence on a patient’s overall quality of life. It is typically classified as functional constipation (alternatively referred to as idiopathic constipation) in instances when diagnostic investigations fail to identify a specific organic, metabolic, or structural etiology.
Chronic constipation may present with infrequent defecation, hard stools, and a sensation of incomplete evacuation. Effective relief and prevention focus on addressing underlying causes and improving bowel habits.
Recommended measures include:
- Adequate hydration: Increases stool softness.
- High-fiber diet: Promotes intestinal motility.
- Regular physical activity: Enhances gastrointestinal transit.
- Scheduled toileting habits: Supports consistent bowel function.
- Medical evaluation: Necessary when symptoms persist, to exclude secondary causes such as metabolic or neurological disorders.
Chronic constipation is a common gastrointestinal condition, with an estimated prevalence of 10–15% globally. According to the Rome IV diagnostic framework, chronic constipation can be divided into four main categories: functional constipation, constipation-predominant irritable bowel syndrome, opioid-induced constipation, and functional defecation disorders, which include inadequate defecatory propulsion and dyssynergic defecation.
The first-line management for these conditions typically emphasizes non-pharmacological interventions such as dietary fiber enhancement, increased fluid intake, lifestyle modification, and the use of conventional over-the-counter laxatives. When initial treatments fail, clinicians must tailor therapeutic strategies to the patient's specific constipation subtype. This targeted approach addresses the unique physiological drivers of the condition rather than relying on a one-size-fits-all protocol. (Expert Review of Gastroenterology & Hepatology. Epub 2020. PMID: 31893959. Aziz, Whitehead, Palsson, Törnblom, Simrén)
Diagnosis of chronic constipation should include a thorough history, physical examination, and, when indicated, diagnostic testing such as colon transit studies, anorectal manometry, and defecography. Understanding the specific subtype is essential for effective treatment planning, as management strategies vary, ranging from dietary and lifestyle modifications, pharmacologic therapy, or specialized interventions like pelvic floor rehabilitation.
2. Functional Constipation
Functional constipation (also primary or idiopathic) is a subtype of primary constipation, distinguished from secondary constipation, and some of the causes are medications, metabolic disorders, neurological diseases, or other underlying conditions. It is the second most common type of constipation, and medical professionals can classify it into three distinct physiological subtypes based on colonic transit time and anorectal function:
a) Normal Transit Constipation
In this familiar form, colonic motility and stool transit through the colon are within normal limits. However, patients report symptoms such as bloating, abdominal discomfort, and straining. The defecation process is perceived as difficult, despite normal stool frequency and consistency. This type is frequently associated with dietary habits, psychosocial factors, and irritable bowel syndrome with constipation (IBS-C).
b) Slow Transit Constipation
This subtype involves delayed movement of stool through the colon due to dysfunction in colonic smooth muscle or the enteric nervous system. Patients typically experience infrequent bowel movements (less than twice per week), minimal urge to defecate, and often require laxatives for relief. This condition is more prevalent in young women, and medical professionals can associate it with colonic inertia (a marked reduction in high-amplitude propagated contractions (HAPCs)), which are necessary for effective stool propulsion.
c) Outlet Constipation (Pelvic Floor Dysfunction)
Also known as dyssynergic defecation, this form of constipation results from impaired coordination of pelvic floor muscles and the anal sphincter during attempted defecation. Patients may experience excessive straining, a sensation of anorectal blockage, and incomplete evacuation. Medical professionals diagnose this condition using anorectal manometry and balloon expulsion tests, and it often responds to biofeedback therapy.
Identifying whether a patient has normal transit, slow transit, or outlet constipation is fundamental in guiding appropriate and effective therapy. Chronic functional constipation, although benign, can be debilitating and requires a tailored, patient-specific approach to achieve symptom relief and restore bowel function.
Functional constipation represents the most prevalent clinical manifestation of colonic dysfunction, though its precise multifactorial etiology remains a subject of ongoing investigation. Current medical literature suggests that significant alterations in physiological mechanisms are frequently secondary to deficiencies in various neuroendocrine and hormonal factors.
Specifically, the regulation of colonic motility is dependent upon a complex interplay of signaling molecules, including motilin, ghrelin, serotonin, and acetylcholine, alongside inhibitory mediators such as nitric oxide and vasoactive intestinal polypeptide. Dysregulation within this neurohumoral framework is theorized to disrupt usual peristaltic patterns, leading to the symptomatic presentation of functional bowel impairment. (Rev Assoc Med Bras. 2023. PMID: 36888769. Arslan, Dogan, Boyacioglu, Caliskan, Elevli)
3. Secondary Constipation
Secondary constipation refers to a type of constipation that arises as a consequence of identifiable medical conditions, medications, or structural abnormalities, in contrast to functional constipation (also known as idiopathic constipation), which has no clear organic or physiological cause. Secondary constipation is not a primary gastrointestinal disorder but rather a symptom or manifestation of an underlying pathology. Recognizing this distinction is critical for accurate diagnosis and appropriate management.
Unlike functional constipation, which is typically related to lifestyle, behavioral, or psychosocial factors, secondary constipation has a direct and often measurable cause. It may present as acute or chronic and can be associated with systemic symptoms such as weight loss, fatigue, or anemia (clinical features that warrant further investigation).
Patients with secondary constipation often report a sudden change in bowel habits, pain, or symptoms resistant to standard laxative treatments. Specialized doctors (gastroenterologists) use a detailed medical history, physical examination, and diagnostic testing to determine the etiology.
Secondary constipation can be categorized based on the underlying cause. The major subtypes include:
a) Metabolic and Endocrine Causes
- Reduced thyroid hormone levels slow down gastrointestinal motility (Hypothyroidism).
- Autonomic neuropathy can impair colonic transit (Diabetes Mellitus).
- Elevated calcium levels reduce neuromuscular excitability, leading to slowed bowel movements (Hypercalcemia).
b) Neurological Causes
- Degeneration of the enteric nervous system impairs gut motility (Parkinson’s Disease).
- Demyelination affects neural control of the bowel (Multiple Sclerosis).
- Disruption of autonomic and voluntary control leads to significant bowel dysfunction (Spinal Cord Injuries).
c) Medication-Induced Constipation
- Common culprits include opioids, anticholinergics, calcium channel blockers, antidepressants (especially tricyclics), and iron supplements. These agents alter colonic transit time or reduce intestinal secretions.
d) Gastrointestinal Disorders
- Colorectal cancer, strictures, or anal fissures may cause obstructive symptoms or lead to avoidance of defecation due to pain.
e) Psychiatric Conditions and Eating Disorders
- Conditions like depression and anorexia nervosa can contribute to secondary constipation due to altered intake, hormonal imbalances, or laxative abuse.
Clinicians must distinguish primary functional impairments from secondary constipation, which develops due to organic pathologies like mechanical obstructions, systemic diseases, or adverse drug reactions. (American Gastroenterological Association. 2013. DOI: 10.1053/j.gastro.2012.10.029. Adil E. Bharucha, MBBS, MD, AGAF, Spencer D. Dorn, MD, MPH, Anthony Lembo, MD, Amanda Pressman, MD)
Secondary constipation requires a high index of suspicion and thorough evaluation to identify and treat the root cause. While it may present similarly to functional constipation, its etiology is distinctly pathological, necessitating tailored therapeutic strategies beyond standard dietary or lifestyle modifications. Early identification can prevent complications and improve patient outcomes.
4. Post-Infectious Constipation
Post-infectious constipation is a type of secondary constipation that develops after an acute gastrointestinal infection, most often caused by viruses or bacteria. It is considered part of the broader spectrum of post-infectious functional gastrointestinal disorders (PI-FGIDs), which also include post-infectious irritable bowel syndrome (PI-IBS).
Unlike idiopathic (primary) constipation, post-infectious constipation follows a prior infection. Health professionals describe it by new or ongoing changes in bowel habits after clinical recovery from the infection.
The precise mechanisms underlying post-infectious constipation are multifactorial and remain under active investigation. It is a consensus that mucosal inflammation during the acute infection triggers alterations in the enteric nervous system (ENS), intestinal microbiota, and epithelial barrier function.
These changes may lead to:
- visceral hyposensitivity
- persistent low-grade inflammation
- impaired colonic motility (reduced peristaltic activity).
Patients with post-infectious constipation typically report the onset of constipation within weeks to months after recovery from gastroenteritis. The condition may manifest as infrequent bowel movements (fewer than three per week), hard or lumpy stools (Bristol Stool Form Scale type 1–2), and straining during defecation.
Abdominal bloating, discomfort, and a sensation of incomplete evacuation are also common. In contrast to post-infectious diarrhea or irritable bowel syndrome with diarrhea (IBS-D), the predominant feature is delayed colonic transit rather than accelerated motility.
Doctors do not use official subtypes for post-infectious constipation, but they often use these functional frameworks to understand it:
- Post-infectious irritable bowel syndrome with constipation predominance (PI-IBS-C): characterized by recurrent abdominal pain associated with constipation, fulfilling the Rome IV diagnostic criteria for IBS.
- Post-infectious functional constipation: presenting without significant abdominal pain but with persistent difficulty in stool passage and reduced stool frequency.
According to a medical study (Phenotypic features of patients with post-infectious irritable bowel syndrome) published by the US National Library of Medicine, “IBS is generally present in approximately 11% of the population, with PI-IBS patients accounting for approximately 10% of them. The female gender is more common in both IBS and PI-IBS.” (AGA. 2019. PMCID: PMC6709955. Rusu, Mocanu, Dumitraşcu).
Most cases of post-infectious constipation improve gradually over months as intestinal homeostasis and microbiota composition are restored. Management of PI-C focuses on dietary modification (adequate fiber and hydration), restoration of gut flora (probiotics), and pharmacologic agents such as osmotic or stimulant laxatives when necessary. In persistent cases, evaluation for secondary motility disorders may be indicated.
Recognizing post-infectious constipation as a distinct entity is essential for appropriate patient counseling, targeted therapy, and prevention of chronic functional bowel disturbances.
5. Habitual Constipation
Habitual constipation is a chronic condition characterized by persistently infrequent, difficult, or incomplete bowel movements resulting from long-standing behavioral or functional habits. It is somehow similar to the previous types of constipation and is often classified under functional constipation, meaning it occurs without an identifiable organic, structural, or metabolic cause.
Habitual constipation typically reflects a disruption in the typical defecation routine, often established over time due to poor bowel habits, psychological factors, or lifestyle influences. According to a medical study about the etiology and management of habitual constipation, “several factors of modern civilization favor habitual constipation, e.g. nutrition devoided of poorly digestible ingredients, and lack of physical exercise.” (PubMed. Gastroenterology. 2000. PMID: 839950. F H Franken, Germany).
This form of constipation is particularly common in industrialized societies, where a sedentary lifestyle, low dietary fiber intake, and voluntary suppression of the defecation urge contribute to its development. Although not life-threatening, habitual constipation can significantly impact quality of life and may lead to complications such as hemorrhoids, anal fissures, and fecal impaction if left untreated.
Patients with habitual constipation often present with the following features:
- Decreased stool frequency (typically fewer than three bowel movements per week).
- Hard or lumpy stools (classified as type 1 or 2 on the Bristol Stool Form Scale).
- Straining during defecation.
- Sensation of incomplete evacuation.
- Use of manual maneuvers to facilitate defecation.
According to the Rome IV criteria for functional constipation, these symptoms must be present for at least three months, with onset at least six months before diagnosis
Habitual constipation can be subclassified based on the underlying physiological dysfunction:
a) Normal Transit Constipation
In the most prevalent subtype, normal transit constipation (NTC), colonic transit occurs within standard physiological timeframes, yet patients report persistent symptoms of constipation. This clinical paradox often involves an overlap with irritable bowel syndrome, as patients frequently experience abdominal bloating and discomfort despite the normal movement of stool through the colon.
b) Slow Transit Constipation
Characterized by delayed movement of feces through the colon due to dysmotility (abnormal muscle contractions). It may result from reduced colonic nerve function and is more prevalent in young women.
c) Dyssynergic Defecation
A defecation disorder involving incoordination of the pelvic floor muscles and anal sphincter during attempted bowel movement. This thing leads to ineffective rectal emptying despite the presence of stool.
Habitual constipation represents a significant subset of functional gastrointestinal disorders. A detailed clinical evaluation is essential to differentiate among its subtypes and exclude secondary causes. Management of habitual constipation focuses on diet changes, regular bowel routines, behavioral therapy, and, when needed, medication. Early intervention not only relieves symptoms but also prevents chronic complications and enhances gastrointestinal health.
6. Occasional Constipation
Occasional constipation refers to a temporary disruption in normal bowel habits, typically characterized by infrequent, hard, or difficult-to-pass stools. Unlike chronic or functional constipation, which persists for weeks or months, occasional constipation is transientand normally resolves on its own or with minimal intervention. It does not meet the diagnostic criteria for chronic constipation (e.g., Rome IV criteria), as it lacks the prolonged duration and recurrent pattern associated with more persistent forms.
This type of constipation is common in the general population and may affect individuals of all ages. Modifiable lifestyle or environmental factors trigger this symptom. Also, health professionals do not associate this symptom with underlying structural, metabolic, or neurological disorders.
The hallmark features of occasional constipation may include:
- Mild straining during defecation.
- Passage of dry, hard, or lumpy stools.
- Temporary sensation of incomplete evacuation.
- Abdominal discomfort or bloating (in some cases).
- Reduced stool frequency (typically fewer than three bowel movements per week for a short duration).
These symptoms are usually mild and short-lived, resolving once the underlying trigger is removed or corrected.
Health professionals often link occasional constipation to one or more of the following contributing factors:
- Sudden reduction in dietary fiber intake or inadequate fluid consumption (dietary changes).
- Changes in daily schedule, time zone, or bathroom access (common during travel).
- Temporary physical inactivity, such as during illness or recovery from surgery (sedentary lifestyle).
- Acute emotional stress or anxiety may affect gut motility (psychological stress).
- Short-term use of constipating medications, such as certain painkillers (e.g., opioids), iron supplements, or antacids containing aluminum or calcium (temporary medication use).
While no formal medical subtypes exist for occasional constipation, you can categorize it by its underlying causes:
- Diet-related Occasional Constipation
- Travel-associated Constipation
- Medication-induced Temporary Constipation
- Stress-related Constipation
An evidence-based review on Functional Disorders published by the Clinical Gastroenterology and Hepatology Journal (AGA) defines occasional constipation as bothersome symptoms that occur irregularly and without warning signs of a serious condition. Symptoms occur frequently enough that the person eventually seeks medical advice. (Functional Disorders. Volume 22. Issue 2p397-412. February 2024. Darren M. Brenner, Maura Corsetti, Douglas Drossman, Jan Tack, Arnold Wald.)
Occasional constipation is a common and generally benign condition that reflects a temporary disturbance in bowel function. While it does not require extensive medical evaluation, preventive measures (such as maintaining adequate hydration, consuming fiber-rich foods, and engaging in regular physical activity) are effective in minimizing its occurrence. If symptoms persist or become recurrent, further assessment may be necessary to rule out chronic or secondary forms of constipation.
7. Opioid-Induced Constipation
Opioid-induced constipation (OIC) is a prevalent and clinically distinct form of bowel dysfunction affecting adults treated with opioid analgesics for acute, chronic, or palliative pain. It represents an essential consideration within the broader spectrum of constipation, as it is driven by medication-related mechanisms rather than primary gastrointestinal disease or lifestyle factors.
The pathophysiology of OIC is primarily mediated through the activation of μ-opioid receptors located throughout the gastrointestinal tract, particularly within the enteric nervous system.
Binding of opioids to these receptors:
- Inhibits excitatory neurotransmitter release.
- suppresses coordinated peristaltic activity.
- Increases segmental non-propulsive contractions.
- Prolongs intestinal transit time.
In clinical practice, adults with opioid-induced constipation typically experience a persistent reduction in bowel movement frequency accompanied by qualitative changes in defecation. Patients often report hard or lumpy stools, excessive straining, a sensation of anorectal blockage, and incomplete evacuation.
Abdominal bloating, discomfort, and cramping are common, and symptoms may appear shortly after initiation of opioid therapy or following dose escalation. Unlike functional constipation, OIC is unique and notable for its poor response to dietary fiber supplementation alone, as bulk-forming strategies may exacerbate bloating when motility is pharmacologically suppressed. Importantly, patients rarely develop tolerance to the gastrointestinal effects of opioids, meaning symptoms frequently persist for as long as opioid exposure continues.
Clinically recognized subtypes or patterns of opioid-induced constipation may include:
- Acute OIC associated with short-term opioid use following surgery or injury.
- Chronic OIC in patients receiving long-term opioid therapy for non-cancer pain.
- Refractory OIC that persists despite standard laxative therapy.
- OIC with predominant anorectal dysfunction, characterized by impaired rectal sensation and outlet obstruction.
These patterns highlight the heterogeneity of opioid-induced constipation and underscore the importance of individualized assessment that accounts for symptom profile, opioid exposure, and patient-specific risk factors.
Health experts from the MDPI – Publisher of Open Access Journals (A Practical Narrative Review on the Role of Magnesium in Cancer Therapy) describe constipation as “a frequent gastrointestinal side effect of opioid treatment with a prevalence of up to 59%, usually managed with osmotic agents, stimulant laxatives, peripherally acting µ-opioid receptor antagonists, or naloxone.”
In real-world settings, this type of constipation (OIC) can substantially impair daily functioning and quality of life. Patients may limit social activities, experience sleep disturbances, and develop anxiety related to bowel habits. In severe cases, complications such as fecal impaction, hemorrhoids, anal fissures, or rectal bleeding may occur. Older adults and individuals with limited mobility are particularly vulnerable, as are patients receiving high-dose or long-acting opioid formulations. Concomitant use of other constipating medications and inadequate hydration further amplifies symptom burden.
Last medically reviewed on December 23, 2025