Etiology of constipation

 

Ref

Ann Med. 2026 Jun 19;58(1):2684172. doi: 10.1080/07853890.2026.2684172

Constipation with bloating: a clinical approach to evaluation and management

David J Cangemi a,✉, Adam P Laitman b, Orit Faiman b, Bianca W Chang 

Etiology of constipation with bloating symptoms

Several GI disorders should be considered in an adult experiencing constipation with bloating, including CIC, IBS (predominant constipation [IBS-C] or mixed type [IBS-M]), pelvic floor dysfunction (PFD; e.g. dyssynergic defecation and structural pelvic floor abnormalities), and intestinal microbial overgrowth, specifically intestinal methanogen overgrowth (IMO). Additionally, though bloating can occur in the setting of impaired GI motility, motility disorders, such as gastroparesis and chronic intestinal pseudo-obstruction, are relatively uncommon (Figure 1) [6,18–30].

 Non-GI, secondary causes of constipation should also be considered [20].

 Constipation may be secondary to or exacerbated by metabolic disorders (e.g. diabetic neuropathy and hypothyroidism), electrolyte imbalances/abnormalities (e.g. hypercalcemia, hypokalemia, and hypomagnesemia), endometriosis, and neurologic disorders (e.g. Parkinson’s disease and small fiber neuropathy), among other causes [20,26–29,31].

 Inquiry about prescription and over-the-counter (OTC) product use is important because many commonly administered medications, such as anticholinergics, calcium-containing antacids, opioid analgesics, and dietary supplements (e.g. iron, calcium) may cause constipation [20]. 

This article focuses on potential GI-related causes; readers seeking additional information on secondary etiologies should consider reviewing these cited references [32–34].

 Celiac disease (i.e. autoimmunity characterized by abnormal reaction to gluten in genetically susceptible individuals), nonceliac gluten sensitivity (i.e. reaction to gluten that is not mediated by allergy or autoimmunity), and food intolerance are potential underlying contributors to bloating; however, these conditions more commonly present with diarrhea than constipation [19,35].