Few things are quite as frustrating and uncomfortable as not being able to go—but plenty of people deal with the issue every day. In fact, according to the American Gastroenterological Association, 16 percent of Americans are chronically constipated, meaning they pass fewer than three stools a week.
On top of the stress and discomfort, chronic constipation can cause a good deal of health problems. “Toxins and other metabolites recirculate and can contribute to concerns like hormone imbalance, weight gain, skin breakouts, headaches, fatigue, hemorrhoids, anal fissures, and more,” explains New York City-based naturopathic doctor Serena Goldstein, N.D.
Here are six of the most common culprits behind constipation—and what you can do to get things moving.
1. You Don’t Eat Enough Fiber
For an average 2,000-calorie diet, the American Heart Association recommends you get 25 grams of fiber a day—but most Americans only manage to rack up 15 grams. “Soluble fiber feeds the good bacteria in the gut and allows water to remain in your stool—making it softer and easier to pass—while insoluble fiber helps move things through by adding bulk,” explains Goldstein.
The Solution: Slowly increase your fiber intake by incorporating more plant foods into your diet. “Fiber is found in plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts and seeds, the very foods we encourage to support all aspects of health,” says dietitian Rachel Begun, R.D.N.
Begun recommends eating a wide variety of plant foods to provide your digestive system with different types of fiber. To meet your needs, eat at least two servings of fruits and vegetables with each meal and at least one with each snack. (In other words: Include fruits and veggies every time you eat.)
Incorporating more legumes, nuts, and seeds—which provide both fiber and protein—into your diet can also help you reach your fiber needs, says Begun. Legumes make a great addition to any soup or salad, while nuts and seeds are easy to add to baked goods or grind to make breading for proteins like fish.
If you’re struggling to get in those 25 grams of fiber daily, a fiber supplement can help you up your intake. Most supplements offer about five grams per serving and can easily be mixed into water or added to smoothies.
2. You’re Not Drinking Enough Water
Fiber aside, dehydration is one of the most common causes of constipation out there. “Even if people think they’re getting enough water, urinating, pooping, sweating, and drinking alcohol or anything caffeinated can contribute to dehydration,” says Goldstein. Water keeps stools soft, which makes it easier for them to pass through the colon.
The Solution: Goldstein recommends keeping a glass of eight to 16 ounces of water on your nightstand and drinking it as soon as you wake up in the morning so you start the day with water in your system. If you’re not a huge H20 lover, infuse it with lemon or fruit to up its appeal. Begun also recommends ‘eating your water’ by loading up on fruits and vegetables that have an especially high concentration of it, such as lettuce, tomatoes, cucumbers, citrus, and melon.
In combination with a high-fiber diet, drinking more water has been shown to boost regularity—so these two tips couldn’t be more important.
3. You’re On Certain Medications
Some prescription drugs, such as narcotics, tricyclic antidepressants, anti-cholinergics, can cause constipation, says board-certified gastroenterologist Samantha Nazareth, M.D.
The Solution: Regular exercise and a fiber-filled diet may help those on certain medications ‘go’ more regularly, but if constipation is a regular issue, Nazareth recommends reviewing your treatment plan with your physician.
4. You Take Calcium Or Iron Supplements
In addition to medications, if your supplement regimen includes and iron and/or calcium supplement, you may also find yourself struggling more than usual on the toilet. Iron can pull water out of the large intestine and cause discomfort and constipation, while calcium (which helps muscles—including those along your digestive tract—contract) can contribute to constipation if taken without magnesium (which helps muscles relax).
The Solution: Get as much of your daily calcium and iron needs through food as possible, recommends Goldstein. For calcium, think quality dairy, greens in the cabbage family (like kale and mustard greens), or tofu. For iron, go for meat and dark leafy greens.
A tip when supplementing: “Gradually work your way up to the recommended dosage, split up your dose throughout the course of the day, and drink lots of water,” says Goldstein.
5. You’re Stressed Out
Research has linked mood and anxiety disorders with constipation, but even just being plain stressed out can contribute to the issue. “Stress puts your system into ‘fight-or-flight’ mode—meaning it thinks there’s a crazy tiger about to eat you—in which the sympathetic nervous system becomes activated,” explains Nazareth. When the sympathetic nervous system is ‘turned on,’ digestion becomes less of a priority, and you may experience constipation.
The Solution: Consider trying yoga, meditation, and/or regular exercise to help you manage stress, advises Nazareth. Yoga specifically may address the culprit behind stress-induced constipation: Research has shown that by activating the parasympathetic nervous system, it produces a physiological state opposite to that of the flight-or-fight stress response.
6. Your Hormones Are Out-Of-Whack
If your thyroid, the butterfly-shaped gland in your neck that produces metabolism-regulating hormones, is sluggish (a condition called hypothyroidism), you’re likely to deal with some constipation, says Nazareth. That’s because low stores of thyroid hormones slow movement of the intestines.
Related: Could You Have A Thyroid Issue?
Fluctuations of the hormones that are involved in premenstrual syndrome (PMS), like progesterone, can also have the same effect.
The Solution: If constipation is a persistent issue, check in with your doctor about having your thyroid function checked.