If you're going less often than you used to, straining more, or never quite feel finished, you're dealing with constipation, even if you wouldn't call it that. It often travels with bloating, too, which is one more reason to take it seriously.
The good news is that the first steps are simple and well studied. Here's a plan to work through in order, one change at a time.
Why it can creep in during midlife
Constipation isn't only a hormone issue, but age and sex seem to matter. In a UCLA study of people with irritable bowel syndrome, 52 postmenopausal women had more severe symptoms than 190 premenopausal women, while men showed no comparable change with age. Constipation became more common with age in both sexes, but it was the main pattern only in women (Lenhart et al., 2020).
Add less movement, more sitting, busier days and new medications or supplements, and it's easy to see how things slow down in your forties and fifties.
The plan, step by step
Step 1: Get a one-week baseline
Before changing anything, write down for seven days:
- How many bowel movements you have
- Whether stools are hard and lumpy, or soft and formed
- How much you strain, from 0 to 10
- Your afternoon bloating, from 0 to 10
This gives you something concrete to compare against in a month, and useful notes if you end up talking to a doctor.
Step 2: Add fiber slowly, and give it four weeks
A 2022 meta-analysis pooled 16 randomized trials with 1,251 adults with chronic constipation. Overall, 66% of people responded to fiber supplements compared with 41% on control treatments. Psyllium and pectin had the clearest effects, and results were better at doses above 10 grams a day and after at least four weeks (van der Schoot et al., 2022).
There was a trade-off: flatulence was more common with fiber. So increase gradually, over one to two weeks, and pay attention to the type. If your gut bloats easily, fast-fermenting fibers can backfire. Here's why inulin is a common culprit.
Step 3: Try kiwifruit or prunes
Food can work, too. In a University of Michigan trial, 79 US adults with chronic constipation (87% of them women, average age 42.7) ate two green kiwifruit a day, 100 grams of prunes a day, or took 12 grams of psyllium for four weeks. All three increased complete bowel movements. Kiwifruit also improved bloating scores, caused the fewest side effects and left the fewest people dissatisfied (Chey et al., 2021).
Two kiwis with breakfast is an easy, low-cost place to start.
Step 4: Drink enough to match your fiber
Fiber works by holding water in the stool, so fluids matter. In a two-month trial, 117 adults aged 18 to 50 with functional constipation all ate about 25 grams of fiber a day. The group asked to drink 2 liters of mineral water daily had a bigger increase in bowel movements and used fewer laxatives than the group that drank as usual (Anti et al., 1998).
You don't need to force it. Keeping a water bottle in sight and adding a glass with each meal covers most of the gap for many people.
Step 5: Give your body a regular, unhurried window
Pick a consistent time, such as after breakfast or your morning coffee, when you can sit without rushing. Keep your phone out of reach so you're not lingering and straining. If you feel an urge during the day, go when you can instead of putting it off for hours.
Step 6: If you're still stuck, ask about medication
If four to six weeks of these changes don't help, it's reasonable to talk to your doctor or pharmacist. A joint guideline from the American Gastroenterological Association and the American College of Gastroenterology made strong recommendations for several options, including polyethylene glycol, a common over-the-counter laxative. It gave conditional recommendations for fiber, senna, lactulose and magnesium oxide (Chang et al., 2023).
Using a laxative that's appropriate for you isn't a failure. It's one of the tools the evidence supports.
