Why Won’t My Constipation Get Better? What GI Experts Want You to Know

Why Won’t My Constipation Get Better? What GI Experts Want You to Know

If you’ve tried multiple treatments for chronic constipation and still aren’t finding relief, there may be more to your symptoms than you realize.

If you’re living with chronic constipation, you know how frustrating it can be to try different treatments and still struggle with bloating, abdominal pain, hard stools, or difficulty having bowel movements.

Maybe you’ve increased your fiber intake, tried over-the-counter laxatives, or taken prescription medications. Perhaps your bowel movements have become more regular, but you still don’t feel better.

So why sn’t your constipation improving?

A recent article in the American Journal of Gastroenterology offers important insights into this common challenge.

In “How I Approach Refractory Constipation Symptoms,” Drs. Yuying Luo, Laurie Keefer, and Kyle Staller share practical guidance for gastroenterologists caring for patients whose constipation symptoms persist despite treatment.

Their message highlights something patients should understand: Successfully treating constipation isn’t just about how often you have a bowel movement. It’s also about addressing the symptoms that affect your quality of life.

What Is Refractory Constipation?

Refractory constipation refers to constipation symptoms that remain difficult to manage despite appropriate treatment.

For some people, that means continuing to have infrequent bowel movements or difficulty passing stool. For others, bowel movements may improve, but symptoms such as abdominal pain, bloating, and discomfort persist.

The article emphasizes that these symptoms can have different underlying causes and may require different treatment approaches.

Understanding what’s driving your symptoms is an important step toward finding more effective relief.

1. Constipation Is About More Than Bowel Movement Frequency

When evaluating constipation, healthcare providers often ask how frequently you’re having bowel movements and whether your stools are hard or difficult to pass.

Those details are important, but they don’t always capture the full experience of living with constipation.

For many patients, abdominal pain, bloating, and discomfort are among the most troublesome symptoms.

You might be having more regular bowel movements but still experience significant bloating after meals, abdominal discomfort, or the sensation that you haven’t completely emptied your bowels.

The AJG authors emphasize that identifying the symptoms causing the greatest distress can help guide treatment decisions.

What this means for you: When speaking with your GI provider, don’t focus only on how often you’re going to the bathroom. Explain which symptoms are most disruptive and how they’re affecting your daily activities.

2. There May Be More Than One Reason Your Constipation Isn’t Improving

Chronic constipation isn’t always caused by a single problem.

Several factors can contribute to persistent symptoms, including:

Slow movement of stool through the colon

Sometimes stool moves more slowly than expected through the large intestine, contributing to infrequent bowel movements and hard stools.

Pelvic floor dysfunction

Having a bowel movement requires coordination between the muscles of the abdomen, rectum, and pelvic floor.

If these muscles don’t relax or coordinate properly, passing stool may be difficult even when the stool itself isn’t particularly hard.

Changes in gut-brain interaction

Your digestive tract and brain constantly communicate through a complex network of nerves and signals.

Changes in this communication can contribute to abdominal pain, bloating, and increased sensitivity to normal digestive activity.

Overlapping digestive conditions

Some people with chronic constipation also experience symptoms associated with irritable bowel syndrome with constipation (IBS-C) or other disorders of gut-brain interaction.

The AJG authors explain that these conditions can overlap, making individualized evaluation especially important.

What this means for you: If treatment isn’t helping, ask your healthcare provider whether other factors could be contributing to your symptoms.

3. More Medication Isn’t Always the Answer

When constipation treatment isn’t working, it may seem logical to increase the dose or try another medication.

But the authors emphasize that treatment decisions should be guided by the symptoms and underlying mechanisms involved.

For example, someone whose primary concern is infrequent bowel movements may benefit from a different approach than someone whose biggest problem is persistent abdominal pain or bloating.

Depending on the individual, treatment options may include:

• Adjusting or combining constipation medications.
• Evaluating for pelvic floor dysfunction.
• Pelvic floor physical therapy with biofeedback when appropriate.
• Treatments that address abdominal pain and gut-brain interaction.
• Working with a GI-focused dietitian or other digestive health specialist.

For some patients, additional testing may help identify problems with pelvic floor coordination or other contributors to persistent symptoms.

What this means for you: If you’ve tried several treatments without adequate relief, ask whether your current approach is addressing the symptoms that bother you most.

Don’t change or combine medications without discussing the plan with your healthcare provider.

4. Your Treatment Goals Matter

One of the most patient-centered messages in the AJG article is the importance of understanding what successful treatment means to each individual.

Your healthcare provider may be tracking bowel movement frequency, stool consistency, and other clinical measures.

But your personal goals may look different.

Perhaps you want to:

• Experience fewer days with abdominal pain or bloating.
• Feel more comfortable eating meals.
• Travel without worrying about digestive symptoms.
• Participate in social activities without discomfort.
• Feel more confident and less preoccupied with your bowel habits.

The authors encourage healthcare providers to ask patients what meaningful improvement would look like in their everyday lives.

This helps patients and providers establish realistic treatment goals and evaluate progress together.

What this means for you: Be specific about what you hope to achieve with treatment. Improving your quality of life is an important part of managing chronic constipation.

5. Relief May Take Time—and Your Treatment Plan May Need Adjustments

Not every constipation treatment addresses every symptom at the same rate.

The AJG authors note that improvements in abdominal pain and bloating may take longer than changes in bowel movement frequency, depending on the treatment.

For certain medications, improvement in these symptoms may become noticeable over several weeks.

This is one reason ongoing communication with your healthcare provider matters.

If a treatment is helping some symptoms but not others, that information can help your provider decide whether to continue, adjust, or reconsider your treatment plan.

What this means for you: Keep track of changes in your symptoms, including improvements that may not involve bowel movement frequency. Discuss persistent problems, side effects, and treatment expectations with your healthcare team.

Questions to Ask Your GI Provider When Constipation Treatment Isn’t Working

If you’re still struggling with constipation despite treatment, consider bringing these questions to your next appointment:

1. Could there be more than one reason my constipation symptoms aren’t improving?
2. Should I be evaluated for pelvic floor dysfunction or another underlying problem?
3. Could IBS-C or changes in gut-brain interaction be contributing to my symptoms?
4. Is my current treatment addressing my most bothersome symptoms?
5. What other treatment approaches might be appropriate for me?
6. How should we measure whether my treatment is successful?

You may also find it helpful to keep a brief record of your symptoms before your appointment, including bowel movement frequency, abdominal pain, bloating, and how symptoms affect your daily activities.

The Gastro Girl Takeaway

If you’re still struggling with constipation despite treatment, the answer may not be as simple as having more bowel movements.

Persistent constipation symptoms can involve several overlapping factors, and successful treatment often requires an individualized approach.

The important message from these GI experts is that your symptoms, experiences, and treatment goals matter.

You deserve a care plan that considers not only how your digestive system is functioning, but also how you’re feeling and living.

If your current treatment isn’t providing adequate relief, talk with your GI provider about whether it’s time to take another look at what’s driving your symptoms.  Successful treatment isn’t just about going more often. It’s about feeling better and getting back to living your life.

Luo Y, Keefer L, Staller K. How I Approach Refractory Constipation Symptoms. American Journal of Gastroenterology. 2026;121(10):2357–2360.

Read the original AJG article

Related Resources

Constipation Health Hub

IBS-C Health Hub

Gastro Girl Podcast Constipation – Related Episodes

Gastro Girl Podcast IBS-C Related Episodes

This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your healthcare provider about your symptoms and treatment options.