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Hard Stool

The most common cause of constipation is stool that becomes hard and dry due to slow movement through the colon, or large intestine. The primary job of the colon is to absorb water from stool. When stool moves too slowly, too much water is absorbed, which causes stool to become drier and harder. Hard, dry stool then moves more slowly through the colon, allowing for further fluid removal and exacerbating the problem. Hard stool can be caused by dehydration, changes in diet and activity, and certain medications.

When constipation is caused by hard stool, treatment often starts with dietary changes, such as increasing fluids and fiber, as fiber helps to hold moisture in stool. Natural sources of fiber include vegetables, fruit, whole-grain breads, and high-fiber cereals. Supplemental fiber, such as psyllium, is an insoluble, or non-absorbable, fiber that can be taken as a supplement in a powder or wafer form. Increased fiber works best when consumed with plenty of fluids.

If dietary changes do not resolve hard stool constipation, a provider may suggest stool softeners, and in some cases, laxatives. There are a variety of stool softeners that can be used, including mixable powders and pill forms, and are generally very safe for regular daily use long-term. Laxatives can be safe for long-term use, but it's recommended that they only be used every two to three days if a bowel movement does not occur naturally. Even some of the "natural" laxatives can have permanent effects on the intestines. There are several types of over-the-counter constipation treatments available, including:

  • Bulking agents: Bulking agents, such as psyllium and methylcellulose, help hold water in the stool and add bulk to it, which stimulates the natural contractions of the large intestine. Bulkier stools are softer and easier to pass.
  • Osmotic agents: Osmotic agents consist of salts or sugars that are poorly absorbed. This keeps large amounts of water in the large intestine, which makes stool soft and loose.
  • Stimulant laxatives: Stimulant laxatives directly cause the walls of the large intestine to contract. They can be taken orally or as a suppository.

In cases where stool is impacted, or packed so tightly in the intestine or rectum that it cannot be pushed out, treatment commonly includes a tap water enema. With this kind of enema, water fills the rectum and sigmoid colon through the anus, and when the water is emptied, the impacted stool passes with it. If enemas fail to work, a provider may need to remove the stool manually with a gloved finger. The patient may then be asked to drink a solution containing dissolved salts and polyethylene glycol to cleanse the digestive tract.