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Constipation causes and risk factors

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Secondary chronic constipation can be due to various clinical situations, each with specific features and causes:

Diseases associated with chronic constipation 
Digestive disorders   Neoplasms, intestinal stenosis, ischemic colitis, inflammatory bowel disease, post-surgical bridles, idiopathic rectal ulcer, rectal prolapse, anal stenosis, weakness of the pelvic floor.  
Endocrine and metabolic diseases  Diabetes, hypothyroidism, chronic kidney disease, hypercalcemia, hyper or hypomagnesemia, hyperparathyroidism, hypokalemia, dehydration, Addison's disease, pheochromocytoma, porphyria.  
Neurological and systemic diseases

Cerebrovascular disease, autonomic neuropathy, spinal cord injury, Parkinson's disease, multiple sclerosis, myotonic dystrophy, systemic lupus erythematosus, amyloidosis or systemic sclerosis.

It should not be forgotten that the use of certain medications can promote or aggravate chronic constipation. Among the drugs most frequently associated with this are: 

Drugs associated with constipation 
Digestive system  Proton pump inhibitors (omeprazole), antispasmodics/anticholinergics (e.g. scopolamine) or musculotropic drugs (mebeverine, papaverine), antiemetics, antacids (calcium, bismuth or aluminium salts), and oral iron supplements.
Nervous system  Antiepileptics, antiparkinsonian drugs, anxiolytics and hypnotics, antidepressants, antipsychotics and neuroleptics. 
Cardiovascular system  Antihypertensives, diuretics (furosemide), hypolipemics (statins), antiarrhythmics.  
Others  Analgesics (anti-inflammatories, opiates), H1 antihistamines, antitussives (codeine), metal ions (aluminium, bismuth, calcium, iron), cytostatics.  

A group of drugs very frequently associated with constipation are opioids such as morphine, used to treat moderate to severe pain that does not respond to other analgesics. The relationship between opioid use and constipation is common, affecting more than 50% of patients who take them. Currently, a specific condition called opioid-induced chronic constipation is considered, as its treatment has certain specific features.

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Substantiated information by:

Faust Feu Caballé
Francesc Balaguer Prunes
Sabela Carballal Ramil

Published: 21 July 2020
Updated: 24 July 2025

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