Hard Stool: Causes, Home Remedies, and Warning Signs

What is hard stool?

Usually, stool has a soft consistency, and going to the toilet isn’t a problem. Hard stool, however, is dryer and consists of small lumps. Passing hard stool typically takes longer and requires straining.

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What is constipation?

Sometimes, hard stool and constipation are used synonymously. Constipation can be short-term (acute) or long-term (chronic). Technically, the definition of constipation is having less than three bowel movements per week without medication. There are also subjective and objective criteria.

In order to be considered functional constipation, at least two of the following should occur in more than 25% of bowel movements for at least three months:

• Straining
• Hard stool
• Feeling of incomplete defecation
• Sensation of a blockage at the rectum or at the last part of the large intestine
• Using fingers to aid bowel movements

Two additional criteria must also be met:

• Without laxatives, stool is rarely loose
• Insufficient symptoms or criteria to diagnose irritable bowel syndrome (IBS)

Other symptoms, like abdominal pain or bloating, can accompany constipation but are not the main complaints.

What causes hard stool?

People who do not consume enough water or fiber tend to have hard stool, which can be a sign of bowel disease. When stool passes through the intestine and the body urgently needs fluid, too much water is withdrawn and causes hard stool, among other things. In most cases, a lack of fluid is caused by dehydration; other causes include diarrhea, fever, excessive sweating, and increased urination.

Slow, decreased movements of the intestine is another reason for hard stool. Sitting too much and having little physical activity also affect the gut. After the urge to go to the toilet, a bowel movement is often not immediately possible. Then, the stool becomes harder, or constipation occurs more often.

How does diet affect stool consistency?

Eating dietary fiber can stimulate intestinal activity (motility) and prevent hard stool. Fiber absorbs water to soften stool and is not absorbed into the bloodstream. Dietary fiber intake significantly increases the amount of stool, which also increases the wave-like muscle movement of the intestine (peristalsis). This results in faster bowel movements because the stretching of the intestinal wall stimulates peristalsis.

Eating more fiber-rich fruits and vegetables and drinking more water may improve symptoms. However, some studies suggest that fiber only has an impact on stool frequency and not on stool consistency. Some studies even suggest that a low-fiber diet reduces constipation. Evidence on this topic remains inconsistent, but some studies' results may be a result of poor study design.

Hard stool in children

For children, hard stool is a common cause of abdominal pain, and it can lead to a vicious cycle with constipation. Straining can be painful and may tear the skin of the anal region (anal fissures). Because of this, children can be afraid of painful bowel movements and hold back stool, causing constipation.

Children may cross the legs, twist the body, clench the buttocks, or grimace to try to avoid it. The rectum can also contain extremely hard stool (scybala, fecaliths, or stone-like stools), which may need to be broken up or removed with a finger. Generally, hard stool and constipation are temporary and not serious. However, they can lead to complications or be signs of an underlying condition.

When to see a healthcare provider

Changes in bowel movements can occur for various reasons, such as diet, and are normally harmless. However, your digestion should not affect your quality of life. Consulting a healthcare provider is sensible, especially if hard stool occurs for a few weeks. Further examination, such as an ultrasound or a colonoscopy, may be necessary.

Those over age 50 should generally take changes and abnormal bowel habits more seriously, as the risk of bowel cancer (colon or colorectal cancers) increases with age. Bloody stool is a cardinal warning sign, as well as fever, night sweats, and weight loss.

Diseases and medications that may cause hard stool

Typically, hard stool is a sign of poor nutrition, inadequate fluid intake, or lack of exercise. However, there are also diseases that can lead to constipation and changes in bowel movements.

Hard stool due to an underactive thyroid (hypothyroidism)

Hypothyroidism is a common trigger for hard stool. Other symptoms include hair and skin problems, increased cold sensitivity, tiredness, weight gain, and depressive mood.

Hard stool due to medication and electrolyte disturbances

Some medications, especially opioids, can decrease intestinal motility, thicken the stool, or increase the muscular tone of the anus. Disorders involving the essential minerals of the blood (electrolytes) can also hinder intestinal movement. For example, potassium deficiency (hypokalemia) slows down the movement of food. When using laxatives long term, there is an increasing loss of electrolytes.

Hard stool due to bowel diseases

Many bowel diseases can cause hard stool; this even applies to bowel diseases that likely cause diarrhea. These include, among others, inflammatory bowel diseases (IBD), like Crohn's disease and ulcerative colitis, and diverticulitis. Diverticulitis describes an inflammation of the small bulges in the wall of the large intestine (colon). With severe inflammation, hard stool may contain blood.

The narrowing of the intestine can also cause hard stools. This includes, for example, the formation of fibrous bands between organs after an operation (adhesions), small growths or cells clumps on the intestinal inner lining (polyps), bulges in the belly (abdominal wall hernias), or tumors.

Colon or colorectal cancers, among other things, present changes in bowel habits, like diarrhea or constipation, or narrow stool, especially if it is pencil-thin. Painful bowel movements, constipation, and hard stool can also be caused by diseases of the rectum or anal region. In particular, anal fissures or piles (hemorrhoids) can lead to discomfort and blood in the stool.

Hard stool due to nervous system diseases

In rare cases, hard stool is caused by nervous system impairment (neurogenic disorders). In Parkinson's disease, multiple sclerosis, or diabetic neuropathy, the signals from the intestine are no longer properly transmitted, causing disorders of intestinal motility.

Hard stool with irritable bowel syndrome (IBS)

If no physical or structural cause is found, yet the definition criteria above are not fulfilled, it may be a case of irritable bowel syndrome (IBS). Those with IBS may have diarrhea and/or constipation, leading to different IBS subtypes. Studies show that those affected most have diarrhea, whereas others describe an equal distribution of diarrhea and constipation. Frequently, abdominal pain, nausea, feeling full, and bloating also occur. In many cases, symptoms change after passing bowel movements.

Causes leading to IBS are still not fully understood. Symptoms are sometimes preceded by a gastrointestinal infection. Therefore, doctors suspect IBS to be connected to bacterial overgrowth, mild intestinal inflammation, or the increased perception of or sensitivity to pain. Symptoms often improve when the affected person avoids stress and gets adequate sleep. The first step in treatment is to change lifestyle and eating habits.

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What are the effects of hard stool?

Hard stool may be a sign of a more serious illness. On the other hand, if you have hard stool for a long time, it can lead to new diseases. It is assumed that increased pressure in the colon, caused by straining during defecation, promotes some diseases. For example, diverticular disease occurs more frequently with constipation because pressure tends to cause intestinal bulges. Hemorrhoids and anal fissures are also more common with hard stool.

Are there home remedies for hard stool?

1. Physical activity

Regular physical activity can stimulate intestinal motility. A study in older people demonstrated that long-term physical activity led to decreased stool frequency and increased flatulence. Generally, good muscle tone is crucial for defecation. If belly muscles or the diaphragm—the muscular separation between the chest and the abdomen—are weak, passing bowel movements will be harder. The urge to defecate should also not be ignored. Instead, go to the toilet early.

2. Adequate hydration

Hard stool can often be softened by drinking enough water. Every day, consume at least one and a half to two liters of water.

3. Dietary fiber

Generally, a daily fiber intake of 14g/1000 kcal is recommended. If following general energy guidelines, this equals 28g/day for women and 36g/day for men. However, most people only consume an average of half of this amount per day. With a high-fiber diet, it is especially important to drink enough water. Fiber should be taken with normal food and can be obtained from high-fiber foods, such as whole-grains (especially rye), vegetables, and fruit.

If this is not enough, you can get more fiber from psyllium husks, bran, flaxseeds, or chia seeds. Pay attention to the package information and your doctor's recommendations. Because these foods bind a lot of water in the intestine, fluid intake must be adjusted accordingly. Also, be aware if you have allergies to these ingredients.

Can medications help with hard stool?

There are certain medications that soften stool, such as lactulose or macrogol (polyethylene glycol (PEG)). They bind water in the intestine and soften stool. Other drugs work by accelerating bowel movements or increasing the amount of fluid in the intestine.

Important

Your body can get used to laxatives (habituation). Once this happens, the stool only becomes sufficiently soft if that laxative is taken. Because continual use of laxatives can lead to water and electrolyte imbalances, they should only be taken with medical supervision.

Heavily thickened stool may need to be removed with your fingers. The main strategies to remove stool include softening, lubricating, or breaking it down. Fatty enemas, suppositories, and osmotic laxatives can also be used to increase the amount of water in the intestine; this can make defecation less painful. Exercise caution with these methods.