Chronic constipation can be an uncomfortable, and even debilitating, problem. Now a large study confirms that a few healthy lifestyle measures may help keep things moving smoothly as you age.

The study, published in the American Journal of Gastroenterology in September, tackled the topic of functional constipation—constipation that’s chronic but not caused by any known underlying health condition. It’s estimated that about 8 percent of adults have functional constipation, with women being affected about twice as often as men.

In general, constipation is defined as having fewer than three bowel movements per week, passing hard stools, needing to strain, or feeling like you’re not “empty” after bowel movements. Experts have long offered advice on preventing constipation (eat enough fiber, drink enough water, be physically active), but it has not been clear how effective those habits are in combination—until now.

In the study, middle-aged and older adults who maintained at least three of five specific lifestyle habits were 40 percent less likely to develop constipation over the next dozen years, versus their peers who eschewed those habits entirely.

The five secrets to staying regular? Vigorous exercise, a healthy diet, adequate sleep, never smoking, and limiting alcohol.

The more, the better

The findings are based on over 100,000 adults ages 40 to 70 who are part of the UK Biobank study, an ongoing research project collecting health and lifestyle information on about half a million volunteers. At the outset, none of the participants had functional constipation, but over the next 12 years, just over 3 percent were newly diagnosed with it, based on medical records (not self-report).

Researchers looked at whether the five lifestyle habits, alone or in combination, were linked to the odds of developing functional constipation. Overall, they found, maintaining one healthy habit was good, but the more, the better: Compared with participants who followed none of the five at the study’s start, those who maintained one were 19 percent less likely to develop constipation, while those who followed two had a 28 percent lower risk, and those who maintained three to five had a 40 percent lower risk.

Certain habits seemed more powerful than others. Three of them—exercise, optimal sleep, and never smoking—were tied to a lower risk of developing functional constipation even on their own. But healthy eating and limiting alcohol intake only seemed to modify the risk when they were combined with other lifestyle measures.

More on the big five

1. Exercise. The study specifically looked at the relationship between high levels of vigorous exercise and constipation risk. Vigorous means activities that get you breathing hard, like jogging, swimming laps, or fast-paced bicycling. “High level” was not clearly defined, however; it included study participants who fell into the top 50 percent for vigorous exercise frequency. It was relative, in other words. (To support overall health, experts generally advise adults to aim for at least 150 minutes of moderate exercise like brisk walking, or 75 minutes of vigorous exercise, each week.)

Exercise may help keep you “regular” by getting the muscles of your digestive tract moving or by promoting a healthier balance of gut bacteria. And based on some past research, vigorous exercise may not be necessary to achieve that: Greater amounts of exercise (more than 150 minutes per week) have also been tied to a lower risk of developing constipation. So if running, fast biking, or swimming laps aren’t the right activities for you, choose less-intense forms of exercise that you can perform more often or for longer duration.

2. Optimal sleep. This was defined as getting seven to nine hours of shuteye each night, finding it easy to get up in the morning, and rarely suffering from insomnia. Past studies have linked chronically poor sleep to a heightened risk of constipation, for reasons that aren’t completely clear. Researchers speculate that because insufficient sleep can affect nervous system activity, that might ultimately affect bowel function, too.
3. Healthy diet. This study used the DASH diet as its model: Participants who scored in the top 25 percent for adherence to DASH were considered to have healthful eating habits. The diet, which was developed to help people manage high blood pressure, is also loaded with the types of fiber- and nutrient-rich foods that can help with constipation: vegetables and fruits, beans and other legumes, and whole grains, for example. (Another new study, published in Gastroenterology in December, found that the Mediterranean diet lowered the risk of functional constipation, while a Western diet increased the risk; the authors noted that the improvement from the Mediterranean diet was more likely due to changes in the gut microbiome than to an increase in fiber.)
4. Never smoking. It’s clear that smoking is bad for you. But why tobacco would affect constipation risk is more complicated. Some research suggests that smoking tends to slow the digestive process, which could mean going to the bathroom less often. Interestingly, though, one large study found that even former smokers were at heightened risk of functional constipation, versus lifelong nonsmokers. (Still, stopping smoking at any stage in life is a good move for your health—and if you currently smoke, there are many other good reasons to quit.)
5. Alcohol only in moderation. In this study, moderate drinking was defined as averaging no more than one alcoholic drink per day. Research suggests that heavier drinking can contribute to constipation, possibly by affecting gut motility (the muscle contractions that move food along), interfering with the absorption of water in the digestive tract, or disrupting the normal balance of gut bacteria.

The takeaway: The study had a number of limitations, including relying on participants’ self-reported lifestyle habits. It also defined “healthy” exercise and diet in fairly narrow ways. Most importantly, the study cannot prove that any of the five lifestyle habits prevent constipation. It can only show a correlation between those habits (especially in combination) and lower constipation risk.

At the same time, the findings align with long-standing advice on supporting overall health, which includes good digestion. Keep moving, eat your fruits and vegetables, get enough sleep, don’t smoke, and if you drink, do so only in moderation.

A final word: True functional constipation can usually be managed with lifestyle measures like diet changes and exercise, and possibly over-the-counter laxatives or stool softeners. But constipation can sometimes be a symptom of a serious underlying condition, such as colorectal cancer. See your doctor if your symptoms last longer than three weeks despite DIY measures; if you see blood in the toilet or on toilet paper, or your stool looks black (often a sign of bleeding); if you have significant abdominal pain during bowel movements; or if you have additional symptoms, such as weight loss.