SARS-CoV-2, the virus responsible for COVID-19, primarily causes respiratory illness but affects multiple body systems. Many people experience symptoms beyond the typical cough and fever, including neurological, cardiovascular, and gastrointestinal issues. Digestive problems are a common complaint during and after infection, prompting questions about specific bowel changes. Understanding the connection between the virus and the gut is important for recognizing the full scope of the disease.
Yes, It Is a Reported Symptom
Constipation is a documented symptom associated with acute COVID-19 infection, though it is often less frequently reported than other digestive complaints like diarrhea or nausea. While not listed among the most common symptoms by public health agencies, clinical studies have confirmed its presence in a segment of patients. Constipation has been reported in patients presenting with COVID-19, sometimes alongside other gastrointestinal symptoms like abdominal pain. The frequency of constipation varies significantly among different patient groups studied during the pandemic. In one study of individuals with COVID-19, approximately 25% reported developing new-onset constipation symptoms during the lockdown period. Constipation also appears as a lingering issue for some individuals experiencing long COVID. In a study of patients with no prior history of digestive issues, constipation was reported by about 6.8% roughly 100 days after their initial infection.
How COVID-19 Affects the Digestive System
The SARS-CoV-2 virus has a direct mechanism for entering cells within the digestive tract, which helps explain its impact on gut function. The virus uses the Angiotensin-Converting Enzyme 2 (ACE2) receptor to gain entry into human cells. This receptor is highly expressed in the epithelial cells lining the gastrointestinal tract, sometimes exceeding the levels found in the respiratory tract.
When the virus binds to these gut receptors, it can disrupt the normal regulatory functions of ACE2, which are connected to nutrient transport and gut permeability. The infection can also trigger a systemic inflammatory response, which affects the entire body, including the digestive system. This inflammation can disrupt gut motility—the normal, rhythmic contractions of the gut muscles that propel waste.
The infection can also impact the enteric nervous system, sometimes called the “second brain,” which controls digestive processes. Damage to the nerve supply that regulates the digestive system can lead to gastrointestinal autonomic dysfunction, further impairing the regular movement of the bowels. Changes in the gut microbiome, the community of bacteria living in the intestines, are also observed in people with COVID-19 and may contribute to digestive symptoms.
Non-Viral Factors That Contribute
Several factors related to being ill with COVID-19, but not directly caused by the virus, can exacerbate or cause constipation. Reduced physical activity is a significant contributor, especially for those experiencing severe fatigue or bed rest during recovery. Immobility slows the movement of waste through the colon, as exercise helps stimulate intestinal muscles.
Decreased fluid intake is also common, particularly when managing fever or a poor appetite. When the body is dehydrated, the colon absorbs more water from the stool, resulting in harder, more difficult-to-pass bowel movements. Dietary changes are frequent during illness, often involving less fiber-rich food like fruits and vegetables, which are essential for adding bulk.
Certain medications used to treat COVID-19 symptoms can also slow digestive function as a side effect. Pain relievers and certain antiviral treatments, for example, can contribute to constipation. Increased stress and anxiety related to the illness can also affect the gut-brain axis, contributing to changes in bowel habits.
Managing Constipation and Seeking Help
Management of constipation associated with COVID-19 focuses on supportive care and addressing the non-viral factors that contribute to the problem. Maintaining proper hydration is a practical first step, as consuming enough water helps keep the stool soft and easier to pass. Incorporating fiber-rich foods back into the diet is beneficial, but this should be done gradually to avoid excessive bloating or discomfort.
Gentle physical activity, such as short walks or light stretching, should be resumed as soon as fatigue allows to help stimulate gut motility. Over-the-counter remedies like fiber supplements or gentle laxatives can be used for temporary relief, but consulting a healthcare provider before starting any new medication is recommended. Establishing a regular time for a bowel movement can also help retrain the body’s natural rhythms.
Seek professional medical attention if constipation persists despite self-care measures or if it is accompanied by other concerning symptoms. These include severe abdominal pain, vomiting, the inability to pass gas, or blood in the stool. Persistent digestive issues that last well after the acute infection has passed should also be discussed with a healthcare professional to manage potential long-term effects.