Constipation

by Rosalyn Carson-DeWitt, MD

Definition

Constipation is infrequent and/or uncomfortable bowel movements. Bowel movements (stools) are often hard and dry. This is a common gastrointestinal complaint.

Causes    TOP

Constipation has many causes, including:

  • Not enough fluid intake
  • Overuse of laxative medications
  • Too little exercise
  • Lengthy bed rest
  • Certain medications, including:
    • Pain relievers
    • Opioids
    • Aluminum-containing antacids
    • Antidepressant and antipsychotic medications
    • Medications for epilepsy and Parkinson's disease
    • Antispasmodic medications
    • Iron supplements
    • Calcium channel blockers
  • Frequently delaying the need to have a bowel movement
  • Pregnancy
  • Diabetes
  • Spasm of the anal sphincter; due to painful anal fissures or hemorrhoids
  • Underactive thyroid
  • Irritable bowel syndrome —periods of constipation may alternate with episodes of diarrhea
  • Neurological diseases such as:
  • Intestinal disorders, including:
    • Scarring
    • Tumors
    • Cancer
    • Inflammation
  • Travel due to schedule changes, stress, and poor diet

Risk Factors    TOP

Constipation is more common in older adults.

Risk factors include:

  • Sedentary lifestyle
  • Prolonged bed rest due to surgery or an accident
  • Diet that is high in fat and sugar and low in fiber

Symptoms    TOP

Symptoms include:

  • Abdominal pain
  • Sensation of abdominal fullness
  • Rectal pain and pressure
  • Difficulty passing stool, despite straining
  • Hard, dry, small stool
  • Feeling of incomplete emptying after a bowel movement

When Should I Call My Doctor?

Call your doctor if you:

  • Have constipation that lasts longer than 2-3 weeks
  • Have a painful or swollen abdomen
  • Have nausea or vomiting
  • Have signs of an infection, such as fever or chills
  • Have pain or burning in the anal area with or without a bowel movement
  • Have blood in your stool or black stool
  • Think that your prescription medication is causing constipation
  • Are losing weight

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. It may include a digital rectal exam of the rectum with the doctor's gloved, lubricated finger inserted into your rectum.

Your bodily fluids may be tested. This can be done with blood tests.

Your bodily structures may need to be viewed. This can be done with:

Barium Enema

Radiology colon
Copyright © Nucleus Medical Media, Inc.

Treatment    TOP

Treatment may include:

Understanding Normal Bowel Movements

Talk to your doctor about what is a normal frequency of bowel movements for you. The range of normal is quite broad. Some people have several per day, while others may have very few over a period of days

Making Lifestyle Changes

  • Eat a healthy, balanced diet that is high in fiber and includes foods such as unprocessed bran, whole-wheat grains, fresh fruit, and cereals. Eating prunes may also improve bowel movements.
  • Limit your intake of processed and fatty foods.
  • Exercise regularly.
  • Drink plenty of water each day.

Taking Laxatives, Stool Softeners, or Glycerin Suppositories    TOP

Regularly using laxatives or enemas can be habit forming. Your bowels can become used to these products and require them to produce a stool. Stool softeners, though, are not habit-forming. Ask your doctor about how often and for how long to use these products.

Examples of medications include:

  • Polyethylene glycol 3350
  • Psyllium
  • Docusate
  • Lactulose
  • Lubiprostone
  • Botulism injections

Retraining Your Bowels    TOP

Set aside the same time each day to move your bowels. Typically, this works best first thing in the morning. Sit on the toilet for 15-20 minutes. Over time, your body will learn to have regular bowel movements at the same time each day.

Using Biofeedback    TOP

Biofeedback may be effective in certain conditions. By working with a therapist, you learn how to control certain muscles that can help you to move your bowels.

Treating Underlying Conditions    TOP

Work with your doctor to treat other conditions that may be causing your constipation.

Changing Medications    TOP

If you are taking medication that causes constipation, talk to your doctor to find out if you can take a different medication.

If you are taking opioids to relieve pain, you may have constipation. A medication called methylnaltrexone may help to reduce this side effect.

Having Surgery    TOP

If you have severe, chronic constipation, your doctor may recommend surgery.

Prevention    TOP

To reduce your chance of getting constipation:

  • Eat a healthy, balanced diet that is high in fiber.
  • Exercise regularly.
  • Drink plenty of water every day.
  • In an effort to train your bowels, schedule a time daily to sit on the toilet just after a meal.
  • Do not rush yourself when using the bathroom.
  • If you feel the urge to move your bowels, do not ignore this feeling. Go to the bathroom right away.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca
Healthy U
http://www.healthyalberta.com

References:

Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358(22):2344-2354.
Constipation. National Digestive Diseases Information Clearinghouse website. Available at:
...(Click grey area to select URL)
Accessed November 28, 2017.
Constipation 107: Managing chronic constipation. American Gastroenterological Association website. Available at:
...(Click grey area to select URL)
Accessed November 28, 2017.
Constipation in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated March 6, 2017. Accessed November 28, 2017.
Constipation in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated August 24, 2017. Accessed November 28, 2017.
6/25/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T526124/Methylnaltrexone : Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358(22):2332-2343.
11/30/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Arebi N, Kalli T, Howson W, Clark S, Norton C. Systematic review of abdominal surgery for chronic idiopathic constipation. Colorectal Dis. 2011;13(12):1335-1343.
6/20/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011;33(7):822-828.
Last reviewed November 2018 by EBSCO Medical Review Board James Cornell, MD
Last Updated: 12/20/2014

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