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Constipation

by Rosalyn Carson-DeWitt, MD

Definition

Constipation is infrequent and/or uncomfortable bowel movements. Stool is often hard and dry. This is a very common gastrointestinal complaint.

Causes

Constipation has many causes, including:

Risk Factors    TOP

Risk factors include:

  • Advancing age
  • 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
  • Black stool
  • "Rabbit pellet" appearance to stool
  • Sensation of retained stool after defecating

When Should I Call My Doctor?

Call your doctor if you:

  • Are constipated and never had this condition before
  • 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 anal area with or without bowel movement
  • Have blood in your stool or black stool
  • Think that your prescription medicine is causing constipation
  • Are losing weight

Diagnosis    TOP

Changes in bowel habits, such as constipation, may indicate a more serious condition. Your doctor may order tests to rule out other conditions. Tests may include:

  • Physical exam
  • Blood tests
  • Digital rectal exam—examination of the rectum with the doctor's gloved, lubricated finger inserted into your rectum
  • Abdominal x-ray—a test that uses radiation to take a picture of structures inside the abdomen
  • Barium enema—injection of fluid into the rectum that makes your colon light up on an x-ray
  • Flexible sigmoidoscopy—a thin, lighted tube with a camera inserted into the rectum to examine the rectum and the lower colon

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 stools a day. Others have one stool every several days.

Making Lifestyle Changes

  • Eat a healthy, balanced diet that is high in fiber (such as unprocessed bran, whole-wheat grains, fresh fruit, and cereals). Eating prunes every day may also improve bowel movements.
  • Limit your intake of processed and fatty foods.
  • Exercise regularly.
  • Drink at least eight, 8-ounce glasses of water each day.

Taking Laxatives, Stool Softeners, or Glycerin Suppositories

Regularly using laxatives or enemas can be habit forming. Your bowels can become accustomed to these products and require them in order 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 medicines include:

  • Polyethylene glycol 3350 (GlycoLax, MiraLax)—a type of laxative
  • Psyllium—a bulk laxative
  • Docusate—a stool softener
  • Lactulose—a type of laxative
  • Lubiprostone (Amitiza)—a medicine that increases fluid in stool
  • Botulism injections—may be used to treat certain types of constipation

Retraining Your Bowels

Set aside the same time each day to move your bowels. Typically, this works best after breakfast and coffee. 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

Biofeedback works by attaching sensors to the body. These sensors give you information about your muscles. By working with a therapist, you learn how to control certain muscles that can help you to move your bowels.

Treating Underlying Conditions

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

Changing Medications

If you are taking medicine that causes constipation, talk to your doctor to find out if you can take another drug.

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

Having Surgery

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

If you are diagnosed with constipation, follow your doctor's instructions.

Prevention    TOP

To reduce your chance of getting constipation:

  • Eat a healthy, balanced diet that is high in fiber.
  • Exercise regularly.
  • Drink at least eight, 8-ounce glasses of water a 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
http://www.hc-sc.gc.ca
Healthy U
http://www.healthyalberta.com

References:

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What I need to know about constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation_ez. Published December 2008. Accessed July 9, 2009.
6/25/2008 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343.
11/30/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Arebi N, Kalli T, Howson W, Clark S, Norton C. Systematic review of abdominal surgery for chronic idiopathic constipation. Colorectal Dis. 2010 Oct 22. [Epub ahead of print]
6/20/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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 October 2012 by Daus Mahnke, MD
Last Updated: 10/31/2012