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Constipation

Definition

Constipation is a problem passing stool. Stool may be too hard or dry to pass. It is a common health problem.

Causes

Causes may be:

  • Not drinking enough fluids
  • Overuse of laxatives
  • Lack of activity
  • Being on bed rest
  • Certain medicines, such as:
    • Pain relievers
    • Opioids
    • Aluminum-containing antacids
    • Antidepressant and antipsychotic medicines
    • Medications for epilepsy and Parkinson disease
    • Antiseizure medicines
    • Iron supplements
    • Calcium channel blockers
  • Frequently delaying the need to pass stool
  • Pregnancy
  • Diabetes
  • Spasm of the anal sphincter due to painful anal fissures or hemorrhoids
  • An underactive thyroid
  • Irritable bowel syndrome
  • Neurological diseases such as:
  • Intestinal disorders, including:
    • Scarring
    • Tumors
    • Cancer
    • Inflammation
  • Travel due to schedule changes, stress, and poor diet

Risk Factors

This problem is more common in older adults.

Other things that may raise the risk are:

  • An inactive lifestyle
  • Lengthy bed rest due to surgery or an accident
  • A diet that is high in fat and sugar and low in fiber

Symptoms

Problems may be:

  • Problems passing stool, despite straining
  • Belly pain
  • A feeling of fullness in the belly
  • Rectal pain and pressure
  • Passing stool that is hard, dry, and small
  • 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 to 3 weeks
  • A painful or swollen belly
  • Nausea or vomiting
  • Signs of an infection, such as fever or chills
  • Pain or burning in the anal area with or without a bowel movement
  • Bloody or black stool
  • Been losing weight

Diagnosis

The doctor will ask about your symptoms and health history. You will also be asked about your bowel movements. A physical exam will be done. The doctor may insert a gloved finger into the rectum to examine it. This is called a digital rectal exam.

Blood tests may be done.

Images may be taken of the colon. This can be done with:

Barium Enema
Radiology colon

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Treatment

Any underlying causes will be treated.

The goal of treatment is to promote bowel movements. Choices are:

  • Dietary changes, such as drinking plenty of water and eating foods that are high in fiber
  • Lifestyle changes, such as exercising regularly
  • Stopping or changing medicines that are causing symptoms
  • Over the counter and prescription medicines to promote bowel movements, such as:
    • Stool softeners
    • Laxatives
    • Glycerine suppositories
  • Retraining the bowels to have regular movements at the same time each day
  • Biofeedback to learn how to control the muscles that are needed to pass stool

People with severe symptoms may need surgery.

Prevention

The risk of this problem can be lowered by:

  • Eating a healthful, balanced diet that is high in fiber
  • Exercising regularly
  • Drinking plenty of water
  • Passing stool as soon as the urge is felt
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

MyHealth.Alberta.ca
https://myhealth.alberta.ca/

REFERENCES:

Camilleri M, Kerstens R, et al. 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: https://www.niddk.nih.gov/health-information/digestive-diseases/constipation. Accessed February 9, 2021.

Constipation in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/constipation-in-adults. Accessed February 9, 2021.

Constipation in children. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/constipation-in-children. Accessed February 9, 2021.

Paquette IM, Varma M, et al. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum. 2016 Jun;59(6):479-492.

Last reviewed December 2020 by EBSCO Medical Review Board James P. Cornell, MD  Last Updated: 2/9/2021