Constipation is infrequent and/or uncomfortable bowel movements. Stool is often hard and dry. It is the most common gastrointestinal complaint in the United States and accounts for 2 million annual visits to the doctor.
Constipation has many causes, including:
- Not enough fluid intake
- Overuse of laxative medicines
- Too little exercise
- Bed rest
- Certain medications, including:
- Frequently delaying the need to have a bowel movement
- 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:
- ]]>Systemic lupus erythematosus]]>
Intestinal disorders, including:
- Travel, due to schedule changes, stress, and poor diet
A risk factor is something that increases your chance of getting a disease or condition.
- 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
- 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
There are over-the-counter medications to treat constipation called laxatives. However, changes in bowel habits, such as constipation, may indicate a more serious medical condition.
Consult a doctor if you have:
- Abdominal pain
- Black stool
- Distended abdomen
- Consistent and significant change in your bowel habits
- Constipation that lasts longer than three weeks
Tests to rule out other medical conditions include:
- Physical exam
- Digital rectal exam—examination of the rectum with the doctor's gloved, lubricated finger inserted into your rectum
- Blood tests
- Abdominal x-rays
- Barium enema x-ray]]> —enema 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
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 healthful, balanced diet that is high in fiber (unprocessed bran, whole-wheat grains, fresh fruit, and cereals). 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 medications include:
- Polyethylene glycol 3350 (eg, MiraLax)—a type of laxative
- Psyllium (eg, Fiber Eze, Fiberalll, Metamucil)—a bulk laxative
- Docusate (eg, Colace, Surfak)—a stool softener
- Lactulose (eg, Cephulac, Enulose, Generlac, Kristalose)—a type of laxative
- Lubiprostone (eg, Amitra)—a medication that increases fluid in stool
- Tegaserod (eg, Miralax)—a medication that brings fluids to the colon
- Cochicine—medication used to treat gout; sometimes used for constipation
- Botulism injections—may be used to treat certain types of constipation
- Prucalopride (eg, Reslolor)—not currently approved but showing promise in clinical trials
- Cisapride—only available as an investigational drug
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.
Biofeedback]]> works by attaching sensors to the body. A therapist helps you understand your body’s signals and then you use them to help you move your bowels.
Treating Underlying Medical Conditions
Work with your doctor to treat other conditions that may be causing your constipation.
If you're taking medication that causes constipation, ask your doctor for an alternative.
If you are diagnosed with constipation, follow your doctor's instructions .
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.
- Don't rush yourself when using the bathroom.
- If you feel the urge to defecate, listen to your body.
American Gastroenterological Association
National Institute of Diabetes and Digestive and Kidney Diseases
American Gastroenterological Association website. Available at: http://www.gastro.org . Accessed June 25, 2008.
Botox, not just for wrinkles. Johns Hopkins Health Alerts website. Available at: http://www.johnshopkinshealthalerts.com/alerts/digestive_health/JohnsHopkinsHealthAlertsDigestiveDisorders_2898-1.html . Accessed March 31, 2009.
Camilleri M, Kerstens R, Rykx A, and Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med . 2008;358:2344-2354.
Cephulac. Drugs.com website. Available at: http://www.drugs.com/mtm/cephulac.html . Accessed March 31, 2009.
Cisapride. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR600429 . Accessed March 31, 2009.
Constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/ . Accessed March 31, 2009.
Goroll AH, Mulley AG. Primary Care Medicine . 4th ed. Lippincott, Williams, and Wilkins; 2000.
Professional Guide to Diseases , 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
Treatment of constipation. International Foundation for Functional Gastrointestinal Disorders website. Available at: http://www.aboutconstipation.org/site/about-constipation/treatment/ . Accessed March 31, 2009.
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 2003. Accessed June 25, 2008.
*6/25/2008 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343.
Last reviewed April 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.