Constipation

Overview

What is constipation?

Constipation is a common digestive problem that makes it difficult for you to have a bowel movement. Having a bowel movement is also called “passing stool.”

As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with digestive tract muscle contractions (squeezing motions). If you are constipated, your bowel movements may be infrequent. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you've had one.

Constipation is not a disease. Most people experience constipation at some point in their lives. Usually, it goes away and is not serious. If you have chronic (frequent) constipation, talk you your doctor. Chronic constipation may be a symptom of a problem with your diet or a health problem.

This content has been supported by Forest Laboratories Inc.

Symptoms

What are the symptoms of constipation?

The symptoms of constipation may include:

Feeling like you still need to have a bowel movement even after you’ve had one
Feeling like your intestines or rectum are blocked
Having hard, dry stool that is difficult to pass
Having fewer than 3 bowel movements in a week
Straining to have a bowel movement

How often should I have a bowel movement?

It’s different for every person. Not everyone has a bowel movement once a day. It's not true that you must have a daily bowel movement to be considered "regular." A normal range is anywhere between 3 times a day to 3 times a week. You may be getting constipated if you start having bowel movements much less often than you usually do, or if your stool becomes hard to pass.

How do I know if my child is constipated?

The symptoms of constipation are the same for children as for adults. For some children, it is normal to pass stools as far apart as every few days. Whether your child is constipated or not depends on how often he or she normally passes stools and how easy this is to do. If your child’s stools are soft and easy to pass, don’t worry about a few days in between. If your child’s stools are hard and difficult to pass, your child is likely constipated.

Do I need to see a doctor?

Probably not. Most cases of constipation are easily treated at home by making some healthy lifestyle changes. However, talk to your family doctor if your symptoms are severe, or if:

Constipation is new and unusual for you
You have constipation for 3 weeks or more despite at-home treatment (such as diet changes)
You have abdominal pain
You lose weight without reason
You notice any blood in your stools

Causes & Risk Factors

What causes constipation?

Usually, constipation occurs when stool passes too slowly through your intestines. This causes the stool to become hard and dry. A number of things can cause your intestines to slow down, including:

Not enough fiber in your diet: The American Dietetic Association recommends that adults eat 20 to 35 grams of fiber each day. Most people get much less than this. See the Treatment section to learn how to get more fiber in your diet.
Not enough liquids in your diet: Liquids add fluid to the intestine and make up part of the stool. If you don’t drink enough liquids, your stool may dry out faster.
Not enough physical activity: Doctors don’t know why, but getting regular exercise seems to help your intestines work properly.
Ignoring the urge to have a bowel movement: If you regularly ignore the urge to have a bowel movement, you may eventually stop feeling the need to have one. This can cause stool to build up in the intestine, making for a larger stool that is harder to pass.
Medicines: Certain medicines may cause constipation. This is very common with opiate pain medication, for example. If you notice that your constipation occurs after taking a new medicine, talk to your doctor. Using laxatives often may also lead to constipation. When you use laxatives often, you can become dependent on them. This means you have to take the laxative in order for your intestines to work like they should.
Life changes or changes in your daily routine: Life events such as pregnancy and aging, and changes in routine, such as travel, may cause constipation.
Intestinal problems: Intestinal problems such as obstruction, tumors, irritable bowel syndrome, or pelvic floor dysfunction, may cause constipation.
Certain diseases: Certain diseases, such as multiple sclerosis, stroke, diabetes, hypothyroidism, and lupus, also may cause constipation.

What causes constipation in children?

Constipation in children is caused by many of the same things that cause adults to have it (see list above). For example, it is likely to happen when your child doesn't drink enough water, milk, or other fluids, or if your child doesn't eat a healthy diet that includes enough fiber.

Constipation may also begin when you switch your baby from breast milk or baby formula to whole cow's milk, and when you switch from baby food to solid food. Sometimes constipation happens after your child has been sick or has taken certain medicines. You should not be concerned if your child becomes constipated for a short period of time. Constipation is common in children and usually goes away on its own.

Young children who have chronic constipation often ignore the urge to have a bowel movement. Your child may not want to interrupt play, or may be afraid or embarrassed to ask a teacher or use a public restroom. When a child avoids bowel movements, stool builds up in the lower bowel. The stool becomes larger and harder. Passage of the stool can be painful and makes children want to avoid having a bowel movement even more.

Diagnosis & Tests

How does my doctor diagnose constipation?

Your doctor probably will do a physical exam and ask you about your symptoms. If you have frequent constipation, you can help your doctor by keeping a day-by-day record of your bowel movements. If you are a parent, you may want to keep a record of your child’s bowel movements. In the record, you should include:

When you/your child had a bowel movement
What the stool looked like, such as its size and consistency, and if there was any blood
Any other digestive symptoms you/your child may have, such as stomach pain, loss of appetite, straining during bowel movements, etc.
Bathroom habits, such as if you regularly ignore the urge to have a bowel movement, or if it seems like your child is avoiding going to the bathroom

Depending on the frequency and severity of your symptoms, your doctor may also want to do other tests, such as a rectal exam, blood tests, X-rays, or colonoscopy.

Treatment

How is constipation treated?

The treatment depends on what is causing your constipation. For most people, eating a healthy diet, getting enough fiber, exercising regularly, and drinking enough fluids are the keys to clearing up constipation.

How do I get more fiber?

It is suggested that men 50 years of age and younger consume at least 38 grams of fiber per day, while women 50 years of age and younger should consume at least 25 grams per day. To add fiber to your diet, choose or add fiber-rich foods to your diet. If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water, also.

Foods rich in fiber include:

Beans (such as navy, kidney, and pinto beans)
Dried fruits (such as prunes, apricots, and figs)
Fresh fruits and vegetables (eat at least 2 cups of fruit and 2 ½ cups of vegetables per day)
Unprocessed wheat bran (try it as a topping on yogurt or fruit)
Unrefined breakfast cereals
Whole-grain bread and brown rice (choose these instead of white bread or rice)

Fiber supplements can also be used:

Flax seed meal
Products that contain psyllium are available in powder and other forms (examples include Metamucil and others)

Should I use laxatives?

In general, try to avoid laxatives. They aren't meant for long-term use. An exception to this is bulk-forming laxatives.

Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. Bulk-forming laxatives can be used every day. They include oat bran, psyllium (one brand: Metamucil), polycarbophil (one brand: FiberCon) and methylcellulose (one brand: Citrucel).

How are bulk-forming laxatives used?

You must use bulk-forming laxatives daily for them to work. Follow the directions on the label. Start slowly and drink plenty of fluids. Gradually increase how much you use every 3 to 5 days (as your body gets used to it) until your stools are softer and easier to pass.

You can help bulk-forming laxatives taste better by mixing them with fruit juice.

Do bulk-forming laxatives have side effects?

You may notice some bloating, gas or cramping at first, especially if you start taking too much or increase the amount you're using too quickly. These symptoms should go away in a few weeks or less.

Is mineral oil a good laxative?

In general, only use mineral oil when your doctor recommends it, such as if you've just had surgery and shouldn't strain to have a bowel movement. Mineral oil shouldn't be used regularly. If it is used regularly, it can cause deficiencies of vitamins A, D, E and K.

Should I try enemas?

Enemas aren't usually necessary to relieve constipation. It's better to let your body work naturally.

What if I've been using enemas or laxatives for a long time?

If you've used laxatives and enemas for a long time, your family doctor may suggest that you gradually reduce the use of them to give your body a chance to return to normal. You may have to retrain your body to go without laxatives or enemas. This means eating plenty of fiber, possibly using a bulk-forming laxative, drinking plenty of water, exercising and learning to give yourself time to have a bowel movement. Be patient. It may take many months for your bowels to get back to normal. Talk with your family doctor about any concerns you have.

What other treatments might my doctor recommend?

Depending on the cause of your constipation, the severity of your symptoms, and the effectiveness of other treatments, your doctor may also recommend:

Prescription medicine, such as lubiprostone, to help relieve your symptoms
Procedures to help remove stool from the intestine
Surgery, which is rarely needed to remove damaged intestine
Other treatments to address the cause of your constipation

What can I do if my child is constipated?

There are many things you can do to help your child:

Diet. You can start by increasing the amount of fluid your child drinks each day. If your baby is eating cereal, you can try adding a little prune juice to it. If you have an older child, make sure she or he is drinking plenty of water. You can also give your child prune juice, bran cereal, fruits and vegetables to increase the amount of fiber in his or her diet and help your child pass a stool. Avoid giving your child candy and refined sugars.
Bowel habit training. Teach your child to go to the bathroom when he or she first feels the urge to have a bowel movement. You can help your child establish a regular bowel habit by asking your child to sit on the toilet for at least 10 minutes at about the same time each day, preferably after a meal. Make sure your child can place his or her feet firmly on the floor while sitting on the toilet. If this is not possible, put a footstool in front of the toilet. While your child is sitting on the toilet, you might let your child read a story book or listen to the radio.
Medicine. Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.
Start a reward program. Begin rewarding your child for just sitting on the toilet. For example, if your child sits on the toilet at the planned time, reward your child with a favorite activity. If your child has a bowel movement, give your child praise and a reward. Avoid using food as a reward. Young children may like to be awarded with stickers or stars on a chart. Older children may like to add up points for a larger reward, such as a trip to a movie theater or the park.
Medicine. If other treatments don’t help, ask your doctor about whether your child may benefit from using a laxative for a short time. Many laxatives are available to treat constipation in children. The choice of laxative depends on the age of your child and how serious the constipation is. Ask your family doctor to suggest a brand name and tell you how much to use.

Complications

What are the possible complications?

Sometimes, constipation can lead to complications, especially if you have chronic (frequent) constipation. Possible complications include:

Anal fissure (a tear in the skin around the anus)
Fecal impaction (when stool becomes too large for you to pass on your own)
Hemorrhoids
Rectal prolapse (when the act of straining to have a bowel movement pushes a small piece of the intestine out of the anus)

If you don’t seek treatment, these complications can become serious and may require surgery. Talk to your doctor right away if you notice blood or mucus in or on your stool, or if you are unable to pass any stool.

Questions to Ask Your Doctor

Is constipation dangerous?
Can constipation be a sign of another health condition?
I’ve been using laxatives regularly for a long time. How can reduce their use?
How can I tell if my baby is constipated?
Besides high-fiber foods, what else can I do to increase my fiber intake?
What lifestyle changes can I make to treat and prevent constipation?

Bibliography

National Digestive Diseases Information Clearinghouse (NDDIC). Constipation. Accessed October 17, 2012

The Merck Manual. Constipation. Accessed October 17, 2012

Written by familydoctor.org editorial staff

Reviewed/Updated: 08/12
Created: 08/96