Constipation

What is constipation?

Constipation is a common condition that makes it difficult to have a bowel movement. A bowel movement occurs when the food you eat passes through your digestive system. Your body takes the nutrients it needs from that food. What’s left over is called stool. Your stool can be soft or hard. Bowel movements usually happen on a regular basis.

Everyone has a bowel movement schedule (how often, how consistent, and what time of day it occurs). If your bowel movements become less frequent, are difficult to pass, and you are physically uncomfortable, you may be constipated. People of all ages experience constipation occasionally. Usually, it goes away and is not serious. See your doctor if your constipation is chronic (frequent). It may be a problem with your diet or health.

Symptoms of constipation

Basic symptoms of constipation include:

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

You should see your doctor if these symptoms do not go away. You should also see a doctor if you have any of the following symptoms:

• Bleeding from your rectum or blood in your stool
• Constant pain in your abdomen
• Inability to pass gas
• Vomiting
• Fever
• Lower back pain
• Weight loss without trying

Chronic (ongoing) constipation can lead to complications, including:

• Anal fissure(a tear in the skin around your anus).
• Stool impaction (when your stool becomes too large to pass on your own).
• Hemorrhoids.
• Rectal prolapse (when a small piece of your intestine comes out of your anus from straining to have a bowel movement).
• Encopresis (when your bowels are so backed up that only liquid can pass through). Many people mistake this for diarrhea take anti-diarrheal medicine, making constipation even worse.

Complications of constipation can become serious if left untreated. They may require surgery.

What causes constipation?

You may be constipated for many different reasons. It may have more than one cause at a time, including:

• Diet (too many processed foods and not enough fiber)
• Certain medicines (opioid medicines given for pain and even too many laxatives, which usually help you have a bowel movement)
• Dehydration (especially not enough water)
• Too little physical activity
• Intestinal problems
• Major life changes, such as pregnancy

Constipation may become more common as you age. Certain diseases and disabilities also can cause constipation. These include multiple sclerosis, stroke, diabetes, hypothyroidism, and lupus.

Dehydration (not enough fluids) and dietary changes are the most common causes of constipation in babies. For example, changing from breast milk to cow’s milk or from baby food to solids can cause constipation.

How is constipation diagnosed?

Your doctor will ask you about your symptoms and medical history. This will include asking you about any medicines you take. Your doctor also will ask when you had your last bowel movement and how often you have them. It might be helpful to write it down for before your appointment. During the visit, your doctor may examine your rectum (the end of your large intestine near your anus). The doctor will insert his or her finger (while wearing rubber gloves) into your rectum to feel for blockages.

Your doctor may order additional tests, including a blood test and X-ray. A more thorough test is a colonoscopy. This is an invasive procedure done with anesthesia. During this test, your doctor will examine your colon with a long, flexible scope attached to a camera.

Can constipation be prevented or avoided?

There are things you can do to reduce constipation. These include:

• Adding more fiber to your diet. Adults should eat between 20-35 grams of fiber each day. Foods, such as beans, whole grains, fruits, and vegetables are high in fiber.
• Drinking more water. Being dehydrated causes your stool to dry out. This makes having a bowel movement more difficult and painful.
• Not waiting when you have to go. When you have the urge to have a bowel movement, don’t hold it in. This causes the stool to build up.
• Getting physical. Exercise is helpful in keeping your bowel movements regular.
• Being aware of medicines. Certain prescription medicines (especially pain medicines) can slow your digestive system. This causes constipation. Talk to your doctor about how to prepare for this if you need these medicines.
• Talking to your doctor. Especially if you are being treated for certain diseases that are related to constipation. They may have additional guidance for lowering your risks.

Constipation treatment

Most cases of constipation are easy to treat at home with diet and exercise. Some cases require doctor recommendations, prescription medicine, or a medical procedure.

At home treatment includes:

Diet: Eating a healthy diet with fiber and drinking plenty of fluids (water is the most helpful) can usually clear up constipation.

High fiber foods include beans, dried fruits, fresh fruits and vegetables, whole-grain foods (choose brown rice or whole wheat bread instead of white), flaxseed meal, and powdered products containing psyllium. For example, 3 cups of popped popcorn has a little more than 3 grams of fiber. One cup of oatmeal has 4 grams of fiber. Adding fiber to each meal and snack will help you reach your goal for the day. Fiber supplements are helpful. Processed foods, such as desserts and sugary drinks, only make constipation worse.

The amount of fiber you need each day varies:

• Men over the age of 50 should get at least 30 grams of fiber per day.
• Women over the age of 50 should get 21 grams per day.
• Children ages 1 to 3 should get 19 grams of fiber per day.
• Children between 4 and 8 years old should get 25 grams per day.
• Girls between 9 and 18 should get 26 grams of fiber each day.
• Boys of the same age range should get between 31 and 38 grams of fiber per day.

Bowel training: Teach your children to go to the bathroom when they have to. Holding it can lead to constipation. This also may be necessary for your elderly parents, if you are caring for them.

Laxatives: This is over-the-counter medicine that helps you have a bowel movement. Laxatives should only be used in rare instances. Do not use them on a regular basis. If you must use a laxative, bulk-forming laxatives are best (two brands: Metamucil and Benefiber). These work naturally to add bulk and water to your stools so they can pass easily. Bulk-forming laxatives can cause some bloating (when your stomach feels full) and gas.

There are other treatments that require consulting with your doctor:

Mineral oil: Do not use this without your doctor’s recommendation. Your doctor may recommend using it if you recently had surgery and should not strain for a bowel movement. Do not use it regularly. It causes your body to lose important vitamins: A, D, E and K.

Enema: This is a liquid medicine. It is inserted into your anus to help with constipation. It is often used after a surgery or before some medical procedures.

Prescription medicine: Your doctor will prescribe a medicine based on the reason for your constipation.

Surgery: This is rare. It might involve removing a damaged intestine for serious reasons.

Living with constipation

Living with constipation can be uncomfortable and miserable. This is true when it’s just for just a couple of days. Long-lasting (chronic) constipation can be so uncomfortable that it influences how your clothes fit, what foods you eat, and your everyday activities. Keep a journal of your bowel movements to see what a normal bowel movement schedule is for you or your child. A normal schedule is between 3 times per day to 3 times per week. Try to keep your diet and lifestyle as routine as possible to prevent constipation.

Questions to ask your doctor

• Does aging play a significant role in constipation?
• Does travel cause constipation?
• How can I avoid a power struggle with my child over going to the bathroom?
• Does straining during constipation affect your heart?
• How can I help my aging parents deal with constipation?

Resources

National Institute of Diabetes and Digestive and Kidney Diseases: Symptoms and Causes of Constipation

National Institutes of Health, MedlinePlus: Constipation