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Constipation
Definition
Constipation is most often defined as having a bowel movement less than 3 times per week. It usually is associated with hard stools or difficulty passing stools. You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing for more than 10 minutes.
Alternative Names
Irregularity of bowels; Lack of regular bowel movements
Considerations
Normal bowel movements are different for each person. You may not have a bowel movement every day. Although some healthy people always have soft or near-runny stools, others have firm stools, but have no trouble passing them.
When you rarely have a bowel movement, or it takes a lot of effort to pass stool, you have constipation. Passing large, wide, or hard stools may tear the anus, especially in children. This can cause bleeding and may lead to an anal fissure.
Causes
Constipation is most often caused by:
- Low-fiber diet
- Lack of physical activity
- Not drinking enough water
- Delay in going to the bathroom when you have the urge to move your bowels
Stress and travel can also contribute to constipation or other changes in bowel habits.
Other causes of constipation may include:
- Colon cancer
- Diseases of the bowel, such as irritable bowel syndrome
- Mental health disorders
- Nervous system disorders
- Pregnancy
- Underactive thyroid
- Use of certain medications
Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.
Home Care
Children and adults should get enough fiber in their diet. Vegetables, fresh fruits, dried fruits, and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, drink plenty of fluids to help pass the stool.
For infants with constipation:
- Over 2 months old -- try 2 - 4 ounces of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
- Over 4 months old -- if the baby has begun solid foods, try baby foods with high-fiber content (peas, beans, apricots, prunes, peaches, pears, plums, spinach) twice a day.
Regular exercise may also help establish regular bowel movements. If you are confined to a wheelchair or bed, change position often. Also do abdominal exercises and leg raises. A physical therapist can recommend exercises that you can do.
Stool softeners (such as those containing docusate sodium) may help. Bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as milk of magnesia liquid, may help you have regular bowel movements.
Enemas or stimulant laxatives should only be used in severe cases. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.
Do NOT give laxatives or enemas to children without first asking your doctor.
When to Contact a Medical Professional
Call your doctor immediately if you have sudden constipation with abdominal cramps and you cannot pass gas or stool. Do NOT take any laxatives.
Also call your doctor if you have:
- Been using laxatives for several weeks or self care is not working
- Blood in your stool
- Constipation alternating with diarrhea
- Rectal pain
- Sharp or severe abdominal pain, especially if you also have bloating
- Thin, pencil-like stools
- Unexplained weight loss
Call your child's pediatrician right away if:
- An infant (except those who are only breastfed) goes 3 days without a stool and is vomiting or irritable
Also call your child's pediatrician if:
- An infant younger than 2 months is constipated
- Non-breastfeeding infants go 3 days without having a bowel movement (call immediately if there is vomiting or irritability)
- A child is holding back bowel movements to resist toilet training
What to Expect at Your Office Visit
Your doctor will perform a physical examination, which may include a rectal exam, and will ask questions such as:
- How long have you had constipation?
- How many days do you go between two bowel movements?
- Is constipation worse when you are stressed?
- What is the color, shape, and consistency of your stools?
- Is there any bleeding with bowel movements?
- Do you have any abdominal pain?
- What surgeries or injuries have you had?
- What medications do you take?
- Do you drink coffee or alcohol? Do you smoke?
- What other symptoms do you have?
The following tests may help diagnose the cause of constipation:
- Anorectal manometry (pressure measurements of the anus and rectum)
- Barium enema
- Complete blood count (CBC)
- Colonoscopy
- Proctosigmoidoscopy (an examination of the lower bowel)
- Stool studies
- Upper GI series
- X-rays of the abdomen
Prevention
Avoiding constipation is easier than treating it, but involves the same lifestyle measures:
- Drink plenty of fluids each day (at least 8 glasses of water per day).
- Eat lots of fiber.
- Exercise regularly.
- Go to the bathroom when you have the urge. Don't wait.
References
Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 138.
Lembo AJ, Ullman SP. Constipation. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 18.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
