Definition

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.

Causes

Constipation has many causes, including:

  • Not enough fluid intake
  • Overuse of laxative medicines
  • Too little exercise
  • Bed rest
  • Certain medications, including:
    • Pain relievers
    • Narcotics
    • Aluminum-containing antacids
    • Antidepressant and antipsychotic medications
    • Medications for epilepsy and Parkinson's disease
    • Antispasmodic medications
    • Tranquilizers
    • Iron supplements
    • Calcium channel blockers
  • Frequently delaying the need to have a bowel movement
  • Pregnancy
  • Diabetes
  • 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:
  • Scleroderma
  • Systemic lupus erythematosus
  • Intestinal disorders, including:
    • Scarring
    • Tumors
    • Cancer
    • Inflammation
  • Travel, due to schedule changes, stress, and poor diet

Risk Factors

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

Symptoms

Symptoms include:

  • 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

Diagnosis

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:

  • Constipation plus:
    • Abdominal pain
    • Bleeding
    • Black stool
    • Distended abdomen
    • Fever
  • 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

Barium Enema

Radiology colon

© 2009 Nucleus Medical Art, Inc.

Treatment

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

Future Treatments

  • Prucalopride (eg, Reslolor)—not currently approved but showing promise in clinical trials
  • Cisapride—only available as an investigational drug

Bowel Retraining

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

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.

Changing Medications

If you're taking medication that causes constipation, ask your doctor for an alternative.

If you are taking opioids to relieve pain, you may have constipation. A study found that the medication methylnaltrexone (Relistor) can rapidly relieve this side effect. *

If you are diagnosed with constipation, follow your doctor's instructions .

Prevention

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.