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Constipation

Definition

Constipation is infrequent and/or uncomfortable bowel movements. Stool is often hard and dry. This is a common gastrointestinal complaint.

Causes

Constipation has many causes, including:

Risk Factors

Constipation is more common in older adults.
Risk factors include:

Symptoms

Symptoms include:

When Should I Call My Doctor?

Call your doctor if you:
  • Have constipation that lasts longer than 2-3 weeks
  • Have a painful or swollen abdomen
  • Have nausea or vomiting
  • Have signs of an infection, such as fever or chills
  • Have pain or burning in anal area with or without bowel movement
  • Have blood in your stool or black stool
  • Think that your prescription medication is causing constipation
  • Are losing weight

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. It may include a digital rectal exam of the rectum with the doctor's gloved, lubricated finger inserted into your rectum.
Your bodily fluids may be tested. This can be done with blood tests.
Your bodily structures may need to be viewed. This can be done with:
Barium Enema
Radiology colon
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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 1 stool every several days.

Making Lifestyle Changes

  • Eat a healthy, balanced diet that is high in fiber and includes foods such as unprocessed bran, whole-wheat grains, fresh fruit, and cereals. Eating prunes may also improve bowel movements.
  • Limit your intake of processed and fatty foods.
  • Exercise regularly .
  • Drink plenty of water each day.

Taking Laxatives, Stool Softeners, or Glycerin Suppositories

Regularly using laxatives or enemas can be habit forming. Your bowels can become used to these products and require them 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—a type of laxative
  • Psyllium—a bulk laxative
  • Docusate—a stool softener
  • Lactulose—a type of laxative
  • Lubiprostone—a medication that increases fluid in stool
  • Botulism injections—may be used to treat certain types of constipation

Retraining Your Bowels

Set aside the same time each day to move your bowels. Typically, this works best first thing in the morning. 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.

Using Biofeedback

Biofeedback may be effective in certain conditions. By working with a therapist, you learn how to control certain muscles that can help you to move your bowels.

Treating Underlying Conditions

Work with your doctor to treat other conditions that may be causing your constipation.

Changing Medications

If you are taking medication that causes constipation, talk to your doctor to find out if you can take a different medication.
If you are taking opioids to relieve pain, you may have constipation. A medication called methylnaltrexone may help to reduce this side effect.

Having Surgery

If you have severe, chronic constipation, your doctor may recommend surgery.
If you are diagnosed with constipation, follow your doctor's instructions.

Prevention

To reduce your chance of getting constipation:

RESOURCES

American Gastroenterological Association http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Healthy U http://www.healthyalberta.com

References

Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358(22):2344-2354.

Constipation. AGA Patient Center, American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/constipation. Accessed December 18, 2014.

Constipation. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation. Accessed December 18, 2014.

Constipation in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 9, 2014. Accessed December 18, 2014.

Constipation in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 3, 2014. Accessed December 18, 2014.

Treatment of constipation. International Foundation for Functional Gastrointestinal Disorders website. Available at: http://www.aboutconstipation.org/site/about-constipation/treatment. Updated November 22, 2013. Accessed December 18, 2014.

6/25/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343.

11/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Arebi N, Kalli T, Howson W, Clark S, Norton C. Systematic review of abdominal surgery for chronic idiopathic constipation. Colorectal Dis. 2010 Oct 22. [Epub ahead of print]

6/20/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011;33(7):822-828.

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