• Constipation

    Definition

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

    Causes

    Constipation has many causes, including:
    • Not enough fluid intake
    • Overuse of laxative medicines
    • Too little exercise
    • Bed rest
    • Certain medicines, including:
      • Pain relievers
      • Narcotics
      • Aluminum-containing antacids
      • Antidepressant and antipsychotic medicines
      • Medicines for epilepsy and Parkinson's disease
      • Antispasmodic medicines
      • 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

    Risk factors include:
    • 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

    When Should I Call My Doctor?

    Call your doctor if you:
    • Are constipated and never had this condition before
    • 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 medicine is causing constipation
    • Are losing weight

    Diagnosis

    Changes in bowel habits, such as constipation, may indicate a more serious condition. Your doctor may order tests to rule out other conditions. Tests may include:
    • Physical exam
    • Blood tests
    • Digital rectal exam—examination of the rectum with the doctor's gloved, lubricated finger inserted into your rectum
    • Abdominal x-ray—a test that uses radiation to take a picture of structures inside the abdomen
    • Barium enema—injection 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
    Copyright © Nucleus Medical Media, 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 healthy, balanced diet that is high in fiber (such as unprocessed bran, whole-wheat grains, fresh fruit, and cereals). Eating prunes every day may also improve bowel movements.
    • 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 medicines include:
    • Polyethylene glycol 3350 (GlycoLax, MiraLax)—a type of laxative
    • Psyllium—a bulk laxative
    • Docusate—a stool softener
    • Lactulose—a type of laxative
    • Lubiprostone (Amitiza)—a medicine 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 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.

    Using Biofeedback

    Biofeedback works by attaching sensors to the body. These sensors give you information about your muscles. 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 medicine that causes constipation, talk to your doctor to find out if you can take another drug.
    If you are taking opioids to relieve pain, you may have constipation. A medicine called methylnaltrexone (Relistor) 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:
    • 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.
    • Do not rush yourself when using the bathroom.
    • If you feel the urge to move your bowels, do not ignore this feeling. Go to the bathroom right away.

    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

    Botox, not just for wrinkles. Johns Hopkins Health Alerts website. Available at: http://www.johnshopkinshealthalerts.com/alerts/digestive%5Fhealth/JohnsHopkinsHealthAlertsDigestiveDisorders%5F2898-1.html. Published January 2009. Accessed July 9, 2009.

    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.

    Cephulac. Drugs.com website. Available at: http://www.drugs.com/mtm/cephulac.html. Updated March 2008. Accessed July 9, 2009.

    Cisapride. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR600429. Updated June 2009. Accessed July 9, 2009.

    Constipation. AGA Patient Center, American Gastroenterological Association website. Available at: http://www.gastro.org/wmspage.cfm?parm1=687. Updated April 2008. Accessed July 9, 2009.

    Constipation. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/constipation.printerview.all.html. Updated July 2010. Accessed January 12, 2012.

    Constipation. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/. Updated July 2007. Accessed January 31, 2012.

    Constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/. Published July 2007. Accessed July 9, 2009.

    Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

    Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

    Treatment of constipation. International Foundation for Functional Gastrointestinal Disorders website. Available at: http://www.aboutconstipation.org/site/about-constipation/treatment. Updated May 2009. Accessed July 9, 2009.

    What I need to know about constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/constipation%5Fez. Published December 2008. Accessed July 9, 2009.

    6/25/2008 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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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