What Is Constipation?
Constipation is a change in bowel habits and can mean stools may be too hard or too small, difficult to pass, or infrequent (less than three times per week). People with constipation may need to strain to empty their bowels and have a sense the bowels are not empty.
Constipation is a common problem that causes more than 2.5 million Americans to visit their doctors each year.
What Are Symptoms of Constipation?
Symptoms of constipation include bowel movements that are:
- Too hard
- Too small
- Difficult to pass
- Occurring fewer than 3 times a week
Occasional constipation is normal. See a doctor if you have symptoms of constipation that are:
- New (a change from the normal pattern)
- Lasting longer than three weeks
- Severe
- Associated with any other concerning features that could signal a more serious problem:
- Blood in the toilet or on the toilet paper after a bowel movement
- Fever
- Weight loss
- Weakness
What Causes Constipation?
Causes of constipation include:
- Lifestyle
- Digestive problems
- Primary colorectal dysfunction
- Slow transit constipation: delay in stool transit throughout the colon
- Dyssynergic defecation: difficulty with bowel movement or inability to expel stool from the rectum
- Irritable bowel syndrome with constipation (IBS-C) is characterized by abdominal pain with altered bowel habits
- Medication side effects
- Opiates
- Antihypertensive drugs
- Tricyclic antidepressants
- Iron preparations
- Antiepileptic drugs
- Anti-Parkinsonian agents (anticholinergic or dopaminergic)
- Barium
- Endocrine or metabolic disorders
- Diabetes mellitus
- Low thyroid hormone (hypothyroidism)
- High calcium (hypercalcemia)
- Porphyria
- Chronic renal insufficiency
- Panhypopituitarism
- Pregnancy
- Neurologic disorders
- Parkinson's disease
- Stroke
- Spinal cord injury
- Paraplegia
- Multiple sclerosis
- Autonomic neuropathy
- Hirschsprung disease
- Chronic intestinal pseudo-obstruction
- Myogenic disorders
- Myotonic dystrophy
- Dermatomyositis
- Scleroderma
- Amyloidosis
- Anorectal problems
- Colorectal cancer
- Anal fissure
- Anal strictures
- Inflammatory bowel disease (IBD)
- Proctitis
- Chronic idiopathic constipation
How Is Constipation Diagnosed?
Constipation is usually diagnosed based upon a patient’s symptoms and a physical examination. A doctor will also want to know about any medications you take regularly because some medications can cause constipation.
Tests used to diagnose the cause of constipation include:
- Rectal exam
- Blood tests
- Sigmoidoscopy or colonoscopy
- X-rays
- Magnetic resonance imaging (MRI)
- Manometry studies
What Is the Treatment for Constipation?
Treatment for constipation can include home remedies such as lifestyle changes, eating foods high in fiber, and using laxatives or enemas if needed.
- Eat high fiber foods such as fruits, vegetables, prune juice, beans, and whole grains, including many breakfast cereals
- Drink plenty of water and other fluids
- Drink a beverage with caffeine in the morning
- Don’t ignore your body’s signals to have a bowel movement
- If you feel like you have to go, do so
- Ignoring signals can cause them to become weaker over time
- Take laxatives if recommended by a doctor
- Laxatives may help relieve constipation fast, within hours
- Increase the dose of fiber gradually to minimize bloating, gas, and cramping
- Bulk forming laxatives: natural fiber and commercial fiber preparations, usually available over-the-counter (OTC); take fiber supplements with plenty of fluid
- Psyllium (Konsyl, Metamucil, Perdiem)
- Methylcellulose (Citrucel)
- Calcium polycarbophil (FiberCon, Fiber-Lax, Mitrolan)
- Wheat dextrin (Benefiber)
- Hyperosmolar laxatives
- Polyethylene glycol (MiraLAX, GlycoLax)
- Lactulose
- Sorbitol
- Saline laxatives
- Magnesium hydroxide (Milk of Magnesia)
- Magnesium citrate (Evac-Q-Mag)
- Stimulant laxatives
- Taking stimulant laxatives regularly or in large amounts can cause side effects, including low potassium levels.
- Senna (e.g., Black Draught, Ex-Lax, Fletcher's, Castoria, Senokot)
- Bisacodyl (e.g., Correctol, Doxidan, Dulcolax).
If you try the above remedies and do not have a bowel movement within a few days, call your doctor.
Medications used to treat severe constipation include:
- Lubiprostone (Amitiza)
- Linaclotide (Linzess)
- Plecanatide (Trulance, Motegrity)
- Tenapanor (Ibsrela)
Biofeedback is a behavioral approach that may help with severe chronic constipation in people who involuntarily squeeze (rather than relax) their muscles during a bowel movement.
How Do You Prevent Constipation?
You can reduce your chances of getting constipation by:
- Consuming adequate amounts of fiber
- Eating less processed food, meat, and dairy which contain low amounts of fiber
- Drinking plenty of water
- Exercising regularly
- Going to the bathroom when you feel the urge