Constipation

Author: Rosalyn Carson-DeWitt, MD
En Español (Spanish Version)

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:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for constipation include:

  • Advancing age
  • Sedentary lifestyle
  • Prolonged bed rest due to surgery or an accident
  • Diet that is high in fat and sugar but 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 or blood tests may be performed.
  • 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 abdomin
  • 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
© 2009 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 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 oz 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 (GlycoLax, MiraLax)—a type of laxative
  • Psyllium —a bulk laxative
  • Docusate —a stool softener
  • Lactulose —a type of laxative
  • Lubiprostone (Amitiza)—a medication that increases fluid in stool
  • Tegaserod —a medication that brings fluids to the colon
  • Colchicine —medication used to treat gout; sometimes used for constipation
  • Botulism injections—may be used to treat certain types of constipation

Future Treatments

  • Prucalopride—not currently approved but showing promise in clinical trials
  • Cisapride —only available as an investigational drug; removed from the market

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 oz 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.

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/index_e.html

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_health/JohnsHopkinsHealthAlertsDigestiveDi...ders_2898-1.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. 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.

Lippincott Williams & Wilkins. 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-cons...ation/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/pu...constipation_ez/. Published December 2008. Accessed July 9, 2009.

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

Last reviewed September 2009 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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