Constipation is the infrequent and difficult passage of stool. The frequency of
bowel movements among healthy people varies greatly, ranging from three
movements a day to three a week. As a rule, if more than three days pass without
a bowel movement, the intestinal contents may harden, and a person may have
difficulty or even pain during elimination. Stool may harden and be painful to
pass, however, even after shorter intervals between bowel movements. Straining
during bowel movements or the feeling of incomplete evacuation may also be
reported as constipation.
What are Some Common Misconceptions About Constipation?
Many false beliefs exist concerning proper bowel habits. One of these is that a
bowel movement every day is necessary. Another common fallacy is that wastes
stored in the body are absorbed and are dangerous to health or shorten the life
What are Some of the Causes of Constipation?
Constipation is a symptom, not a disease. Like a fever, constipation can be
caused by many different conditions. Most people have experienced an occasional
brief bout of constipation that has corrected itself with diet and time. The
following is a list of some of the most common causes of constipation:
What Causes Constipation in Children?
- Poor Diet - A main cause of constipation may be a diet high in
animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and
other sweets), but low in fiber (vegetables, fruits, whole grains). Some studies
have suggested that high fiber diets result in larger stools, more frequent
bowel movements, and therefore less constipation.
- Imaginary Constipation - This is very common and results from
misconceptions about what is normal and what is not. If recognized early enough,
this type of constipation can be cured by informing the sufferer that the
frequency of his or her bowel movements is normal.
- Irritable Bowel Syndrome (IBS) - Also known as spastic colon,
IBS is one of the most common causes of constipation in the United States. Some
people develop spasms of the colon that delay the speed with which the contents
of the intestine move through the digestive tract, leading to constipation.
- Poor Bowel Habits - A person can initiate a cycle of
constipation by ignoring the urge to have a bowel movement. Some people do this
to avoid using public toilets, others because they are too busy. After a period
of time a person may stop feeling the urge. This leads to progressive
- Laxative Abuse - People who habitually take laxatives become
dependent upon them and may require increasing dosages until, finally, the
intestine becomes insensitive and fails to work properly.
- Travel - People often experience constipation when traveling
long distances, which may relate to changes in lifestyle, schedule, diet, and
- Hormonal Disturbances - Certain hormonal disturbances, such as
an underactive thyroid gland, can produce constipation.
- Pregnancy - Pregnancy is another common cause of constipation.
The reason may be partly mechanical, in that the pressure of the heavy womb
compresses the intestine, and may be partly due to hormonal changes during
- Fissures and Hemorrhoids - Painful conditions of the anus can
produce a spasm of the anal sphincter muscle, which can delay a bowel movement.
- Specific Diseases - Many diseases that affect the body tissues,
such as scleroderma or lupus, and certain neurological or muscular diseases,
such as multiple sclerosis, Parkinson's disease, and stroke, can be responsible
- Loss of Body Salts - The loss of body salts through the kidneys
or through vomiting or diarrhea is another cause of constipation.
- Mechanical Compression - Scarring, inflammation around
diverticula, tumors, and cancer can produce mechanical compression of the
intestine and result in constipation.
- Nerve Damage - Injuries to the spinal cord and tumors pressing
on the spinal cord can produce constipation by affecting the nerves that lead to
- Medications - Many medications can cause constipation. These
include pain medications (especially narcotics), antacids that contain aluminum,
antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements,
anticonvulsants for epilepsy, antiparkinsonism drugs, and antihypertensive
calcium channel blockers.
- Colonic Motility Disorders - The peristaltic activity of the
intestine may be ineffective resulting in colonic inertia or outlet obstruction.
Constipation is common in children and may be related to any of the causes noted in the previous section. In a small number of children, constipation may be the result of physical problems. Children with such defects as the absence of normal nerve endings in portions of the bowel, abnormalities of the spinal cord, thyroid deficiency, mental retardation, and certain other inherited metabolic disorders often suffer symptoms of constipation. Constipation in children, however, usually is due to poor bowel habits.
Studies show that many children who suffer from constipation when they are older
have a history of passing stools that are firmer than average in their early
weeks of life. Because this occurs before there are significant variations in
diet, habits, or attitudes, it suggests that many children who develop
constipation have a normal tendency to have firmer stools. Such children suffer
little from the tendency unless it is aggravated by poor bowel habits or poor
Constipation may result in pain when the child has bowel movements. Cracks in
the skin, called fissures, may develop in the anus. These fissures can bleed or
increase pain, causing a child to withhold his or her stool.
Children may withhold their stools for other reasons as well. Some find it
inconvenient to use toilets outside the home. Also, severe emotional stress
caused by family crises or difficulties at school may cause children to withhold
their stools. In these instances, the periods between bowel movements may become
quite long, in some cases lasting longer than one or two weeks. These children
may develop fecal impactions, a situation where the stool is packed so tightly
in the bowel that the normal pushing action of the bowel is not enough to expel
the stool spontaneously.
What Causes Constipation in Older Adults?
Older adults are five times more likely than younger adults to report problems
with constipation. Poor diet, insufficient intake of fluids, lack of exercise,
the use of certain drugs to treat other conditions and poor bowel habits can
result in constipation. Experts agree, however, that too often older people
become overly concerned with having a bowel movement and that constipation is
frequently an imaginary ailment.
Diet and dietary habits can play a role in developing constipation. Lack of
interest in eating - a problem common to many single or widowed older people -
may lead to heavy use of convenience foods, which tend to be low in fiber. In
addition, loss of teeth may force older people to choose soft, processed foods,
which also tend to be low in fiber.
Older people sometimes cut back on fluids, especially if they are not eating
regular or balanced meals. Water and other fluids add bulk to stools, making
bowel movements softer and easier to pass.
Prolonged bedrest, for example, after an accident or during an illness, and lack
of exercise may contribute to constipation. Also, drugs prescribed for other
conditions, such as antidepressants, antacids containing aluminum or calcium,
antihistamines, diuretics, and antiparkinsonism drugs, can produce constipation
in some people.
The preoccupation with bowel movements sometimes leads older people to depend
heavily on laxatives, which can be habit-forming. The bowel begins to rely on
laxatives to bring on bowel movements, and over time, the natural mechanisms
fail to work without the help of drugs. Habitual use of enemas also can lead to
a loss of normal function.
What Diagnostic Tests Can Help Determine the Causes of Constipation?
Constipation may be caused by abnormalities or obstructions of the digestive
system in some people. A doctor can perform tests to determine if constipation
is the symptom of an underlying disorder.
In addition to routine blood, urine, and stool tests, a sigmoidoscopy may help
detect problems in the rectum and lower colon. In this procedure, which can be
done in the doctor's office, the doctor inserts a flexible, lighted instrument
through the anus to examine the rectum and lower intestine. The doctor may
perform a colonoscopy to inspect the entire colon. In colonoscopy, an instrument
similar to the sigmoidoscopy, but longer and able to follow the twists and turns
of the entire large intestine, is used. A barium enema X-ray will provide
similar information. If bleeding is present, a double-contrast barium enema is
Other highly specialized techniques are available for measuring pressures and
movements within the colon and its sphincter muscles, but these are used only in
Is Constipation Serious?
Although it may be extremely bothersome, constipation itself usually is not
serious. However, it may signal and be the only noticeable symptom of a serious
underlying disorder such as cancer. Constipation can lead to complications, such
as hemorrhoids caused by extreme straining or fissures caused by the hard stool
stretching the sphincters. Bleeding can occur for either of these reasons and
appears as bright red streaks on the surface of the stool. Fissures may be quite
painful and can aggravate the constipation that originally caused them. Fecal
impactions tend to occur in very young children and in older adults and may be
accompanied by a loss of control of stool, with liquid stool flowing around the
Occasionally, straining causes a small amount of intestinal lining to push out
from the rectal opening. This condition is known as rectal prolapse and may lead
to secretion of mucus that may stain underpants. In children, mucus may be a
feature of cystic fibrosis.
When Is Medical Attention Needed?
The doctor should be notified when symptoms are severe, last longer than three
weeks, are disabling, or when any of the complications listed above occur. The
doctor should be informed whenever a significant and prolonged change of usual
bowel habits occurs.
The symptoms of constipation are key to helping the physician determine a
diagnosis and treatment. They include: infrequency of bowel movements,
straining, pain, or unsatisfied defecation. In addition, a full record of
prescription and over-the-counter medications should be provided to the
What Is The Treatment For Constipation?
The first step in treating constipation is to understand that normal frequency
varies widely, from three bowel movements a day to three a week. Each person
must determine what is normal to avoid becoming dependent on laxatives.
For most people, dietary and lifestyle improvements can lessen the chances of
constipation. A well-balanced diet that includes fiber-rich foods, such as
unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is
recommended. Drinking plenty of fluids and exercising regularly will help to
stimulate intestinal activity. Special exercises may be necessary to tone up
abdominal muscles after pregnancy or whenever abdominal muscles are lax.
Bowel habits are also important. Sufficient time should be set aside to allow
for undisturbed visits to the bathroom. In addition, the urge to have a bowel
movement should not be ignored.
If an underlying disorder is causing constipation, treatment will be directed
toward the specific cause. For example, if an underactive thyroid is causing
constipation, the doctor may prescribe thyroid hormone replacement therapy.
In most cases, laxatives should be the last resort and taken only under a
doctor's supervision. A doctor is best qualified to determine when a laxative is
needed and which type is best. There are various types of oral laxatives, and
they work in different ways.
Above all, it is necessary to recognize that a successful treatment program
requires persistent effort and time. Constipation does not occur overnight, and
it is not reasonable to expect that constipation can be relieved overnight.
Prevention of Constipation
The frequency of bowel movements among healthy people varies from three
movements a day to three a week. Individuals must determine what is normal. As a
rule, constipation should be suspected if more than three days pass between
bowel movements or if there is difficulty or pain when passing a hardened stool.
Most people experience occasional short bouts of constipation, but if a laxative
is necessary for longer than three weeks, check with a doctor.
Doctors agree that prevention is the best approach to constipation. While there
is no way to ensure never experiencing constipation, the following guidelines
- Know what is normal and do not rely unnecessarily on laxatives.
Eat a well-balanced diet that includes unprocessed bran, whole-wheat grains,
fresh fruits and vegetables.
- Drink plenty of fluids.
- Exercise regularly.
Set aside time after breakfast or dinner for undisturbed visits to the toilet.
- Don't ignore the urge to defecate.
Whenever there is a significant or prolonged change in bowel habits, check
with a doctor.