Constipation National Digestive Diseases Information Clearinghouse Constipation is defined as having a bowel movement fewer than three times per week. Large intestine (colon) With constipation stools are usually hard, dry, small in size, and difficult to eliminate. National Stomach Institute of Some people who are constipated find it Diabetes and painful to have a bowel movement and Digestive often experience straining, bloating, and the and Kidney Small Diseases sensation of a full bowel. intestine NATIONAL Some people think they are constipated if INSTITUTES OF HEALTH they do not have a bowel movement every day. However, normal stool elimination Illeum may be three times a day or three times a week, depending on the person. Constipation is a symptom, not a disease. Rectum Sigmoid Almost everyone experiences constipation Anus at some point in their life, and a poor diet colon typically is the cause. Most constipation is Lower digestive system temporary and not serious. Understanding its causes, prevention, and treatment will Self-treatment of constipation with over- help most people find relief. the-counter (OTC) laxatives is by far the most common aid. Around $725 million Who gets constipated? is spent on laxative products each year in America. Constipation is one of the most common gastrointestinal complaints in the United States. More than 4 million Americans What causes constipation? have frequent constipation, accounting To understand constipation, it helps to for 2.5 million physician visits a year. know how the colon, or large intestine, Those reporting constipation most often works. As food moves through the colon, are women and adults ages 65 and older. the colon absorbs water from the food while Pregnant women may have constipation, it forms waste products, or stool. Muscle and it is a common problem following child­ contractions in the colon then push the birth or surgery. stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed. U.S. Department of Health and Human Services Constipation occurs when the colon absorbs Americans eat an average of 5 to 14 grams too much water or if the colon’s muscle con­ of fiber daily,* which is short of the 20 to 35 tractions are slow or sluggish, causing the grams recommended by the American stool to move through the colon too slowly. Dietetic Association. Both children and As a result, stools can become hard and dry. adults often eat too many refined and Common causes of constipation are processed foods from which the natural fiber has been removed. • not enough fiber in the diet • lack of physical activity (especially in A low-fiber diet also plays a key role in con­ the elderly) stipation among older adults, who may lose interest in eating and choose foods that are • medications quick to make or buy, such as fast foods, or • milk prepared foods, both of which are usually • irritable bowel syndrome low in fiber. Also, difficulties with chewing • changes in life or routine such as preg­ or swallowing may cause older people to nancy, aging, and travel eat soft foods that are processed and low in fiber. • abuse of laxatives • ignoring the urge to have a bowel Not Enough Liquids movement Research shows that although increased • dehydration fluid intake does not necessarily help relieve constipation, many people report • specific diseases or conditions, such as some relief from their constipation if they stroke (most common) drink fluids such as water and juice and • problems with the colon and rectum avoid dehydration. Liquids add fluid to the • problems with intestinal function colon and bulk to stools, making bowel (chronic idiopathic constipation) movements softer and easier to pass. People who have problems with constipation should Not Enough Fiber in the Diet try to drink liquids every day. However, liq­ People who eat a high-fiber diet are less uids that contain caffeine, such as coffee and likely to become constipated. The most cola drinks will worsen one’s symptoms by common causes of constipation are a diet causing dehydration. Alcohol is another low in fiber or a diet high in fats, such as beverage that causes dehydration. It is cheese, eggs, and meats. important to drink fluids that hydrate the body, especially when consuming caffeine Fiber—both soluble and insoluble—is the containing drinks or alcoholic beverages. part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves *National Center for Health Statistics. Dietary Intake easily in water and takes on a soft, gel-like of Macronutrients, Micronutrients, and Other Dietary texture in the intestines. Insoluble fiber Constituents: United States, 1988–94. Vital and passes through the intestines almost Health Statistics, Series 11, Number 245. July 2002. unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass. 2 Constipation Lack of Physical Activity Abuse of Laxatives A lack of physical activity can lead to The common belief that people must constipation, although doctors do not know have a daily bowel movement has led to self- precisely why. For example, constipation medicating with OTC laxative products. often occurs after an accident or during an Although people may feel relief when they illness when one must stay in bed and can­ use laxatives, typically they must increase not exercise. Lack of physical activity is the dose over time because the body grows thought to be one of the reasons constipa­ reliant on laxatives in order to have a bowel tion is common in older people. movement. As a result, laxatives may become habit-forming. Medications Some medications can cause constipation, Ignoring the Urge to Have a including Bowel Movement • pain medications (especially narcotics) People who ignore the urge to have a bowel movement may eventually stop feeling the • antacids that contain aluminum need to have one, which can lead to consti­ and calcium pation. Some people delay having a bowel • blood pressure medications (calcium movement because they do not want to use channel blockers) toilets outside the home. Others ignore the • antiparkinson drugs urge because of emotional stress or because they are too busy. Children may postpone • antispasmodics having a bowel movement because of stress­ • antidepressants ful toilet training or because they do not • iron supplements want to interrupt their play. • diuretics • anticonvulsants Changes in Life or Routine During pregnancy, women may be consti­ pated because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addi­ tion, people often become constipated when traveling, because their normal diet and daily routine are disrupted. 3 Constipation Specific Diseases Problems with Intestinal Diseases that cause constipation include Function neurological disorders, metabolic and The two types of constipation are idiopathic endocrine disorders, and systemic condi­ constipation and functional constipation. tions that affect organ systems. These Irritable bowel syndrome (IBS) with pre­ disorders can slow the movement of stool dominant symptoms of constipation is cate­ through the colon, rectum, or anus. gorized separately. Conditions that can cause constipation are Idiopathic (of unknown origin) constipation found below. does not respond to standard treatment. • Neurological disorders Idiopathic constipation may be related to problems with intestinal function, including – multiple sclerosis hormonal control, nerve, and muscle prob­ – Parkinson’s disease lems in the colon, rectum, or anus. – chronic idiopathic intestinal pseudo- Functional constipation means that the obstruction bowel is healthy but not working properly. – stroke It is not caused by organic (occurring natu­ – spinal cord injuries rally in the body) disease. Functional con­ stipation is often the result of poor dietary • Metabolic and endocrine conditions habits and lifestyle. It occurs in both chil­ – diabetes dren and adults and is most common in – uremia women. Colonic inertia, delayed transit, – hypercalcemia and pelvic floor dysfunction are three types of functional constipation. Colonic inertia – poor glycemic control and delayed transit are caused by a decrease – hypothyroidism in muscle activity in the colon. These syn­ • Systemic disorders dromes may affect the entire colon or may – amyloidosis be confined to the lower, or sigmoid, colon. – lupus Pelvic floor dysfunction is caused by a weak­ – scleroderma ness of the muscles in the pelvis surround­ ing the anus and rectum. However, because Problems with the Colon this group of muscles is voluntarily con­ and Rectum trolled to some extent, biofeedback training is somewhat successful in retraining the Intestinal obstruction, scar tissue (adhe­ muscles to function normally and improving sions), diverticulosis, tumors, colorectal the ability to have a bowel movement. stricture, Hirschsprung’s disease, or cancer can compress, squeeze, or narrow the intes­ Functional constipation that stems from tine and rectum and cause constipation. problems in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal mus­ cles that allow stool to exit. People with IBS having predominantly con­ stipation also have pain and bloating as part of their symptoms. 4 Constipation How is the cause of Physical Examination constipation identified? A physical exam may include a rectal exam with a gloved, lubricated finger to evaluate The tests the doctor performs depend on the tone of the muscle that closes off the the duration and severity of the constipa­ anus (anal sphincter) and to detect tender­ tion, the person’s age, and whether blood ness, obstruction, or blood. In some cases, in stools, recent changes in bowel habits, or blood and thyroid tests may be necessary to weight loss have occurred. Most people look for thyroid disease and serum calcium with constipation do not need extensive or to rule out inflammatory, metabolic, and testing and can be treated with changes in other disorders.