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Constipation

What Is ? - Anal fissures – small tears in your anus that may cause

itching, pain, or bleeding. Constipation is a condition in which you typically have: - Fewer than three movements a week - – when your slips so it sticks out of - Bowel movements with stools that are hard, dry, and your anus. Rectal prolapse can if you strain during bowel small, making them painful or difficult to pass movements, among other reasons. Rectal may cause mucus to leak from your anus. Rectal prolapse is most common in Some people think they are constipated if they don’t older adults with a history of constipation and is also more have a bowel movement every day. However, people common in women than men. have different bowel movement patterns. Some people may have three bowel movements a day. Other people What Are the Symptoms of Constipation? may only have three bowel movements a week. The most common symptoms of constipation are: - Fewer than normal bowel movements Constipation most often lasts for only a short time and is - Stool that is difficult or painful to pass not dangerous. You can take steps to prevent or relieve - Pain or in the abdomen constipation What Causes Constipation? How Common Is Constipation? Constipation can happen for many reasons, and Constipation is one of the most common gastrointestinal constipation may have more than one cause at a time. (GI) problems, affecting about 42 million people in the Among the most common causes of constipation are: United States. Diets Low in Fiber Who Is More Likely to Become Constipated? Fiber helps the stool stay soft. Drinking liquids also Constipation is common among all ages and populations helps keep the stool soft. in the United States, yet certain people are more likely to become constipated, including: Older Age - Women, especially during pregnancy or after birth Older adults commonly have constipation because of - Older adults limited , lack of physical activity, and - Non-Caucasians . - People with lower incomes - People who just had Lack of Physical Activity - People taking painkillers, antidepressants, and many If you don’t exercise or move around regularly you other medications may get constipated. For example, people may be less active because they: What Are the Complications of Constipation? - Have other health problems - Sit all day and don’t exercise regularly Chronic, or long-lasting, constipation can lead to health - Have to stay in bed most of the time because of problems such as , anal fissures, rectal an illness prolapse, or fecal impaction. Medicines - Hemorrhoids – swollen and inflamed veins around your Some medicines that doctors prescribe to treat other anus or in your lower rectum. You can develop hemorrhoids if you strain to have a bowel movement. If health problems can cause constipation. Medicines you have hemorrhoids, you may have bleeding in your that can cause constipation include: rectum. You have bleeding in the rectum when you see - Antacids – used to neutralize stomach acid—that bright red blood in your stool, on toilet paper, or in the contain aluminum and calcium toilet

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- Anticholinergics — used to treat muscle spasms common functional GI disorder, and many people in the intestines, bladder, and prostate with IBS can have IBS with constipation. - Anticonvulsants — used to decrease abnormal electrical activity in the brain to prevent seizures How do doctors diagnose Constipation? - Antispasmodics — used to reduce muscle spasms Doctors diagnose constipation by: in the intestines - Taking a medical history - Diuretics — used to help the kidneys remove fluid - Performing a physical Exam from the blood - Performing diagnostic tests (blood test) - Iron supplements — used to build up higher iron levels in the blood Medical History will include questions about your - Narcotics — used to treat severe pain constipation, such as: - Some medicines used to treat depression - Medicines used to treat Parkinson’s disease - How often you have a bowel movement - Cardiac medications - How long you have symptoms - What your stools look like and whether you Life Changes or Daily Routine Changes have blood in your stool Constipation can happen when your life or daily - Your eating habits routine changes. For example, your bowel - Your level of physical activity movements can change: - The medicines you take - When you travel - If you become pregnant Physical Exam may include a rectal exam. During a - As you get older rectal exam, your doctor will have you over a table or lie on your side while holding your knees close to Ignoring the Urge to Have a Bowel Movement your chest. After putting on a glove, the doctor If you ignore to have the urge to have a bowel slides a lubricated finger into your anus to check for movement, over time, you may stop feeling the need tenderness, blockage, or blood. to have one. You may delay having a bowel movement because you do not want to use toilets Blood Tests – a health care may take a blood sample outside of your home, do not have access to a toilet, from you to test for certain conditions that can or you may feel you are too busy. This habit can lead cause constipation, such as anemia or to constipation.

Certain Health Problems Flexible Sigmoidoscopy or Colonoscopy Some health problems can make stool move more Although the tests are similar, doctors use a slowly through your colon and cause constipation. colonoscopy to view your rectum and entire colon, These health problems include: while they use a flexible sigmoidoscopy to view just - Parkinson’s disease your rectum and lower colon. - Spinal cord or brain injuries - - Hypothyroidism

Gastrointestinal (GI) Tract Problems Problems in your GI tract that compress or narrow your colon and rectum can cause constipation. These problems include: - Tumors - Inflammation, swelling, such as or Inflammatory Bowel Disease

Functional GI Disorders Functional GI disorders happen when your GI tract behaves in an abnormal way, yet without evidence of damage due to a disease. For example, IBS is a

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soften stool. Older adults and people with heart or How do doctors treat Constipation? kidney failure should be careful when taking osmotic agents. They can cause or mineral Treatment for constipation depends on: imbalance. Brand names include: 1. What’s causing your constipation - Cephulac 2. How bad your constipation is - Miralax 3. How long you’ve been constipated - Milk of Magnesia - Sorbitol Treatment for constipation may include the following: Stool softeners - help mix fluid into stools to soften them. Doctors recommend stool softeners for people who Changes in Eating, Diet, and Nutrition: strain while having a bowel movement. Brand names These changes include: include: - Drinking liquids throughout the day - Colace - Eating more fruits and vegetables - Docusate - Eating more fiber or taking fiber supplements - Surfak Lubricants - work by coating the surface of stool, which Exercise and Lifestyle Changes: helps the stool hold in fluid and pass more easily. Exercising every day may help prevent and relieve Lubricants are simple, inexpensive . Doctors may constipation. Picking a specific time of day may help you recommend lubricants with anorectal blockage. Brand have a bowel movement regularly. Eating helps your names include: colon move stool. Make sure you give yourself enough - Fleet time to have a bowel movement. You should also use the - Zymenol bathroom as soon as you feel the urge to have a bowel If these laxatives don’t work for you. Your doctor may movement. recommend other types of laxatives, including: - Correctol Over-the-Counter (OTC) Medicines - Dulcolax Your doctor may suggest using a for a short time - Senokot if you’re doing all the right things and are still If you’ve been taking laxatives for a long time and can’t constipated. OTC laxatives come in many forms, including have a bowel movement without taking a laxative, over liquid, tablet, capsule, prodder, and granules. time, your colon should start moving stool normally.

If you’re taking an OTC or prescription medicine or Prescription Medicines supplement that can cause constipation, your doctor If OTC medicines do not relieve your symptoms, your may suggest you stop taking it or switching to a different doctors may prescribe one of the following for IBS or one. unknown constipation:

Bulk-Forming Agents - absorb fluid in your intestines, - Chloride Channel Activator - Lubiprostone (Amitiza) making your stool bulkier. Bulkier stool helps trigger the This increases fluid in your GI tract, bowel to contract and push stool out. Be sure to take which helps to: bulk-forming agents with water or they can cause an - Reduce discomfort in your abdomen obstruction or a blockage in your bowel. They can cause - Make your stool softer bloating and pain in your abdomen. Brand names - Prevent strain include: - Increases bowel movements - Citrucel - FiberCon - Guanylate Cyclase-C Agonist - Linaclotide (Linzess) & - Metamucil Plecanatide (Trulance) - Serutan These medications ease pain in your abdomen and speeds up how often you have bowel movements Osmotic Agents - help stool retain fluid. Stools with more fluid increase your number of bowel movements and

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How can my diet help prevent constipation? Examples of Foods That Have Fiber 3 Beans, cereals, and breads Fiber You can drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in your ½ cup of beans (navy, pinto, kidney, etc.), 6.2–9.6 diet work better. This change should make your stools cooked grams more normal and regular. Ask your doctor about how 2.7-3.8 ½ cup of shredded wheat, ready-to-eat cereal much you should drink each day based on your health and grams activity level and where you live. ⅓ cup of 100% bran, ready-to-eat cereal 9.1 grams

Depending on their age and sex, adults should get 22 to 34 1 small oat bran muffin 3.0 grams grams of fiber a day.3 Older adults sometimes don’t get enough fiber in their diets, because they may lose interest 1 whole-wheat English muffin 4.4 grams in food. Fruits 1 small apple, with skin 3.6 grams Talk with your doctor to plan a diet with the right amount 1 medium pear, with skin 5.5 grams of fiber for you. Be sure to add fiber to your diet a little at a ½ cup of raspberries 4.0 grams time so that your body gets used to the change. ½ cup of stewed prunes 3.8 grams

Use this table as a tool to help replace less healthy foods Vegetables with foods that have fiber. ½ cup of winter squash, cooked 2.9 grams 1 medium sweet potato, baked in skin 3.8 grams What should I avoid eating if I'm constipated? 3.5-4.4 ½ cup of green peas, cooked grams If you’re constipated, try not to eat too many foods with 1 small potato, baked, with skin 3.0 grams little or no fiber, such as ½ cup of mixed vegetables, cooked 4.0 grams 2.6-2.8 - cheese ½ cup of broccoli, cooked grams - chips - fast food ½ cup of greens (spinach, collards, turnip 2.5-3.5 - ice cream greens), cooked grams - meat - prepared foods, such as some frozen meals and snack foods - processed foods, such as hot dogs or some microwavable dinners

More information

All info regarding this handout was obtained from the National Institute of Diabetes and Digestive and Kidney Diseases. Please visit this web address below for more detailed information regarding Constipation.

https://www.niddk.nih.gov/health-information/digestive- diseases/constipation

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