Constipation

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:

• Not enough fluid intake
• Overuse of laxative medicines
• Too little exercise
• Bed rest
• Certain medications, including:
  
  • Pain relievers
  • Narcotics
  • Aluminum-containing antacids
  • Antidepressant and antipsychotic medications
  • Medications for epilepsy and Parkinson's disease
  • Antispasmodic medications
  • Tranquilizers
  • Iron supplements
  • Calcium channel blockers
• Frequently delaying the need to have a bowel movement
• Pregnancy
• Diabetes
• Spasm of the anal sphincter, due to painful anal fissures or hemorrhoids
• Underactive thyroid
• Irritable bowel syndrome (periods of constipation may alternate with episodes of diarrhea)
• Neurological diseases such as:
  
  • Parkinson's disease
  • Multiple sclerosis
  • Stroke
  • Spinal cord injuries
  • Spinal cord tumors
• Scleroderma
• Systemic lupus erythematosus
• Intestinal disorders, including:
  
  • Scarring
  • Tumors
  • Cancer
  • Inflammation
• Travel, due to schedule changes, stress, and poor diet

Risk Factors

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

• Advancing age
• Sedentary lifestyle
• Prolonged bed rest due to surgery or an accident
• Diet that is high in fat and sugar, and 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
• Digital rectal exam—examination of the rectum with the doctor's gloved, lubricated finger inserted into your rectum
• Blood tests
• Abdominal x-rays
• Barium enema x-ray —enema 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

Treatment

Treatment may include:

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-ounce 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.