What Is It?

Under normal circumstances, stool should be passed easily without much straining or discomfort, and bowel movements should occur at fairly regular intervals. Although the normal frequency of bowel movements varies from person to person, about 95 percent of healthy adults have a pattern that ranges from three times a day to three times a week.

In constipation, bowel movements either occur less often than expected or the stool is hard, dry and difficult to pass. In most cases, someone who suffers from constipation has no underlying illness or digestive disorder. Instead, the problem is related to diet, lifestyle, medications (including the overuse of laxatives) or some other factor that either is hardening the stool or is interfering with its ability to pass comfortably. Some common triggers of constipation in adults include:

• A diet low in fiber — Although you need about 25 to 30 grams of fiber every day to soften the stool and encourage proper bowel function, most American diets contain less than half that amount.
  
  
• Inadequate fluid intake — To help prevent stools from becoming dry and hard, your daily fluid intake should be equivalent to at least six to eight glasses of water. This amount includes fluids found in milk, juice and other beverages, as well as in fruits, soups and stews.
  
  
• A sedentary lifestyle — Because regular exercise is necessary to promote normal muscle contractions in the bowel wall, having a sedentary job or rarely exercising puts you at high risk of constipation.
  
  
• Ignoring the urge to defecate — Sometimes, because of a busy schedule or limited access to restrooms, a person ignores the urge to defecate. Over time, postponing bathroom trips until a more convenient time can lead to constipation
  
  
• Travel and scheduling factors — Travel can promote constipation by changing the character of your diet, interfering with the normal timing of your meals, and limiting your access to restrooms.
  
  
• Laxative overuse — Long-term use of over-the-counter laxatives can teach your bowel to rely on these medicines, eventually causing constipation rather than relieving it.
  
  
• A side effect of medications — Constipation can occur as a side effect of many different prescription and nonprescription medications, including iron supplements and vitamins that contain iron; calcium supplements; antacids that contain aluminum; psychiatric medications, including antidepressants and tranquilizers; narcotic pain killers; general anesthesia; diuretics; and certain prescription drugs used to treat hypertension, especially verapamil (sold under several brand names), seizure disorders or Parkinson’s disease.
  
  
• Local pain or discomfort around the anus — An anal fissure (small tear in the skin around the anus) or hemorrhoids can make bowel movements painful or uncomfortable. To avoid this, a person may resist the urge to defecate.

Less often, constipation may be a symptom of some underlying illness or condition that either affects the digestive tract alone or involves larger portions of the body. Some examples include irritable bowel syndrome, intestinal obstruction, diverticulitis, colorectal cancer, hypothyroidism, hypercalcemia (abnormally high blood calcium levels), multiple sclerosis, Parkinson’s disease and spinal cord injury.

Constipation is a very common problem that affects at least 80 percent of people at some time during their lives. Currently in the United States, treatment for constipation accounts for more than 2.5 million visits to doctors’ offices each year, with at least $800 million spent annually for laxatives. Although adults of all ages can suffer from constipation, the risk of this problem increases dramatically after age 65 in both men and women.

In rare cases, long-term constipation progresses to fecal impaction, the accumulation of a very large amount of stool that cannot be passed voluntarily. In most cases, the impacted stool lies in the rectum alone, but about 30 percent of those affected have larger stool accumulations that extend further in the colon. Fecal impaction is a fairly common complication of long-term constipation in the elderly and bedridden, occurring in about 30 percent of all nursing home residents. It also occurs in people who have colorectal cancer, rectocele, hypothyroidism, hypercalcemia or neurological conditions, such as spinal cord injuries, stroke, multiple sclerosis or Parkinson’s disease.

Symptoms of constipation include:

• Fewer than three bowel movements per week
• Small, hard, dry stools that are difficult or painful to pass
• The need to strain excessively to have a bowel movement
• A feeling that your rectum is not empty after a bowel movement
• Frequent use of enemas, laxatives or suppositories

Symptoms of fecal impaction include:

• Passing stool involuntarily because of liquid stool leaking around the impacted mass of feces (can be mistaken for diarrhea)
• Abdominal pain, especially after meals
• A persistent urge to move the bowels
• Nausea and vomiting
• Headache
• Poor appetite, weight loss
• Malaise (a generally sick feeling)
• If the problem is not treated, dehydration, rapid pulse, rapid breathing, fever, agitation, confusion and urinary incontinence

Most people with simple constipation can diagnose and treat themselves. If you suffer from constipation, begin by examining your lifestyle. Review your current diet, your level of daily exercise, and your bowel habits. In particular, do you often ignore the urge to have a bowel movement because it is inconvenient? Then follow the suggestions for dealing with uncomplicated constipation as described in the Prevention and Treatment sections below. If these suggestions do not relieve your problem, contact your doctor.

If you have constipation together with rectal bleeding, abdominal pain or abdominal distention, contact your doctor immediately. Your doctor may wish to see you for further evaluation, including a brief physical exam and digital rectal examination.

If your doctor suspects that you have a fecal impaction, he or she will confirm the diagnosis by examining your abdomen and by checking for a mass of impacted feces during the digital rectal exam. Blood tests, plain abdominal X-rays, a barium enema or sigmoidoscopy (in which a special instrument is used to view the lower colon) also may be necessary.

The duration of constipation depends on its cause. In most otherwise healthy adults, constipation improves gradually within a few weeks after they increase their intake of dietary fiber and fluid and begin exercising regularly. However, constipation in bedridden people with neurological problems can recur and become a risk for fecal impaction.

In many cases, you can prevent constipation by taking the following steps:

• Add more fiber to your diet — Set a dietary goal of 25 to 30 grams of fiber daily. Choose from a variety of high-fiber foods such as beans, broccoli, carrots, bran, whole grains and fresh fruits. To avoid bloating and gas, add these foods gradually over a period of several days.
  
  
• Drink adequate amounts of fluid — For most healthy adults, this is the equivalent of six to eight glasses of water daily.
  
  
• Begin a program of regular exercise — As little as 20 minutes of brisk walking daily can stimulate your bowel function.
  
  
• Help train your digestive tract to have regular bowel movements — Schedule a 10-minute period to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal.
  
  
• Do not postpone having a bowel movement until the time is more convenient — Respond to the urge immediately.

If you suffer from mild, uncomplicated constipation, you can begin by following all of the measures described in the Prevention section above. If these suggestions do not work, you may try an over-the-counter stool softener or suppository to relieve occasional constipation. Always follow the dosage instructions exactly as written on the labels of these nonprescription constipation remedies. These remedies should not be used regularly unless your doctor has ordered it.

If you have fecal impaction, your doctor may remove at least part of the fecal mass manually by using a lubricated, gloved finger inserted in the rectum. The rest of the mass usually can be removed with an enema, or by using water irrigation through a sigmoidoscope. Once the impacted stool is removed, your doctor will have you follow a high-fiber diet and take stool-softening medication to promote regular bowel movements.

Call your doctor immediately if your bowel movements stop suddenly and completely, and you develop abdominal pain or distention. Also contact your doctor immediately whenever constipation occurs together with any rectal bleeding.

Call your doctor for advice if constipation persists, or if you need over-the-counter preparations regularly to assist with bowel function.

The prognosis is excellent, because the majority of people who suffer from constipation have no underlying digestive disease. Most can achieve normal bowel function through diet and lifestyle changes.

The prognosis for most people with fecal impaction is good. However, those who are bedridden must be monitored carefully to ensure that bowel movements are regular and that stool does not accumulate in the rectum again. A long-term program of mild laxatives, periodic enemas or both may be necessary.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.