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Constipation

Aria Health Center for Gynecology & Women's Health

Constipation is a condition in which a person experiences difficult or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week, but this is only a very approximate standard. Nearly everyone experiences constipation at one time or another. However, there is no standard number of bowel movements per day or per week that is normal. The point at which persons are constipated differs for each individual according to his or her normal bowel habits are patterns. Some people also naturally have stool with a firmer consistency than others.

Constipation is the most common significant gastrointestinal complaint, experienced by millions of people in the U.S. every year and resulting in millions of physician visits. Constipation can cause complications such as hemorrhoids, which occur as a result of muscular straining during bowel movement, or anal fissures (tears in the skin around the anus) that occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding.

Sometimes, straining also causes rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening. Constipation may also cause fecal impaction, which occurs mostly in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.

Causes/risk factors

Hard, dry stools are the result of the colon absorbing too much water out of the fecal matter. Normally, as food moves through the colon (also known as the large intestine) the intestinal wall absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.

When the colon's muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. The removed water and the muscular contractions of the colon cause the stool to become compressed and thus harder. Compacted stool can also result from systemic dehydration. Other factors that can contribute to constipation include:

  • medications;
  • lack of exercise;
  • not enough fiber in the diet;
  • irritable bowel syndrome;
  • ignoring the urge to have a bowel movement;
  • changes in habits or lifestyle, such as travel, pregnancy, and old age;
  • problems with intestinal function;
  • dysfunction of pelvic muscles
  • hormonal disturbances;
  • neurologic, metabolic/endocrine, or system diseases;
  • abuse of laxatives.

Constipation is more common in women, children, and older adults. It is also a complaint associated with pregnancy.


Signs & symptoms

Common symptoms of constipation are:

  • difficult and painful bowel movements;
  • bowel movements less often than three times a week;
  • feeling bloated or uncomfortable in the lower abdomen;
  • pain or cramping in the abdomen;
  • feeling sluggish.


Diagnosis

In addition to a medical history and physical examination, diagnostic procedures for constipation can include the following:

  • abdominal x-ray;
  • barium, lower-GI x-ray (lower GI series or barium enema);
  • and colonoscopy or sigmoidoscopy.


Treatment

Acute, sudden stoppage of bowel movements may need quick medical evaluation and intervention. Most constipation, however, is of a milder, chronic, intermittent type.

Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms and help prevent the condition. Treatment may include:

  • diet modifications. A diet with 20 to 35 grams of fiber daily helps in forming soft, bulky stool. Adding foods such as beans, whole grains, bran cereals, fresh fruits, and vegetables is helpful for increasing fiber to the diet. Limiting foods such as ice cream, cheeses, meats, and processed foods, which contain little or no fiber can also be helpful.
  • lifestyle changes. Increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements can also help to mitigate constipation.
  • laxatives. Your doctor may prescribe laxatives if diet and lifestyle changes have not produced adequate relief of symptoms. These may be bulk-forming laxatives, lubricant laxatives, emollient (stool softening) laxatives, or stimulant laxatives, among others.
  • eliminating or changing medication.
  • biofeedback. This technique treats chronic constipation caused by anorecta dysfunction. Biofeedback is a technique for retraining the muscles that control release of stool.

For an impacted bowel that does not resolve with noninvasive steps, a medical enema is sometimes necessary.