Constipation is a reduction in stool production, commonly defined as having less than three bowel movements in a week. This intestinal complaint is extremely common and is a symptom of an underlying medical problem. Usually the cause of the problem is very easily treated and often a visit to a general practitioner can provide a patient with relief. In some cases, this condition is a sign of a more serious problem and it may be necessary to see a gastroenterologist or surgeon for appropriate treatment.
Frequency of defecation is highly variable. Some people poop multiple times a day, while others may produce a bowel movement every two days or so. Generally, fewer than three bowel movements a week are a cause for concern. People with constipation commonly have hard, dry stool and may experience painful defecation. In addition, there is often a feeling of fullness and a need to defecate, without being able to do so.
The leading cause of constipation is poor diet. People who do not eat enough fiber or are receiving inadequate fluids can develop constipation, and changing the diet should address the issue. Some medications are also linked with this symptom. Changing medications may be an option, or a patient may be provided with a stool softener or some dietary recommendations to treat the constipation, if it is necessary to stay on the medication.
More seriously, this problem can sometimes be a sign of a bowel obstruction preventing stool from passing through, such as a foreign object in the bowel or a kink in the bowel. It can also be associated with some diseases, such as dehydration, lupus, diabetes, and underlying gastrointestinal diseases. Stroke and paralysis can cause this symptom, as can using laxatives excessively, a problem sometimes seen in people with eating disorders. If the problem does not respond to conservative treatment, more aggressive medical evaluation may be recommended to see if there is a more serious medical issue going on.
Treatment for constipation usually starts with a patient interview and a physical examination, sometimes paired with X-rays to see what is happening inside the bowel. Based on this information, doctors can discuss medications, diets, and surgery, depending on the cause of the constipation. In some cases, impacted stool may need to be manually removed to address constipation, as sometimes seen when people try to withhold bowel movements and become constipated as a result. Clearing out the impacted feces may resolve the problem and allow the patient to defecate normally again.
Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including:
not eating enough fibre, such as fruit, vegetables and cereals
a change in your routine or lifestyle, such as a change in your eating habits
having limited privacy when using the toilet
ignoring the urge to pass stools
immobility or lack of exercise
not drinking enough fluids
being underweight or overweight
anxiety or depression
psychiatric problems brought on by sexual abuse, violence or trauma, for example
Sometimes, constipation may be a side effect of a medicine that you are taking. Common types of medication that can cause constipation include:
aluminium antacids (medicine to treat indigestion)
antidepressants
antiepileptics (medicine to treat epilepsy)
antipsychotics (medicine to treat schizophrenia and other mental health conditions)
calcium supplements
diuretics (water tablets)
iron supplements
If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless your GP advises you to.
Speak to your GP if you experience constipation due to a medicine. They may be able to prescribe an alternative.
About 40% of women experience some form of constipation during their pregnancy, mostly during the early stages of their pregnancy.
Constipation occurs during pregnancy as a result of hormonal changes. During pregnancy, your body produces more of the female hormone progesterone. This hormone acts as a muscle relaxant.
Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles that line the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.
If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby. See Treating constipation for more information about this.
Not having a bowel movement every day doesn't necessarily mean you're constipated. You likely have constipation, however, if you've had at least two of the following signs and symptoms for at least three of the past six months:
Pass fewer than three stools a week
Experience hard stools
Strain excessively during bowel movements
Experience a sense of rectal blockage
Have a feeling of incomplete evacuation after having a bowel movement
Need to use manual maneuvers to have a bowel movement, such as finger evacuation or manipulation of your lower abdomen
Although constipation may be bothersome, it's usually not serious. Most people who have constipation don't seek a doctor's care. However, chronic constipation may lead to complications or be a sign of a serious underlying disorder.
See your doctor if you experience an unexplained onset of constipation or change in bowel habits, or if symptoms are severe and last longer than three weeks. Also seek medical care if you experience any of the following signs or symptoms, which might indicate a more serious health problem:
Bowel movements occurring more than three days apart, despite corrective changes in diet or exercise
Intense abdominal pain
Blood in your stool
Constipation that alternates with diarrhea
Rectal pain
Thin, pencil-like stools
Unexplained weight loss
A diet low in fiber may play a role in constipation. Insoluble fiber, which passes through the body almost unchanged, gives stools bulk and a soft texture, making them easier to pass.
Foods that are high in insoluble fiber include whole grains, fruits, and vegetables. Try wheat bran, brown rice, or whole grain bread.
Soluble fiber dissolves in water and forms a gel-like substance in the intestines. Prunes and figs can be added to breakfast or eaten as a snack.
Another option is to sprinkle one teaspoon of ground flaxseeds over any meal. They can be found in packages at the health food store or some grocery stores. They have a mild, nutty taste.
Fiber supplements are also available, the most popular being psyllium husk supplements such as Metamucil.
Add fiber to your diet gradually to avoid bloating and gas. Also, be sure to drink enough water otherwise fiber can have the opposite effect and be constipating.
Making sure you drink enough fluids such as water may help some people with constipation. Fluids make bowel movements softer and easier to pass.
Watch your consumption of alcoholic beverages and caffeinated beverages such as coffee and cola drinks, which can be dehydrating.
Many herbal laxatives and "dieter's teas" are called stimulant laxatives, or anthranoid laxatives. They include herbs such as:
Cascara sagrada
Rhubarb
Aloe
Senna
Buckthorn
Some of these herbs, such as senna, are approved as over-the-counter treatments for constipation. Although they are meant to be short-term treatments, in reality, people can become dependent on them and use them for weeks, months, or even years at a time in order to have a daily bowel movement.
They should not be used for longer than a week unless under medical supervision. Prolonged use may cause the bowels to lose the ability to move on their own, and has been linked to chronic diarrhea, potassium depletion leading to muscle weakness and potentially dangerous irregular heart rhythms, and kidney or liver impairment.
Biofeedback therapy may help people with constipation resulting from pelvic floor dysfunction, a condition in which the pelvic floor muscles do not function properly. It occur as a result of conditions such as obesity, an enlarged prostate, or after childbirth.
Biofeedback therapists teach how to better coordinate muscles used to defecate. Approximately 70% of people have improved symptoms after biofeedback training.
Although biofeedback has only been explored as a treatment for this type of constipation relatively recently, results are promising.
For example, one study compared biofeedback (one session a week for five weeks) to laxatives (polyethylene glycol 14.6 to 29.2 grams per day) plus education in people with chronic, severe pelvic floor dysfunction. All participants had previously tried fiber supplements plus enemas or suppositories but hadn't responded.
After six months, biofeedback sessions were more effective than the laxative, with 43 of 54 (80%) of the biofeedback patients versus 12 of 55 (22%) laxative-treated patients reporting major improvements. Benefits appeared to last at least two years.
Probiotics, such as lactobacillus acidophilus, are live microbial organisms that are naturally present in the digestive tract. Some of the ways they are thought to promote health include suppressing the growth of potentially harmful bacteria, improving immune function, enhancing the protective barrier of the digestive tract, and helping to produce vitamin K.
There is some preliminary evidence that probiotic supplements may improve constipation. For example, one study looked at the effect of a probiotic beverage containing a strain of beneficial bacteria called Lactobacillus casei Shirota (65 milliliters a day) or a placebo in people with chronic constipation. The probiotic drink resulted in significant improvement in severity of constipation and stool consistency.
Another study examined the effectiveness of another strain of probiotics on constipation in children and found no effect. Eighty four children between two and 16 years of age with constipation took lactulose (a laxative) plus a probiotic supplement containing lactobacillus GG or lactulose alone. After 12 and 24 weeks, lactobacillus was not more effective than lactulose alone at treating constipation.
Acupressure is a traditional healing practice that involves the application of finger pressure to specific acupuncture points on the body.
A point that is often recommended by acupuncturists for constipation is Large Intestine. Although it hasn't been studied for constipation, it is a simple home remedy that may work for some people. The point is at the highest spot of the muscle between the thumb and index finger when they are brought close together. Caution: do not use this point if you are pregnant.
With your thumb or middle finger at a 90 degree angle to the skin, apply gradually increasing pressure. Hold for three minutes. The pressure should not be painful or uncomfortable.
A deficiency of the mineral magnesium may contribute to constipation. Magnesium is found naturally in foods such as green leafy vegetables, nuts, seeds, and whole grains and in supplements.
Magnesium is needed for normal muscle function, including intestinal muscles. One recent study examined the intake of magnesium with constipation in 3835 women. Low magnesium intake was associated with constipation.