Constipation

ARTICLE SECTIONS

Introduction

Constipation is a common digestive system problem in which you have infrequent bowel movements, pass hard stools, or strain during bowel movements.

In terms of frequency, what constitutes constipation for one person may be normal for someone else. That's because the normal frequency of bowel movements varies widely - from three a day to three a week. What's normal for you may not be normal for someone else.

In general, though, you're probably experiencing constipation if you pass hard and dry stools less than three times a week. In some cases, constipation also may make you feel bloated or sluggish or experience discomfort or pain.

Fortunately, a few common-sense lifestyle changes, including getting more exercise, eating high-fibre foods and drinking plenty of water, can go a long way toward preventing or alleviating constipation.

Definition

Constipation is often regarded as a trivial symptom, however for patients it can be a major disability. It is a symptom which means different things to different people, and the term has been shown to be ambiguous and misleading. To some it implies stools that are too small, too hard, difficult to expel, while to others it refers to prolonged and repeated attempts at defecation, and even the need for digital assistance. Attention has been drawn to the importance of stool weight and transit time. However since these parameters are difficult to assess, stool frequency remains a common guide. 

Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others.

At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.

Who Gets Constipated?

Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. However, most people treat themselves without seeking medical help, as is evident from the $725 million Americans spend on laxatives each year.

The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Figure 2 lists the most common causes of constipation.

Common Causes of Constipation Not enough fibre in diet Not enough liquids Lack of exercise Medications Irritable bowel syndrome Changes in life or routine such as pregnancy, older age, and travel Abuse of laxatives Ignoring the urge to have a bowel movement Specific diseases such as multiple sclerosis and lupus Problems with the colon and rectum Problems with intestinal function (Chronic idiopathic constipation).

Diet

Fiber--soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

On average, Americans eat about 5 to 20 grams of fiber daily, short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods in which the natural fiber is removed.

A low-fiber diet also plays a key role in constipation among older adults. They often lack interest in eating and may choose fast foods low in fiber. In addition, loss of teeth may force older people to eat soft foods that are processed and low in fiber.

Not Enough Liquids

Lack of Exercise

Medications

Changes in Life or Routine

Abuse of Laxatives

Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

Ignoring the Urge to Have a Bowel Movement

Specific Diseases

Figure 3

Diseases That Cause Constipation Neurological disorders that may cause constipation include: Multiple sclerosis Parkinson's disease Chronic idiopathic intestinal pseudo-obstruction Stroke Spinal cord injuries. Metabolic and endocrine conditions include: Diabetes Underactive or overactive thyroid gland Uremia. Systemic disorders include: Amyloidosis Lupus Scleroderma.

Problems with the Colon and Rectum

Problems with Intestinal Function (Chronic Idiopathic Constipation)

Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the left or lower (sigmoid) colon.

Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.

Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition is known as rectal prolapse and may lead to secretion of mucus from the anus. Usually, eliminating the cause of the prolapse such as straining or coughing is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.

Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers in the anus.

Diagnostic and Treament (next page)

Additional Resources

Intestinal Disease Foundation
1323 Forbes Avenue, Suite 200
Pittsburgh, PA 15219
(412) 261-5888

Further reading:

Constipation(National Institute of Diabetes and Digestive and Kidney Diseases)

Constipation: Keeping Your Bowels Moving Smoothly(American Academy of Family Physicians)