Constipation is infrequent and/or uncomfortable bowel movements. Stool is often hard and dry. This is a common gastrointestinal complaint.
Constipation has many causes, including:
Not enough fluid intakeOveruse of laxative medicationsToo little exerciseLengthy bed rest
Certain medications, including:
Pain relieversNarcoticsAluminum-containing antacidsAntidepressant and antipsychotic medicines
Antispasmodic medicationsIron supplementsCalcium channel blockersFrequently delaying the need to have a bowel movementPregnancyDiabetes
Spasm of the anal sphincter; due to painful
hemorrhoidsUnderactive thyroidIrritable bowel syndrome—periods of constipation may alternate with episodes of
Neurological diseases such as:
Parkinson's diseaseMultiple sclerosisStrokeSpinal cord injuries or tumors
Intestinal disorders, including:
ScarringTumorsCancerInflammationTravel due to schedule changes, stress, and poor diet
Constipation is more common in people of increased age.
Risk factors include:
Sedentary lifestyleProlonged bed rest due to surgery or an accidentDiet that is high in fat and sugar and low in fiber
Abdominal painSensation of abdominal fullnessRectal pain and pressureDifficulty passing stool, despite strainingHard, dry, small stoolSensation of retained stool after defecating
Call your doctor if you:
Have constipation that lasts longer than 2-3 weeksHave a painful or swollen abdomenHave nausea or vomitingHave signs of an infection, such as fever or chillsHave pain or burning in anal area with or without bowel movementHave blood in your stool or black stoolThink that your prescription medication is causing constipationAre losing weight
You will be asked about your symptoms and medical history. A physical exam will be done. It may include a digital rectal exam of the rectum with the doctor's gloved, lubricated finger inserted into your rectum.
Your bodily fluids may be tested. This can be done with blood tests.
Your bodily structures may need to be viewed. This can be done with:
x-rayBarium enemaFlexible sigmoidoscopy or colonoscopy
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Treatment may include:
Talk to your doctor about what is a normal frequency of bowel movements for you. The range of normal is quite broad. Some people have several stools a day. Others have one stool every several days.
Eat a healthy, balanced diet that is
high in fiber
and includes foods such as unprocessed bran, whole-wheat grains, fresh fruit, and cereals. Eating prunes may also improve bowel movements.
Limit your intake of processed and fatty foods.Exercise
Drink plenty of water each day.
Regularly using laxatives or enemas can be habit forming. Your bowels can become used to these products and require them to produce a stool. Stool softeners, though, are not habit-forming. Ask your doctor about how often and for how long to use these products.
Examples of medications include:
Polyethylene glycol 3350—a type of laxative
Psyllium—a bulk laxative
Docusate—a stool softener
Lactulose—a type of laxative
Lubiprostone—a medication that increases fluid in stool
Botulism injections—may be used to treat certain types of constipation
Set aside the same time each day to move your bowels. Typically, this works best first thing in the morning. Sit on the toilet for 15-20 minutes. Over time, your body will learn to have regular bowel movements at the same time each day.
may be effective in certain conditions. By working with a therapist, you learn how to control certain muscles that can help you to move your bowels.
Work with your doctor to treat other conditions that may be causing your constipation.
If you are taking medication that causes constipation, talk to your doctor to find out if you can take a different medication.
If you are taking opioids to relieve pain, you may have constipation. A medication called
methylnaltrexone may help to reduce this side effect.
If you have severe, chronic constipation, your doctor may recommend surgery.
If you are diagnosed with constipation, follow your doctor's
To reduce your chance of getting constipation:
Eat a healthy, balanced diet that is high in fiber.Exercise regularly.Drink plenty of water a day.In an effort to train your bowels, schedule a time daily to sit on the toilet just after a meal.Do not rush yourself when using the bathroom.If you feel the urge to move your bowels, do not ignore this feeling. Go to the bathroom right away.
Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation.
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AGA Patient Center, American Gastroenterological Association website. Available at:
http://www.gastro.org/patient-center/digestive-conditions/constipation. Updated January 2013.
Accessed December 12, 2013.
Constipation. American Academy of Family Physicians' Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/constipation.printerview.all.html. Updated October 17, 2012. Accessed December 12, 2013.
Constipation. National Digestive Diseases Information Clearinghouse website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/constipation. Updated September 18, 2013. Accessed September 18, 2013.
Treatment of constipation. International Foundation for Functional Gastrointestinal Disorders website. Available at:
http://www.aboutconstipation.org/site/about-constipation/treatment. Updated November 22, 2013. Accessed December 12, 2013.
What I need to know about constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
Published September 11, 2013. Accessed December 12, 2013.
6/25/2008 DynaMed Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness.
N Engl J Med.
11/30/2010 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Arebi N, Kalli T, Howson W, Clark S, Norton C.
Systematic review of abdominal surgery for chronic idiopathic constipation.
2010 Oct 22. [Epub ahead of print]
6/20/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation.
Aliment Pharmacol Ther.
Last reviewed December 2013 by Peter Lucas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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