Constipation

What is constipation?

Constipation, a common complaint, is usually simple to prevent and easy to treat when it occurs. However, constipation may reflect a more serious problem that will require the help of your medical provider to suggest tests, medical intervention and, rarely, surgery.

What is normal bowel function?

The colon and rectum (i.e., large intestine) serve to remove water and certain electrolytes and store fecal material prior to elimination. The range of "normal" is quite wide, but in general, bowel movements should occur at least every third day and no more than three per day; stool should pass easily and not require excessive straining; and lastly, one should experience a sense of completeness of elimination. The belief that one should have a bowel movement every day simply is not accurate and can lead to unnecessary concern and even abuse of laxatives.

How is Constipation Defined?

Given the range of normal, constipation may mean different things to different people. For some, constipation may mean infrequent bowel movements. To others, it is a hard, difficult-to-pass stool that requires excessive straining and causes pain as it passes. And to others still, constipation may mean a bowel movement that does not completely evacuate and leaves the person with a sense of dissatisfaction as if they "still need to go." Constipation is often associated with a bloating sensation, mild nausea and mild cramping pain, all of which are generally relieved by bowel movements.

What causes constipation?

Most often, constipation is due to any combination of three factors: a low fiber diet, poor fluid intake, or a lack of physical activity or exercise. However, there are other causes that must be considered. First, specific medical conditions can cause constipation, including diabetes, low thyroid hormone (hypothyroidism), depression or other less common diseases. Medications may contribute to constipation, including those commonly prescribed for pain relief, high blood pressure, antidepressants, psychiatric drugs and antacids.

Unfortunately, there are serious causes of constipation that are more mechanical in nature. Diseases that cause inflammation, such as diverticulitis or Crohn's disease, can cause excessive scarring and narrowing. In addition, tumors or growths in the colon can physically block the bowel. Although less likely to be the cause, these more serious causes should be evaluated and ruled out by your physician.

How is constipation avoided or treated?

Generally, constipation is avoided by following the basics of good intestinal health: healthy diet, proper fluid intake and physical activity. Twenty-five to thirty-five grams of fiber per day is the recommended daily amount of dietary fiber. Eating a diet rich in whole grain breads, cereals and fiber bars, in addition to fresh fruits and vegetables, often will improve bowel habits by adding bulk to the stool. Drinking six to eight glasses of water per day will help keep the stool from being hard and make it easier to pass the stool. Lastly, regular exercise, which can be as simple as taking a brisk walk for 30 minutes per day, will likely improve bowel movements. There are many different laxatives available over the counter in grocery stores and pharmacies. The way in which laxatives work varies by laxative, but they can be very effective for acute relief of constipation. Although it may be necessary to take laxatives on a regular basis, you should only do so after consultation with your medical provider.

When should I seek help from my medical provider?

Medical attention should be sought if:

  • There is a new onset of persistent constipation.
  • Longstanding constipation becomes progressive either in frequency or severity, and it is not manageable with the simple measures described above.
  • Constipation is associated with a change in bowel habits from the normal pattern (narrow stools or loose stools), excess weight loss or bleeding.

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