Overview

Constipation means having a hard time passing stools and passing fewer stools. Some people are overly concerned with how often they have bowel movements. That's because they've been taught that a healthy person has a bowel movement every day. But this isn't true. Most people pass stools anywhere from 3 times a day to 3 times a week. If your stools are soft and pass easily, you aren't constipated.

You have constipation if you have 3 or fewer bowel movements each week. And you may have some of the following problems:

• Straining
• Feeling that you don't completely empty your bowels
• Hard stools, or stools that look like pellets
• A feeling of being blocked up
• Not being able to pass stools unless you put a finger in your rectum or use manual pressure to pass a stool

Constipation may occur with cramping and pain in the rectum caused by the strain of trying to pass hard, dry stools. You may have some bloating and nausea. You may also have small amounts of bright red blood on the stool or on the toilet tissue. This is caused by bleeding hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. It should stop when the constipation is controlled.

Constipation can also mean the slow movement of stool through the intestines or problems releasing a stool.

Slow transit constipation

Lack of fibre is a common cause of constipation. Other causes include:

• Irritable bowel syndrome.
• Travel or other change in daily routine.
• Lack of exercise.
• Immobility caused by illness or aging.
• Medicine use.
• Overuse of laxatives.
• Pregnancy.

Constipation is sometimes a sign of another health problem, such as diabetes, hypothyroidism, or hypercalcemia.

Outlet delay constipation

Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Straining too much, needing manual pressure on the vaginal wall, or feelings of incomplete emptying may be a symptom of this type of constipation. Outlet delay constipation is caused by:

• Physical disorders that cause loss of function. These include colon cancer, uterine prolapse or rectal prolapse, scarring (adhesions), and injury caused by physical or sexual abuse.
• Nervous system diseases, such as Parkinson's disease, multiple sclerosis, or stroke.
• Spinal cord injury.
• Pain from hemorrhoids or anal fissures.
• Delaying bowel movements because of convenience issues or because having a bowel movement causes pain.

Constipation is more common in people older than 65. People in this age group are more likely to have poor dietary habits and take more medicines. Older adults also often have less muscular activity of the intestinal tract. This increases the time it takes for stool to move through the intestines. Physical problems, such as arthritis, may make sitting on the toilet uncomfortable or painful.

If a stool can't pass through the rectum (impacted), mucus and fluid may leak out around the stool. This can sometimes lead to leakage of fecal material (fecal incontinence). So you may go back and forth between having constipation and diarrhea.

Self-Care

Here are some things you can do to help relieve constipation.

• First try healthy habits.
  • Try gentle exercise. Take a short walk each day. Bit by bit, increase your walking time until you are walking for at least 20 minutes.
  • Make sure you drink enough fluids. Avoid alcohol and caffeine. They can increase dehydration. If you have heart failure or kidney failure, talk to your doctor about what amount of fluid is right for you.
  • Include fruits, vegetables, and fibre in your diet each day. Have a bran muffin or bran cereal for breakfast. And try eating a piece of fruit for a mid-afternoon snack.
  • Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time having a bowel movement, but don't sit for more than 10 minutes at a time. And don't strain too much.
• Support your feet with a small step stool when you sit on the toilet.

  This will help flex your hips and place your pelvis in a more normal "squatting" position for having a bowel movement.

• If you're still constipated, try fibre, stool softeners, or suppositories.
  • Add some processed or synthetic fibre—such as Benefibre or Metamucil—to your diet each day.
  • Try a stool softener, such as Colace, if your stools are very hard.
  • Try a rectal glycerin suppository. Follow the directions on the label. Do not use more often than recommended on the label.
• If other treatments don't help, try a laxative.

  If your teen has constipation problems, talk to your teen's doctor before trying laxatives.

  • Osmotic laxatives (such as Milk of Magnesia or Restoralax) and non-absorbable sugars (such as lactulose or sorbitol) hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.
  • Stimulant laxatives (such as Senokot or bisacodyl) speed up the movement of stool through the intestine. Use these sparingly. Overuse of these laxatives decreases the tone and sensation in the large intestine, causing dependence on using laxatives. Regular use may interfere with your body's ability to absorb vitamin D and calcium, which can weaken your bones. Don't use laxatives for longer than 2 weeks without talking to your doctor.
• Talk to your doctor before you use an enema.

  Your doctor may need to check your symptoms or may suggest a different way to treat your constipation.

Treating chronic constipation

There are many ways to treat chronic constipation, depending on what's causing it. Many people need to combine treatments. You may have already tried increasing activity or changing your diet.

Your doctor may also suggest some of these treatments.

Fibre.

Fibre helps keep water in your stool, making it softer and easier to pass.

Drinking more water.

Your body needs water to be able to pass stool.

Laxatives.

Some foods have a natural laxative effect, like prunes. There are also laxative medicines. One type (osmotic) holds water in the intestine to make it easier to pass stool. The other type (stimulant) increases movement in the intestine.

Stool softeners.

These keep stool soft.

Prescription medicines.

Some medicines may help with your bowels. But others can make constipation worse. Talk with your doctor about everything you take. You may be able to switch to a different medicine that will not cause constipation.

Biofeedback.

This can help retrain your pelvic floor muscles to know when to relax and when to push.

Laxatives

There are four types of products for preventing or treating constipation.

Bulking agents.

Food such as bran or products such as Benefibre or Metamucil ease constipation by absorbing more fluid in the intestines. This makes the stool bigger, which gives you the urge to pass the stool. Regular use of bulking agents is safe and often lets you have more stools.

Stool softeners.

Products such as Colace lubricate and soften the stool in the intestine, making it easier to pass. Stool softeners do not often cause problems but they don't work as well if you don't drink enough water during the day.

Osmotic laxatives.

Products such as Milk of Magnesia, Miralax, or RestoraLAX and non-absorbable sugars such as lactulose or sorbitol hold fluids in the intestine and draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.

Stimulant laxatives.

Products such as Dulcolax, Ex-Lax, or Senokot speed up how fast a stool moves through the intestines by irritating the lining of the intestines. Regular use of stimulant laxatives is not recommended. Stimulant laxatives change the tone and feeling in the large intestine and you can become dependent on using laxatives all the time to have a bowel movement.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• Constipation or changes in the stool that continue after a few days to 1 week of home treatment.
• New or worse rectal pain.
• New or worse blood in the stool.
• Uncontrolled leakage of stool.
• Symptoms occur more often or are more severe.

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