Constipation

Constipation is the repeated painful or difficult passage of a hard stool or having a bowel movement two or less times a week. Constipation is not the absence of a bowel movement every day.


Causes/associated factors
The movement of fecal matter through the gastrointestinal tract depends largely on water, fiber and activity. Dietary fiber pulls water into the intestinal tract to soften the stool and make it easier to pass. The more active you are, the more the intestines move and help propel fecal matter through the tract. Bowel movement patterns vary for each person. You don't need a bowel movement at least once a day to be considered regular or normal. What's important is any change in your bowel habits.
Most people are constipated once in a while. Constipation is often harmless and lasts just a few days. However, it can be a symptom of a more serious problem, so see your doctor if symptoms persist.

Here are some possible causes of constipation:

inadequate fluid intake
lack of fiber in your diet
lack of exercise
misuse of laxatives
chronic kidney failure
anal fissures (tears in the skin around the anus)
irritable bowel syndrome (a condition that causes stomach pain, diarrhea and constipation)
ignoring the urge to have a bowel movement or not allowing yourself enough time to have one
hypothyroidism (underactive thyroid) or, less commonly, hyperthyroidism (overactive thyroid)
diabetes
colon or rectal cancer
frequent travel or changes in shift work
certain medications, including some antidepressants, narcotics, antacids containing aluminum or calcium, iron supplements, diuretics and drugs used to treat Parkinson's disease (a degenerative disorder characterized by trembling and muscle rigidity)
some neurological disorders, such as Parkinson's disease or multiple sclerosis
rarely, neurological problems (such as lacking certain nerve cells in the large intestine)

Symptoms
Each person has a unique bowel pattern. Frequency of normal bowel movements can range from a couple stools a day to only three per week. Signs of constipation include:
hard stools
straining to have a bowel movement
painful passage of stools
less frequent bowel movements than what's normal for you
abdominal cramping
abdominal bloating
a feeling of not completely emptying the bowel

Diagnosis
The doctor will do a physical exam and ask questions about your medical history. If an underlying disease may be causing the constipation, the doctor may recommend diagnostic tests, including:
barium enema (an X-ray of the bowel after you drink a solution of barium sulfate)
flexible sigmoidoscopy (examination of the rectum and lower part of the colon)
colonoscopy (examination of the lower digestive tract)
colorectal transit study (a series of X-rays that shows how well food moves through the colon)
anorectal function tests (a measure of muscle tone and contractions to identify problems with the anus and rectum)
basic lab tests, such as blood counts and stool studies

Treatment/prevention
Treatment depends on the cause. If you've never consulted your doctor about constipation or you experience a significant or prolonged change in bowel habits, schedule an exam. If no underlying disease is noted, your doctor may recommend the following steps to relieve your symptoms and prevent recurring constipation.
For people who exercise regularly, 64 to 90 ounces of water are often recommended per day. Of course, this may vary depending on your health status, size, activity level, environment and dietary patterns. Researchers have found that healthy adults who are sedentary don't need as much water on a daily basis as people who exercise regularly. Some foods, such as soups and certain fruits and vegetables, have a high water content and may be considered part of your daily water intake. Keep in mind that certain beverages, such as caffeinated drinks, may cause some fluid loss by increasing urination.

Gradually increase the amount of fiber in your diet to 20 to 35 grams a day. Eat more fruit, other than bananas. Apricots, pears, peaches and prunes (fresh or canned) are good choices. Aim for four to five servings per day. To reduce abdominal cramping and bloating, it's important to increase the amount of fiber in your diet slowly.

Eat bran cereals and whole-grain products.

Add unprocessed bran to your diet, if your doctor approves. This "miller's bran" can be added to baked goods, cereals and fruit.

Eat more leafy green vegetables, such as spinach and salad greens.

Limit binding foods, such as bananas and dairy products. Drinking large amounts of milk can cause constipation.

Reserve time for a bowel movement, such as after a meal.

Exercise regularly. Always consult your doctor before beginning an exercise program.
Use medications for constipation only as directed by your doctor to avoid dependency, including over-the-counter laxatives. If you feel the urge to have a bowel movement, get to a restroom right away. Finally, remember that normal bowel habits vary.


Complications
Occasional complications of constipation may include:
hemorrhoids
anal fissures
hernia (the protrusion of tissue through a weakened area)
uterine or rectal prolapse (when the uterus or rectum drops or falls down)
fecal impaction (accumulation of feces in the rectum)
laxative dependency, if you take them in an effort to relieve constipation
Chronic or severe constipation may lead to:

sores in the rectal tissue
rarely, depletion of fluid and electrolytes if you abuse laxatives
rarely, megacolon (severe dilation of the colon)

Pregnancy-specific information
During pregnancy, several factors may contribute to constipation. Hormonal changes may make the muscles of your intestines more relaxed and sluggish, thus allowing greater time for the water to be reabsorbed from the stool while passing through the colon. Increased pressure on your intestines from the enlarging uterus may slow down normal intestinal activity. Iron supplements can also have a constipating effect.
If the preventive measures listed above aren't effective, consult your doctor. You may need to use a bulk-forming laxative or take a stool softener. Enemas and strong laxatives are typically not suggested during pregnancy. Mineral oil should also be avoided because it interferes with your body's absorption of important vitamins (including vitamin K, which helps the blood to clot, an essential element during delivery). Remember to only take medications recommend by your doctor, even those available without a prescription.


Senior-specific information
Constipation and related complications may be especially common for older adults, often due to changes in fiber and liquid intake and activity levels. In addition to the causes listed above, constipation for older adults may be related to any of the following factors:
various medical or surgical conditions (including the use of certain medications)
regular use of a bedpan
generalized muscle weakness
inactive colon with reduced responsiveness to the usual urge to have a bowel movement
dietary requirements to treat other medical problems
dietary changes due to changes in dental health
For older adults, straining to have a bowel movement can affect blood flow through the arteries. When circulatory conditions that affect the blood vessels in the brain are present, extreme straining during a bowel movement can interfere with blood supply to the brain and cause loss of consciousness or other medical problems.