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It’s defined as having hard, dry bowel movements, or going fewer than three times a week.Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause people to strain excessively in order to have a bowel movement.
It happens most often due to changes in diet or routine, or due to inadequate intake of fiber. You should call your doctor if you have severe pain, blood in your stools, or constipation that lasts longer than three weeks.
Other key features that usually define constipation include:
- Your stools are dry and hard.
- Your bowel movement is painful and stools are difficult to pass.
- You have a feeling that you have not fully emptied your bowl.
causes–
Common causes of constipation include:
- low-fiber diet, particularly diets high in meat, milk, or cheese
- dehydration
- lack of exercise
- delaying the impulse to have a bowel movement
- travel or other changes in routine
- certain medications, such as high calcium antacids and pain medications
- pregnancy
- 8.Tiny tears in the skin around the anus (anal fissure)
- A blockage in the intestines (bowel obstruction)
- Colon cancer
- Narrowing of the colon (bowel stricture)
- Other abdominal cancer that presses on the colon
- Rectal cancer
- Rectum bulge through the back wall of the vagina (rectocele)
Fiber-rich foods are generally made from plants. Fiber comes in soluble and insoluble forms. The soluble fiber can dissolve in water and creates a soft, gel-like material as it passes through the digestive system.
insoluble fiber retains most of its structure as it goes through the digestive system. Both forms of fiber join with stool, increasing its weight and size while also softening it. This makes it easier to pass through the rectum.
The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stool remains in the colon too long, it can become hard and difficult to pass.
Lack of fiber in the diet
People with a high intake of dietary fiber are less likely to experience constipation.
This is because fiber promotes regular bowel movements, especially when a person combines it with proper hydration.
High fiber foods include:
- fruits
- vegetables
- whole grains
- nuts
- lentils, chickpeas, and other legumes
Low fiber foods include:
- high fat foods, such as cheese, meat, and eggs
- highly processed foods, such as white bread
- fast foods, chips, and other premade foods
Learn more about foods that can prevent and treat constipation here.
Physical inactivity
Low levels of physical activity may also lead to constipation.
Some past studies have found that physically fit people, including marathon runners, are less likely to experience constipation than other people, although the exact reasons for this remain unclear.
A study from 2013 notes that increasing mobility might help improve constipation among older adults.
People who spend several days or weeks in bed or sitting in a chair may have a higher risk of constipation.
Some medications
Some medications can also increase the risk of constipation. These include:
Opioid pain relief drugs: These include codeine (present with acetaminophen in Tylenol #3), oxycodone (OxyContin), and hydromorphone (Dilaudid).
Tricyclic antidepressants: These include amitriptyline (Elavil) and imipramine (Tofranil).
Certain anticonvulsants: Examples include phenytoin (Dilantin) and carbamazepine (Tegretol).
Calcium channel blockers: These lower blood pressure, and certain types lower heart rate. They include diltiazem (Cardizem) and nifedipine (Procardia).
Antacids that contain aluminum: These include Amphojel and Basaljel.
Antacids that contain calcium: One example is Tums.
Diuretics: These remove excess fluid from the body. They include hydrochlorothiazide (Hydrodiuril) and furosemide (Lasix).
Iron supplements: Doctors prescribe these to treat iron deficiency anemia.
Irritable bowel syndrome
People with functional intestinal difficulty, such as irritable bowel syndrome (IBS), have a higher risk of constipation than people without the condition.
A person with IBS may experience:
- abdominal pain
- bloating
- distension
- changes in the frequency or consistency of stools
With IBS, constipation can fluctuate over time. When constipation is not present, there may instead be loose stools with diarrhea.
Aging
As people age, the prevalence of constipation tends to increase. Up to 40% of older people in the community and up to 60% of those in institutions may experience constipation.
The exact cause of this remains unclear. It may be that as people age, food takes longer to pass through the digestive tract. Many people also become less mobile, which may also contribute to constipation.
Medical conditions, medications, and a low intake of fiber or water may be other factors that lead to constipation with age.
Changes in routine
When a person travels, for example, their usual routine changes. This can affect the digestive system. In an article from 2008, scientists asked 83 people about the digestive changes they experienced while traveling outside of the United States.
The results showed that 9% of people experienced constipation when they went to another country.
Eating meals, going to bed, and using the bathroom at different times than usual could increase the risk of constipation.
Overuse of laxatives
Some people worry that they do not use the bathroom often enough, and they take laxatives to try to solve this problem. Laxatives can help with bowel movements, but regular use of certain laxatives allows the body to get used to their action.
This may cause a person to continue taking laxatives when they no longer need them. The person may also need higher doses to get the same effect.
In other words, laxatives can be habit forming — especially stimulant laxatives. This means that the more a person depends on laxatives, the greater their risk of constipation when they stop using them.
Overuse of laxatives can also lead to:
- dehydration
- an electrolyte imbalance
- internal organ damage
Some of these complications can become life threatening. For this reason, people should talk to a healthcare professional before they start using laxatives.
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Not using the bathroom when necessary
If a person ignores the urge to have a bowel movement, the urge may gradually go away until they no longer feel the need to go.
However, the longer they delay, the drier and harder the stool will become. This will increase the risk of fecal impaction.
Not drinking enough water
Regularly drinking enough water can help reduce the risk of constipation.
Other suitable fluids include naturally sweetened fruit or vegetable juices and clear soups.
It is important to note that some liquids can increase the risk of dehydration and make constipation worse for some people. For example, those who are prone to constipation should limit their intake of caffeinated sodas, coffee, and alcohol.
Colorectal problems
Some health conditions that affect the colon can impede and restrict the passage of stool, leading to constipation.
Examples of such conditions include:
- cancerous tumors
- a hernia
- scar tissue
- diverticulitis
- colorectal stricture, which is an abnormal narrowing of the colon or rectum
- inflammatory bowel disease (IBD)
Other conditions
Some other medical conditions can also cause or contribute to constipation.
These include:
Neurological conditions: Multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries, and chronic intestinal pseudo-obstruction can lead to constipation.
Conditions that involve hormonal function, electrolytes, or renal function: These include uremia, diabetes, hypercalcemia, and hypothyroidism.
Intestinal blockage: This can occur if a tumor blocks or squeezes part of the digestive system.
Conditions that affect the digestive system: Constipation can occur with celiac disease, IBD, and other inflammatory conditions.
Cancer treatment: Chemotherapy and opioid pain relief medications, can also trigger constipation.
Problems with the nerves around the colon and rectum
Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:
- Damage to the nerves that control bodily functions (autonomic neuropathy)
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
- Stroke
Risk factors
Factors that may increase your risk of chronic constipation include:
- Being an older adult
- menstrution
- Being dehydrated
- Eating a diet that’s low in fiber
- Getting little or no physical activity
- Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure
- Having a mental health condition such as depression or an eating disorder
Complications
Complications of chronic constipation include:
- Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
- Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
- Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
- Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.
Marker study–
A marker study, also called a colorectal transit study, is used to test how food is moving through your colon. For this test, you’ll swallow a pill that contains tiny markers that will show up on an X-ray.
Anorectal manometry
An anorectal manometry is a test used to evaluate anal sphincter muscle function. For this test, your doctor will insert a thin tube with a balloon tip into your anus.
Barium enema X-ray
A barium enema X-ray is a type of test used to examine the colon. For this test, you’ll drink a special liquid the night before the test to clean out the bowel.
Colonoscopy
A colonoscopy is another type of test doctors use to examine the colon. In this test, your doctor will examine your colon using a tube that’s outfitted with a camera and light source (colonoscope).
Symptoms
Constipation makes it difficult to pass stools.
The main symptoms of constipation are:
- difficulty passing stool
- straining when passing stool
- passing less stool than usual
- lumpy, dry, or hard stool
Other symptoms include:
- pain and cramping in the abdomen
- feeling bloated
- nausea
- a loss of appetite
What does it mean if a person has abdominal pain as well as constipation?
In children and babies
Constipation can sometimes affect children and babies. The following sections discuss this in more detail.
Newborns
If a newborn does not pass meconium, their first solid stool, within 48 hours of birth, they may have Hirschsprung’s disease.
This is a condition wherein certain nerve cells are missing from part of the large intestine. Stool is unable to move forward in the affected area of colon, which causes a backup.
A healthcare provider will usually be able to spot these symptoms and recommend surgery as treatment. In most cases, the outlook is good for babies born with this condition.
Young infants
If a breastfed baby goes a week without passing stool, this is not usually a problem. Breastfed infants do not usually experience constipation.
However, if parents or caregivers have concerns about a baby’s bowel movements, they can seek medical advice.
More commonly, constipation can occur:
- when an infant first starts taking formula feeds
- during weaning
- during potty training
- at times of stress
If an infant experiences constipation while consuming formula feed, they may benefit from drinking extra water between feeds. Parents and caregivers should not add extra water to the formula, however.
If the infant is already consuming solids, they may need more fiber and water in their diet. Fruit can be a good option. However, do not force children to eat if they do not want to, as this can cause or add to stress.
During potty training, constipation can occur if a child feels stressed, especially if other changes are occurring, such as starting at nursery. Giving the child plenty of time to empty their bowels may help.
Apart from not passing stool, some symptoms that indicate constipation in children include:
- a firm or distended abdomen
- low energy
- reduced appetite
- irritability
In pregnancy
According to one source, around 40% of women experience constipation during pregnancy.
This can result from:
- hormonal changes
- physical changes, such as when the uterus presses on the intestines
- dietary or physical activity changes
Many women take iron supplements during pregnancy. These can contribute to constipation and other changes in bowel habits.
Treatment
Constipation usually resolves itself without the need for prescription treatment. In most cases, making lifestyle changes — such as getting more exercise, eating more fiber, and drinking more water — can help.
Allowing time for defecation, without stress or interruption, may also help. People should also not ignore the urge to have a bowel movement.
Laxatives can improve symptoms in the short-term, but people should use them with care and only when necessary. This is because some laxatives can have severe adverse effects.
The Food and Drug Administration (FDA) urge people to check with their doctor before using them, and to follow the instructions on the label with care.
If constipation persists, people should see a doctor. They may need stronger medication. The doctor may also test for any underlying conditions.
Keeping a record of bowel movements, stool characteristics, and dietary and other factors may help find a suitable treatment.
Laxatives
Some laxatives are available over the counter, while others are available with a prescription.
People should only consider using laxatives if making lifestyle changes has not helped. It is best to check with a doctor before use.
The following are some laxatives and stool softeners that may help ease constipation:
Fiber supplements: Also known as bulk-forming laxatives, these may be the safest option. FiberCon is one example. People should take these with plenty of water. Bulk-forming laxatives are available from pharmacies and to purchase online.
Stimulants: These cause the muscles in the intestines to contract rhythmically. Senokot is one example.
Lubricants: These help the stool move smoothly through the colon. One example is mineral oil (Fleet).
Stool softeners: These moisten the stool. Examples include Colace and Surfak.
Osmotics: These draw water into the colon to hydrate the stool and ease movement. Saline laxatives are a type of osmotic.
Neuromuscular agents: These include opioid antagonists and 5-HT4 agonists. They work at specific receptors to regulate movement through the gut.
How do stool softeners compare with other laxatives?
Other treatment options
If laxatives do not work, a doctor may need to remove impacted stool manually or surgically.
If constipation does not respond to treatment or if there are other symptoms, a doctor may suggest an abdominal imaging study — such as a CT scan, MRI scan, or X-ray — to see if there is a blockage due to an underlying disease process in the gut.
If there is, a person may need specific prescription medications or surgery to resolve it. Depending on the results of the tests and the person’s response to medical or surgical therapy, they may also need further treatment.
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