Symptom

Constipation

Overview | Possible Causes | Care and Treatment | HOME REMEDies | When to Call the Doctor | References

constipation

Overview

Having fewer than three bowel movements a week is, technically, the definition of constipation. However, how often you “go” varies widely from person to person. Some people have bowel movements several times a day while others have them only one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you – as long as you don’t stray too far from your pattern.

Regardless of your bowel pattern, one fact is certain: the longer you go before you “go,” the more difficult it becomes for stool/poop to pass. 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 bowels.

Possible Causes

There are many causes of constipation – lifestyle choices, medications, medical conditions, and pregnancy.

Common lifestyle causes of constipation include:

Eating foods low in fiber.
Not drinking enough water (dehydration).
Not getting enough exercise.
Changes in your regular routine, such as traveling or eating or going to bed at different times.
Eating large amounts of milk or cheese.
Stress.
Resisting the urge to have a bowel movement.

Medications that can cause constipation include:

Strong pain medicines, like the narcotics containing codeine, oxycodone (Oxycontin®) and hydromorphone (Dilaudid®).
Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
Antidepressants, including the selective serotonin reuptake inhibitors (like fluoxetine [Prozac®]) or tricyclic antidepressants (like amitriptyline [Elavil®]).
Antacids containing calcium or aluminum, such as Tums®.
Iron pills.
Allergy medications, such as antihistamines (like diphenhydramine [Benadryl®]).
Certain blood pressure medicines, including calcium channel blockers (like verapamil [Calan SR], diltiazem [Cardizem®] and nifedipine [Procardia®]) and beta-blockers (like atenolol [Tenormin®]).
Psychiatric medications, like clozapine (Clozaril®) and olanzapine (Zyprexa®).
Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
Antinausea medications, like ondansetron (Zofran®).

Many drugs can cause constipation. Ask your doctor or pharmacist if you have any questions or concerns.

Medical and health conditions that can cause constipation include:

Endocrine problems, like underactive thyroid gland (hypothyroidism), diabetes, uremia, hypercalcemia.
Colorectal cancer.
Irritable bowel syndrome (IBS).
Diverticular disease.
Outlet dysfunction constipation. (A defect in the coordination of pelvic floor muscles. These muscles support the organs within the pelvis and lower abdomen. They are needed to help release stool.)
Neurologic disorders including spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke.
Lazy bowel syndrome. The colon contracts poorly and retains stool.
Intestinal obstruction.
Structural defects in the digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus, or malrotation.)
Multiple organ diseases, such as amyloidosis, lupus, and scleroderma.
Pregnancy.

Care & 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.

It is advisable to check with your 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.

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.

Home Remedies

Most cases of mild to moderate constipation can be managed by you at home. Self-care starts by taking an inventory of what you eat and drink and then making changes.

Some recommendations to help relieve your constipation include:

Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration.
Add fruits, vegetables, whole grains and other high-fiber foods to your diet. Eat fewer high-fat foods, like meat, eggs and cheese.
Eat prunes and/or bran cereal.
Keep a food diary and single out foods that constipate you.
Get moving, exercise.
Check how you sit on the toilet. Raising your feet, leaning back or squatting may make having a bowel movement easier.
Add an over-the-counter supplemental fiber to your diet (like Metamucil®, Citrucel®, and Benefiber®).
If needed, take a very mild over-the-counter stool softener or laxative (such as docusate [Colace®] or Milk of Magnesia®). Mineral oil enemas, like Fleet®, and stimulant laxatives, like bisacodyl (Dulcolax®) or senna (Senokot®), are other options. There are many laxative choices. Ask your pharmacist or doctor for help in making a choice. Do not use laxatives for more than two weeks without calling your doctor. Overuse of laxatives can worsen your symptoms.
Do not read, use your phone or other devices while trying to move your bowels.