Constipation

Definition

Constipation is most often defined as having a bowel movement less than 3 times per week. It usually is associated with hard stools or difficulty passing stools. You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing for more than 10 minutes.

Infants who are exclusively breastfed may go 7 days without a bowel movement.

Alternative Names

Irregularity of bowels; Lack of regular bowel movements

Considerations

Normal patterns of bowel elimination vary widely from person to person and you may not have a bowel movement every day. While some healthy people have consistently soft or near-runny stools, others have consistently firm stools, but no difficulty passing them.

When the stool is infrequent, or requires significant effort to pass, you have constipation. The passage of large, wide, or hard stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.

Common Causes

Constipation is most often caused by:

• Low-fiber diet
• Lack of physical activity
• Not drinking enough water
• Delay in going to the bathroom when you have the urge to move your bowels

Stress and travel can also contribute to constipation or other changes in bowel habits.

Other causes of constipation may include:

• Colon cancer
• Diseases of the bowel, such as irritable bowel syndrome
• Pregnancy
• Underactive thyroid
• Mental health disorders
• Neurological disorders and diseases
• Use of certain medications

Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.

Home Care

Children and adults should get enough fiber in their diet. Vegetables, fresh fruits, dried fruits, and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, drink plenty of fluids to help pass the stool.

For infants with constipation:

• Over 2 months old -- try 2 - 4 ounces of fruit juice (grape, pear, apple, cherry, or prune) twice a day.
• Over 4 months old -- if the baby has begun solid foods, try baby foods with high-fiber content (peas, beans, apricots, prunes, peaches, pears, plums, spinach) twice a day.

Regular exercise may also help establish regular bowel movements. If you are confined to a wheelchair or bed, change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend exercises appropriate for your physical capabilities.

Stool softeners (such as those containing docusate sodium) may help. Additionally, bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as milk of magnesia liquid, may establish regular bowel movements. Enemas or stimulant laxatives should be reserved for severe cases only. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.

Do NOT give laxatives or enemas to children without first asking your doctor.

Call your health care provider if

Call your doctor immediately if you have sudden constipation with abdominal cramps and an inability to pass gas or stool. Do NOT take any laxatives.

Also call your doctor if you have:

• Sharp or severe abdominal pain, especially if you also have bloating
• Blood in your stool
• Constipation alternating with diarrhea
• Thin, pencil-like stools
• Rectal pain
• Unexplained weight loss
• Been using laxatives for several weeks or self care is not working

Call your child's pediatrician immediately if:

• An infant (except those exclusively breastfed) goes 3 days without a stool and is vomiting or irritable

Also call your child's pediatrician if:

• An infant younger than 2 months is constipated
• Non-breastfeeding infants go 3 days without having a bowel movement (call immediately if there is vomiting or irritability)
• A child is holding back bowel movements in order to resist toilet training

What to expect at your health care provider's office

Your doctor will perform a physical examination, which may include a rectal exam, and ask questions such as:

• How long have you had constipation?
• How many days between two bowel movements?
• Is it worse when you are stressed?
• What is the color, shape, and consistency of the stools?
• Is there any bleeding with bowel movements?
• Do you have any abdominal pain?
• What surgeries or injuries have you had?
• What medications do you take?
• Do you drink coffee or alcohol? Do you smoke?
• What other symptoms are also present?

The following tests may help diagnose the cause of constipation:

• Anorectal manometry (pressure measurements of the anus and rectum)
• Barium enema
• Complete blood count (CBC)
• Blood clotting tests (PT or PTT)
• Colonoscopy
• Proctosigmoidoscopy (an examination of the lower bowel)
• Stool studies
• Upper GI series
• X-rays of the abdomen

Prevention

Avoiding constipation altogether is easier than treating it, but involves the same lifestyle measures:

• Eat lots of fiber.
• Drink plenty of fluids each day (at least 8 glasses of water per day).
• Exercise regularly.
• Go to the bathroom when you have the urge. Don't wait.

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References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 138.

Wyllie R. Motility disorders and Hirschsprung disease. In: Kliegman RM, Jenson HP, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 329.