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.

Alternative Names

Irregularity of bowels; Lack of regular bowel movements

Considerations

Normal bowel movements are different for each person. You may not have a bowel movement every day. Although some healthy people always have soft or near-runny stools, others have firm stools, but have no trouble passing them.

When you rarely have a bowel movement, or it takes a lot of effort to pass stool, you have constipation. Passing large, wide, or hard stools may tear the anus, especially in children. This can cause bleeding and may lead to an anal fissure.

Causes

Constipation is most often caused by:

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

Other causes of constipation may include:

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:

Regular exercise may also help establish regular bowel movements. If you are confined to a wheelchair or bed, change position often. Also do abdominal exercises and leg raises. A physical therapist can recommend exercises that you can do.

Stool softeners (such as those containing docusate sodium) may help. 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 help you have regular bowel movements.

Enemas or stimulant laxatives should only be used in severe cases. 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.

When to Contact a Medical Professional

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

Also call your doctor if you have:

Call your child's pediatrician right away if:

Also call your child's pediatrician if:

What to Expect at Your Office Visit

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

The following tests may help diagnose the cause of constipation:

Prevention

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

References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 138.

Lembo AJ, Ullman SP. Constipation. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 18.