Constipation is the infrequent and difficult passage of stools. It is the most common digestive complaint in the United States, resulting in approximately two million doctor visits annually. Women, especially those who are pregnant, and adults aged 65 and older are most commonly affected. Virtually everyone experiences an occasional bout of constipation that resolves itself with dietary changes and time. Although uncomfortable, it is usually not dangerous. However, it can lead to other problems such as hemorrhoids or signal an underlying health condition.
Although bowel movement frequency varies greatly for each person, if more than three days pass without a bowel movement, the contents in the intestines may harden, making it difficult or even painful to pass. Straining during bowel movements or the feeling of incomplete emptying also may be considered constipation.
Constipation is a symptom, not a disease, and can be caused by many factors. The most common are poor diet and lack of exercise. Other causes include irritable bowel syndrome, pregnancy, laxative abuse, travel, specific diseases, hormonal disturbances, loss of body salts and nerve damage. A variety of medications also can cause constipation, such as pain medications, especially narcotics, antacids that contain aluminum, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, antiparkinsonism drugs and antihypertensive calcium channel blockers.
Your doctor will ask about your medical history, perform a physical examination and order routine blood, urine and stool tests. Other diagnostic tests used to make a diagnosis of constipation include sigmoidoscopy and colonoscopy.
For a sigmoidoscopy, the doctor uses a special instrument called a colonoscope, which is a long, flexible tube that is about as thick as your index finger and has a tiny video camera and light on the end, to exam your rectum and lower part of your colon. During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and the oxygen level in your blood will be carefully monitored.
Treatment for constipation depends on the cause, severity and duration. However, in most cases, dietary and lifestyle changes will help relieve symptoms and prevent the condition altogether. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread and fresh fruits and vegetables, is recommended. Ideally, you should consume 20 to 35 grams of fiber each day. In addition, drinking plenty of fluids and exercising regularly helps stimulate intestinal activity.
Although most people who are mildly constipated do not need laxatives and an overuse of laxatives can actually cause constipation, they may be recommended for those who are still suffering from the condition even after making diet and lifestyle changes. Your doctor is best qualified to determine when a laxative is needed and which type.
Reviewed by health care specialists at UCSF Medical Center.