Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. Bowel habits vary, but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.
Constipation is one of the most common medical complaints in the United States. It can occur at any age and is more common among individuals who resist the urge to move their bowels at the body's signal. This often happens when children start school or enter daycare and feel shy about asking permission to use the bathroom.
Constipation is more common in women than in men and is especially apt to occur during pregnancy. Age alone does not increase the frequency of constipation, but elderly people are more likely to suffer from the condition.
Although this condition is rarely serious, it can lead to:
- bowel obstruction
- chronic constipation
- hemorrhoids (a mass of dilated veins in swollen tissue around the anus)
- hernia (a protrusion of an organ through a tear in the muscle wall)
- spastic colitis (irritable bowel syndrome, a condition characterized by alternating periods of diarrhea and constipation)
- laxative dependency
Chronic constipation may be a symptom of colorectal cancer, depression, diabetes, diverticulosis (small pouches in the muscles of the large intestine), lead poisoning, or Parkinson's disease. An opioid overdose (as in excessive codeine from cough suppressants or heroin addiction) also may result in constipation.
In someone who is elderly or disabled, constipation may be a symptom of bowel impaction, a more serious condition in which feces are trapped in the lower part of the large intestine. A doctor should be called if an elderly or disabled person is constipated for more than a week or if a child seems to be constipated.
A doctor should be notified whenever constipation occurs after starting a new prescription, vitamin, or mineral supplement or is accompanied by blood in the stools, changes in bowel patterns, fever, or abdominal pain.
Causes & symptoms
Constipation usually results from not getting enough exercise, not drinking enough water or clear fluids, or from a diet that does not include an adequate amount of fiber-rich foods like beans, bran cereals, fruits, raw vegetables, rice, and whole-grain breads.
Other causes of constipation include anal fissure (a tear or crack in the lining of the anus), chronic kidney failure, colon or rectal cancer, depression, hypercalcemia
Constipation can also be a side effect of:
- aluminum salts in antacids
- antipsychotic drugs
- belladonna (Atopa belladonna, source of atropine, a medication used to relieve spasms and dilate the pupils of the eye)
- beta blockers (medications used to stabilize irregular heartbeat, lower high blood pressure, reduce chest pain)
- blood pressure medications
- calcium channel blockers (medication prescribed to treat high blood pressure, chest pain, some types of irregular heartbeat and stroke, some non-cardiac diseases)
- codeine or opioids.
- diuretics (drugs that promote the formation and secretion of urine)
- iron or calcium supplements
- narcotics (potentially addictive drugs that relieve pain and cause mood changes)
- tricyclic antidepressants (medications prescribed to treat chronic pain, depression, headaches, and other illnesses)
An adult who is constipated may feel bloated, have a headache, swollen abdomen, pass rock-like feces, or strain, bleed, or feel pain during bowel movements. A constipated baby may strain, cry, draw the legs toward the abdomen, or arch the back when having a bowel movement.
Everyone becomes constipated once in a while, but a doctor should be notified if significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber and fluid intake.
The patient's observations and medical history help a primary care physician diagnose constipation. The doctor uses his fingers to see if there is a hardened mass in the abdomen and may perform a rectal examination. Other diagnostic procedures include a barium enema, which reveals blockage inside the intestine; laboratory analysis of blood and stool samples for internal bleeding or other symptoms of systemic disease; and a sigmoidoscopy (examination of the sigmoid area of the colon with a flexible tube equipped with a magnifying lens).
Physical and psychological assessments and a detailed history of bowel habits are especially important when an elderly person complains of constipation.
Initially, alternative practitioners will suggest that the patient drink an adequate amount of water each day (six to eight glasses), exercise on a regular basis, and eat a diet high in soluble and insoluble fibers. Soluble fibers include pectin, flax, and gums. Insoluble fibers include psyllium and brans from grains like wheat and oats. Fresh fruits and vegetables contain both soluble and insoluble fibers, and since constipation is aggravated by folate, calcium, and magnesium deficiencies, sources of these nutrients, such as asparagus, spinach, parsley, and other dark green leafy vegetables, should be part of the daily diet. Various fruit juices can also help maintain normal bowel function; sorbitol, the natural sugar found in apple juice has known laxative properties. Castor oil, applied topically to the abdomen and covered by a heat source (a heating pad or hot water bottle), can help relieve constipation when used nightly for 20-30 minutes. For babies, about 1 tablespoon of corn syrup mixed with warm water might help relieve constipation.
This form of acupuncture is said to relax the abdomen, ease discomfort, and stimulate regular bowel movements when diet and exercise fail to do so. After lying down, patients close their eyes and take deep breaths. For two minutes, the practitioner applies gentle fingertip pressure to a point about two inches below the navel. Acupressure can also be applied to the outer edges of one elbow crease and maintained for 30 seconds before pressing the crease of the other elbow. This should be done three times a day to relieve constipation.
Six drops of rosemary (Rosmarinus officinalis) and six drops of thyme (Thymus spp.) diluted by one ounce of almond oil, olive oil, or another carrier oil can relieve constipation when used to massage the abdomen. A circular motion for massage is recommended, beginning up the right side of the abdomen, coming across the top, and down the left side. Massaging the leg from knee to hip in the morning, at night, and before trying to move the bowels is said to relieve constipation.
A variety of herbal therapies can be useful in the treatment of constipation. Several herbs, including
The knee-chest position, said to relieve gas and stimulate abdominal organs, involves:
- standing straight with arms at the sides
- lifting the right knee toward the chest
- grasping the right ankle with the left hand
- pulling the leg as close to the chest as possible
- holding the position for about eight seconds
- repeating these steps with the left leg
The cobra position, which can be repeated as many as four times a day, involves:
- lying on the stomach with legs together
- placing the palms just below the shoulders, holding elbows close to the body
- inhaling, then lifting the head (face forward) and chest off the floor
- keeping the navel in contact with the floor
- looking as far upward as possible
- holding this position for three to six seconds
- exhaling and lowering the chest
The spine twist is another pose that is recommended for daily use in relieving constipation. Practicing relaxation and meditation can also have a powerful effect on the digestive system. Slow, steady music can relieve tension that leads to constipation.
If changes in diet and activity fail to relieve occasional constipation, an over-the-counter laxative may be used for a few days. Preparations that soften stools or add bulk (bran, psyllium, ducosate sodium) work more slowly but are safer than Epsom salts and other harsh laxatives or herbal laxatives containing senna (Cassia senna) or buckthorn (Rhamnus purshianna), which, if used long term, can harm the nerves and lining of the colon because they are peristaltic stimulants.
A woman who is pregnant should never use a laxative. She can use flaxseed, bran, ducosate sodium, prunes, or oatmeal. Anyone who is experiencing abdominal pain, nausea, or vomiting should also avoid laxatives. A warm-water or mineral oil enema can relieve constipation, and a non-digestible sugar (lactulose) or special electrolyte solution is recommended for adults and older children with stubborn symptoms. If a patient has an impacted bowel, the doctor may insert a gloved finger into the rectum and gently dislodge the hardened feces.
In 2002, a new study compared a non-toxic food ingredient called polyethylene glycol to lactulose for relieving constipation in children. A preliminary study showed that it may work faster, prove easier to administer, and be just as safe and effective. However, more research was suggested before recommending the substance over lactulose.
Changes in diet and exercise usually eliminate the problem of constipation.
Most Americans consume between 11-18 grams of fiber a day. Consumption of 30 grams of fiber and between 6-8 glasses of water each day can generally prevent constipation, and 35 grams of fiber a day (an amount equal to five servings of fruits and vegetables, and a large bowl of high-fiber cereal) can relieve constipation. Fiber supplements containing psyllium (Plantago psyllium) usually become effective within about two days and can be used every day without causing dependency. Powdered flaxseed (Linium usitatissimum) works the same way. Insoluble fiber, like wheat or oat bran, is as effective as psyllium but may give the patient gas at first.
Daily use of 500 mg vitamin C and 400 mg magnesium can prevent constipation. If symptoms do occur, each dosage can be increased by 100 mg a day, up to a maximum of 5,000 mg vitamin C and 1,000 mg magnesium. Use of preventive doses should be resumed after relief occurs. If the patient developes diarhea, the vitamin C should be decreased. Calcium is also important. Children over five can take up to 1,300 mg and adults ages 19-50 can take up to 2,000 mg.
Sitting on the toilet for 10 minutes at the same time every day, preferably after a meal, can induce regular bowel movements. This may not become effective
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Teresa G. Odle