Constipation

Constipation is when your stools are painful or they do not happen often enough. It is the most common GI (gastrointestinal) problem.

You may have constipation if:

• You have bowel movements less than 3 times a week
• Your stool is hard, dry, and in small pieces

Normal bowel movements vary depending on the person. They may happen as often as 3 times a day. Or they may happen just 3 times a week.

Your stool gets hard and dry when your colon (large intestine) absorbs too much water.

In most cases, as food moves through your colon, the colon absorbs water while it makes stool. Muscle movements (contractions) push the stool toward your rectum. When the stool gets to the rectum, most of the water has been soaked up. The stool is now solid.

If you have constipation, your colon's muscle movements are too slow. This makes the stool move through your colon too slowly. The colon absorbs too much water. The stool gets very hard and dry.

Some of the most common diet and lifestyle causes of constipation are:

• Not getting enough exercise
• Not drinking enough liquids
• Not eating enough fiber
• Not taking a bowel movement when you need to
• Changes in your lifestyle, such as travel, pregnancy, and old age

Other causes of constipation include:

• Medicines
• A problem with how your stomach and bowels work (such as irritable bowel syndrome)
• Your intestine does not work well
• Taking too many medicines that help to loosen your bowels (laxatives)
• Metabolic problems such as thyroid disease
• Intestinal blockage

Each person’s symptoms may vary. Symptoms of constipation may include:

• Difficult and painful bowel movements
• Less than 3 bowel movements a week
• Feeling swollen (bloated)
• Not having much energy
• Stomach (abdominal) pain
• Ineffective straining to move your bowels

The symptoms of constipation can look like other health problems. Always talk to your healthcare provider to be sure.

Most people have constipation at one time or another. To see if you have constipation, your healthcare provider will do several tests. These tests will depend on how long you have had symptoms and how serious your case is.

First your healthcare provider will look at:

• Your age
• If you have any blood in your stool
• Any changes in your bowel habits
• Weight loss

Your healthcare provider will likely:

• Ask about your past health. You will be asked to give details about your constipation. This will include how long you have had symptoms, how often you have bowel movements, and any other information that may be helpful.
• Give you a physical exam.
• Do a digital rectal exam. For this, your healthcare provider will gently put a gloved, lubricated finger into your rectum. Using his or her finger, your healthcare provider will check the muscle that closes off the anus. This exam helps tell if the area is soft, blocked, or bloody. It can also check how much and what kind of stool you have. Your healthcare provider will also see if your rectum is bigger than normal.

Your healthcare provider may also do other tests such as:

• Abdominal X-ray.
• Blood work.
• Lower GI series (also called barium enema). This is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine. You will be given a fluid called barium. Barium coats the organs, so that they can be seen on an X-ray. The barium is put into a tube and inserted into your rectum as an enema. An X-ray of your belly will show if you have any narrowed areas (strictures), blockages, or other problems.
• Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube (colonoscope) is put into your rectum up into the colon. This tube lets your healthcare provider see the lining of your colon and take out a tissue sample (biopsy) to test it. He or she can also treat some problems that may be found.
• Sigmoidoscopy. This test lets your healthcare provider check the inside of part of your large intestine. It helps to tell what is causing constipation. A short, flexible, lighted tube (sigmoidoscope) is put into your intestine through the rectum. This tube blows air into your intestine to make it swell. This makes it easier to see inside.
• Colorectal transit study. This test shows how long it takes for food to move through your colon. You will be asked to swallow pills (capsules) filled with small markers that can be seen on an X-ray. You must also eat a high-fiber diet during the test. X-rays will be taken 3 to 7 days after you have the capsules. The X-rays will show how the capsules moved through your colon.
• Anus and rectum (anorectal) function tests. These tests can tell if you are constipated because your anus or rectum is not working well.

Your healthcare provider will come up with a care plan for you based on:

• Your age, overall health, and past health
• How serious your case is
• How well you handle certain medicines, treatments, or therapies
• If your condition is expected to get worse
• Your opinion and what you want to do

In most cases, diet and lifestyle changes can help reduce constipation symptoms. They can also stop it from happening. These changes may include:

• Drinking more water and juice.
• Getting regular exercise.
• Giving yourself time to have a bowel movement each day.
• Eating more fiber. Eating 20 to 35 grams of fiber each day will help your body to make soft, large stool. Foods with a lot of fiber include beans, whole grains, bran cereals, fresh fruits, and vegetables. Eat fewer foods that have little or no fiber. These include ice cream, cheeses, meats, and processed foods.
• Taking laxatives. Your healthcare provider may have you take laxatives to help loosen your bowels if diet and lifestyle changes have not worked.
• Stopping or changing medicine.
• Doing biofeedback. Biofeedback is a way of using the mind to control a body function. It is used for chronic constipation that is caused by problems with the anus or rectum (anorectal dysfunction). It retrains the muscles that control the release of bowel movements.

Foods	Moderate fiber		High fiber
Bread	Whole-wheat bread, granola bread, wheat bran muffins, grain bars, waffles, popcorn
Cereal	100% whole-grain cereals, oatmeal, granola, and oat bran	100% bran cereals
Vegetables	Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Fruits	Apples with peel, dates, papayas, mangoes, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins	Cooked prunes, dried figs
Meat substitutes	Peanut butter, nuts	Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

Constipation can cause other health problems such as:

• Hemorrhoids. Red, swollen veins in the rectum. They happen when you need to keep straining to have a bowel movement.
• Anal fissures. Tears in the skin around the anus. They happen when hard stool stretches your sphincter muscle. They can cause bleeding in your rectum.
• Rectal prolapse. This is when a small amount of your intestinal lining pushes out from your anal opening. It is caused by straining to have a bowel movement.
• Fecal impaction. This is when a large lump of hard, dry stool stays stuck in your rectum. The colon’s normal pushing action can’t push out the stool. This is seen mostly in children and older adults.

Many of the same lifestyle changes that help treat constipation may also help to stop it from happening:

• Have plenty of fiber, water, and liquids each day.
• Get regular exercise.
• Allow plenty of time for bowel movements. When you need to have a bowel movement, be sure to do it.
• Try to have a bowel movement at the same time each day.
• If another health problem makes you more likely to have constipation, take your healthcare provider’s advice for treating that problem.

Most people have constipation at one time or another. But call your healthcare provider if:

• Constipation lasts longer than 3 weeks.
• Constipation pain is stopping you from doing your daily activities.
• You have symptoms of any of the complications of constipation.

• Constipation is the most common GI (gastrointestinal) problem.
• You may be constipated when your stools are painful and happen less than 3 times a week.
• Your stool will be hard, dry, and in small pieces.
• Your stools get hard and dry when your colon absorbs too much water.
• Constipation symptoms can include stomach cramps and feeling tired.
• Constipation can cause other health problems such as hemorrhoids (red, swollen veins in the rectum).
• Making diet and lifestyle changes can reduce constipation symptoms. These changes can also stop constipation from happening.

Tips to help you get the most from a visit to your healthcare provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.