Constipation

Constipation
Definition
Constipation is infrequent and/or uncomfortable bowel movements. Stool is often hard and dry. It is the most common gastrointestinal complaint in the United States and accounts for 2 million annual visits to the doctor.
Causes
Constipation has many causes, including:
• Not enough fluid intake
• Overuse of laxative medicines
• Too little exercise
• Bedrest
• Certain medications, including:
o Pain relievers
o Narcotics
o Aluminum-containing antacids
o Antidepressant and antipsychotic medications
o Medications for epilepsy and Parkinson's disease
o Antispasmodic medications
o Tranquilizers
o Iron supplements
o Calcium channel blockers
• Frequently delaying the need to have a bowel movement
• Pregnancy
• Diabetes
• Spasm of the anal sphincter, due to painful anal fissures or hemorrhoids
• Underactive thyroid
• Irritable bowel syndrome (periods of constipation may alternate with episodes of diarrhea)
• Neurological diseases such as:
o Parkinson's disease
o Multiple sclerosis
o Stroke
o Spinal cord injuries
o Spinal cord tumors
• Scleroderma
• Systemic lupus erythematosus
• Intestinal disorders, including:
o Scarring
o Tumors
o Cancer
o Inflammation
• Travel, due to schedule changes, stress, and poor diet
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Advancing age
• Sedentary lifestyle
• Prolonged bed rest due to surgery or an accident
• Diet that is high in fat and sugar, and low in fiber
Symptoms
Symptoms include:
• Abdominal pain
• Sensation of abdominal fullness
• Rectal pain and pressure
• Difficulty passing stool, despite straining
• Hard, dry, small stool
• Black stool
• "Rabbit pellet" appearance to stool
• Sensation of retained stool after defecating
Diagnosis
There are over-the-counter medications to treat constipation called laxatives. However, changes in bowel habits, such as constipation, may indicate a more serious medical condition.
Consult a doctor if you have:
• Constipation plus:
o Abdominal pain
o Bleeding
o Black stool
o Distended abdomen
o Fever
• Consistent and significant change in your bowel habits
• Constipation that lasts longer than three weeks
Tests to rule out other medical conditions include:
• Physical Exam
• Digital Rectal Exam – examination of the rectum with the doctor's gloved, lubricated finger inserted into your rectum
• Blood Tests
• Abdominal X-rays
• Barium Enema X-ray – enema of fluid into the rectum that makes your colon light up on an x-ray
• Flexible Sigmoidoscopy – a thin, lighted tube with a camera inserted into the rectum to examine the rectum and the lower colon
Treatment
Treatment may include:
Understanding Normal Bowel Movements
Talk to your doctor about what is a normal frequency of bowel movements for you. The range of normal is quite broad. Some people have several stools a day; others have one stool every several days.
Lifestyle Changes
• Eat a healthful, balanced diet that is high in fiber (unprocessed bran, whole-wheat grains, fresh fruit, and cereals).
• Exercise regularly.
• Drink at least eight, 8-ounce glasses of water each day.
Laxatives, Stool Softeners, or Glycerin Suppositories
Do not regularly use laxatives or enemas; these can be habit forming and your bowels can become accustomed to these products and require them in order to produce a stool. Ask your doctor about how often and for how long to use these products.
Treating Underlying Medical Conditions
Work with your doctor to treat other conditions that may be causing your constipation.
Consider Changing Medications
If you're taking a medication that causes constipation, ask your doctor for a less-constipating alternative.
Prevention
To reduce your chance of getting constipation:
• Eat a healthy, balanced diet that is high in fiber.
• Exercise regularly.
• Drink at least eight, 8-ounce glasses of water a day.
• In an effort to train your bowels, schedule a time daily to sit on the toilet just after a meal.
• Don't rush yourself when using the bathroom.
• If you feel the urge to defecate, listen to your body.