Constipation is really more a complaint than a disorder—in fact, it is one of the most common gastrointestinal complaints in the United States. It is usually defined as the failure to have a bowel movement after three days or more, and is often accompanied by a hardening of the stool and by straining during defecation.
Symptoms include infrequent bowel movements, hard stools that can cause strain or pain when passing, abdominal swelling, continued sensation of fullness after a bowel movement, too-small stools, or no bowel movements in at least three days (four days for children). Though constipation can be a sign of an underlying health problem, in most cases it’s nothing you need to worry about and can be remedied with self-care measures.
One of the biggest myths about constipation is that you’re constipated if you don’t have a daily bowel movement. Although a daily bowel movement is often thought of as “regular,” there is no norm for regularity. It is perfectly normal for a person to have a bowel movement once a day, twice a day, every other day, or perhaps only two or three times a week.
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What causes constipation in adults
A lack of fiber in the diet is probably the most common cause. Fiber from fruits, vegetables, and whole grains adds bulk to stool, helps to soften stool by absorbing water, and stimulates the colonic contractions that produce the urge to defecate. A lack of fiber and fluids can result in hardened stools that are slow to pass.
Other common causes of constipation include not drinking enough fluids on a daily basis, a sedentary lifestyle, emotional stress, obsessive-compulsive disorder, laxative abuse, or depression, which can bring about a change in bowel habits. Ignoring the urge to defecate can also cause constipation, as can travel, lack of access to toilets, or any other shift in your daily routine that changes your regular toilet habits.
Constipation can be caused by various medications, including pain medications, calcium supplements, antacids containing aluminum, iron supplements, antidepressants, and diuretics. There are also medical conditions associated with constipation, including diabetes, kidney failure, backache, certain types of bowel disease, and irritable bowel syndrome. Pregnancy can also cause constipation because of hormonal changes.
What causes constipation in children?
Infants and young children often get constipated, especially when their diet is composed largely of highly refined foods. As with adults, bowel movement frequency for children varies tremendously, from several times a day to as little as once a week. A decrease in normal bowel habits can be triggered by several causes, including a sudden change in diet; a resistance to toilet training due to parental pressure; stress or emotional turmoil, such as the birth of a sibling, divorce, or the death or departure of a loved one; and the memory of a painful bowel movement. It’s always best to check with your pediatrician to make certain there is no underlying health reason for constipation.
What if you do nothing?
If you have no other symptoms, constipation may clear up on its own in a matter of days. However, at the very least you may need to make some changes in your diet or other lifestyle habits to alleviate constipation.
Treatment depends on the specific cause, severity, and duration of constipation, but in most cases these straightforward measures will quickly bring relief.
- Drink plenty of nonalcoholic fluids. Beverages will soften the stool, and soft stools are easier to pass than hard ones. Drinking a caffeinated beverage such as coffee in the morning may also be help.
- Eat a diet high in fiber. Examples of high-fiber foods are grains (including unprocessed wheat bran), fruits (particularly citrus fruits), vegetables, and legumes. Prunes, raisins, and figs are all excellent for avoiding constipation, as your grandmother may have taught you. Try to eat five to six servings of fiber-rich foods daily (which should provide at least 20 to 30 grams of dietary fiber). For more, see The Best Foods for Fiber. But be careful to increase your fiber intake gradually: Consuming excessive amounts of fiber can lead to bloating and gas.
- Get regular exercise. Physical activity helps stimulate bowel movements.
- Set aside regular bathroom time. Try not to ignore the urge to defecate, even when it may not be convenient.
- Use laxatives or enemas sparingly, if at all. Chronic use of either interferes with the colon’s ability to contract.
Home remedies for constipation in children
Dietary changes usually relieve childhood constipation, so be sure to increase the child’s daily intake of fiber-rich foods (whole grain products, fruits, and vegetables) and liquids. If the constipation stems from toilet training, stop the training and use diapers until the child actually has the urge to use a toilet. Habit training has also been shown to be successful for children with severe constipation.
How to prevent constipation
The steps for alleviating constipation should also prevent its recurrence. In short, eat a lot of fiber in fruits, vegetables, and whole grains. Drink sufficient amount water or other nonalcoholic fluid daily. Exercise on a regular basis. Try to keep regular toilet hours and don’t ignore the urge to defecate.
Don’t rely on laxatives
Worry about “irregularity” leads many people to rely routinely, chronically, and unnecessarily on laxatives or enemas. Americans spend more than $725 million each year on laxatives—a waste of money because laxatives don’t promote normal bowel movements or accomplish any health objective. In fact, excessive laxative use often causes diarrhea and vomiting.
Taking a mild laxative may be appropriate if your eating or exercise habits have been altered by travel or some other circumstance. But relying on laxatives can actually weaken bowel function and cause irritable bowel syndrome or other problems that will intensify constipation. A laxative is a drug and should not have a permanent place in your medicine cabinet. The most habit-forming laxatives are the so-called stimulants, which work by irritating the walls of the intestine. Laxatives that increase stool bulk (such as psyllium-containing products) are less of a problem, but any laxative can cause dependency.
If you feel you need a laxative, ask your doctor about the type of laxative, the dosage, and frequency.
When to call your doctor about constipation in adults
Constipation that lasts longer than a week without apparent cause and continues despite self-care measures is a signal to consult a doctor—it can occasionally be a symptom of some underlying disorder. You also should contact your doctor if any of the following occurs:
- Constipation accompanied by fever, severe lower abdominal cramping, bloating, or pain. This may indicate a diverticular disorder.
- Bright red bloody streaks on your bowel movement. This can be a sign of hemorrhoids, caused when the hardened stool stretches and tears the anal opening. Bloody streaks can also signal anal fissures or even rectal carcinoma.
- Constipation after beginning a new prescription medication, vitamin, or mineral. You may need to discontinue the medication, change it, or reduce the dosage.
- Impacted bowel movement. The fecal mass becomes hardened, cannot be excreted, and must be removed by a doctor.
- Any other significant changes in your bowel habits.
When to call the doctor about constipation in children
Call your child’s pediatrician or your family doctor if your child suffers discomfort or severe pain while defecating, has blood in the stool, has not had a bowel movement within four days, has an urge to defecate but can’t pass anything, or if you have specific concerns you want answered.
What your doctor will do
After taking a thorough history, the doctor may perform a physical examination, including a digital rectal exam (DRE) with a gloved finger to evaluate the anal sphincter (the muscle that closes off the anus) and to detect any signs of impaction, tenderness, or blood. Diagnostic tests may also be prescribed, including one or more of the following: special blood tests, stool study, upper GI (gastrointestinal) series, barium enema x-ray, proctosigmoidoscopy, or colonoscopy.
