Constipation is really more a complaint than a disorder—in fact, it is the most common gastrointestinal complaint 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. 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.
Symptoms of Constipation
- Infrequent bowel movements
- Hard stools that can cause strain and pain when passing
- Abdominal swelling
- Continued sensation of fullness after a bowel movement
- No bowel movement in at least three days (four days for children)
What Causes Constipation?
A lack of fiber in the diet is probably the most common cause; fiber adds bulk to stool, it absorbs water to help soften stool, and it stimulates peristalsis, 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, or depression, which can bring about a change in bowel habits; ignoring the urge to defecate; travel or any other shift in your daily routine that changes your regular toilet habits; laxative abuse; and a lack of access to toilet facilities.
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, bowel disease, and irritable bowel syndrome. Pregnancy can also cause constipation because of hormonal changes.
Constipation in Children
Constipation is frequently encountered in infants and children, particularly when the 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
- Sudden change in diet
- Resistance to toilet training (e.g., 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
The child’s pediatrician or your family physician should be contacted if
- the 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 you have concerns you want answered.
Dietary changes usually relieve childhood constipation, so be sure to increase the child’s daily intake of fiber-rich food (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.
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 it.
Home Remedies for Constipation
Treatment depends on the specific cause, severity, and duration of the problem, but in most cases these straightforward measures will quickly bring relief.
- Drink plenty of nonalcoholic fluids. These will soften the stool, and soft stools are easier to pass than hard ones. Be sure to drink at least eight glasses of water or fruit juice a day.
- Eat a diet high in fiber. Examples of high-fiber foods are grains (including unprocessed wheat bran), fruits, vegetables, and legumes. As your grandmother may have told you, prunes are particularly effective in preventing constipation, as are raisins and figs. Try to eat five to six servings of fiber-rich foods daily (which should provide 20 to 30 grams of dietary 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 by strengthening your abdominal and pelvic floor muscles.
- Eat regularly. If possible, eat three meals per day at least 4 hours apart. Don’t eat a large meal before going to bed.
- 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.
In January 2014, the U.S. Food and Drug Administration (FDA) issued a warning against exceeding the recommended dosage of over-the-counter (OTC) oral solutions and enemas containing sodium phosphate. In rare cases, taking a larger-than-recommended single dose of these medications, or taking more than one dose in a day can lead to severe kidney or heart damage. According to the FDA, OTC constipation remedies should only be used as directed. Children, adults over the age of 55, people who are dehydrated, and those who have kidney or bowel disease or are taking certain other medications (e.g., NSAIDs, diuretics, ACE inhibitors, ARBs) are at higher risk for these serious complications.
The steps for alleviating constipation should also prevent its recurrence. In short, keep your fiber intake high; drink a minimum of eight glasses of 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 $400 million annually on laxatives—a mostly useless expenditure that fails to promote normal bowel movements or accomplish any health objective. In fact, excessive laxative use often causes diarrhea and vomiting.
While a mild laxative may occasionally be appropriate if your eating or exercise habits have been altered by travel or some other circumstance, 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 in need of one, consult your physician about the type of laxative, the dosage, and frequency.
Beyond Home Remedies: When To Call Your Doctor
Constipation that lasts longer than a week without apparent cause and continues despite self-care measures is a signal to consult a doctor, for it can occasionally be a symptom of some underlying disorder. You also should contact your physician 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 physician.
- Any other significant changes in your bowel habits.
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.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media