Constipation occurs when stools are
difficult to pass. Some people are overly concerned with the frequency of their
bowel movements because they have been taught that a healthy person has a bowel
movement every day. This is not true. Most people pass stools anywhere from 3
times a day to 3 times a week. If your stools are soft and pass easily, you are
not constipated.
Constipation is present if you have 2 or fewer
bowel movements each week or you do not take laxatives
and have 2 or more of the following problems at least 25% of the time:
Straining
Feeling that you do not
completely empty your bowels
Hard stools, or stools that look like
pellets
A feeling of being blocked up
You cannot pass
stools unless you put a finger in your rectum or use manual pressure to pass a
stool.
Constipation may occur with cramping and pain in the rectum
caused by the strain of trying to pass hard, dry stools. You may have some
bloating and nausea. You may also have small amounts of bright red blood on the
stool or on the toilet tissue, caused by bleeding
hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the
anus. This should stop when the constipation is
controlled.
There are three types of constipation: normal movement
(transit) of stool through the intestines, slow transit constipation, and
outlet delay.
Normal and slow transit constipation
Two of the
most common types of constipation are normal and slow transit (functional)
constipation. Lack of fiber is a common cause of functional constipation. Other
causes include:
Constipation is
sometimes caused by poor muscle tone in the pelvic area (outlet delay).
Excessive straining, needing manual pressure on the vaginal wall, or feelings
of incomplete emptying may be a symptom of this type of constipation. Outlet
delay constipation is caused by:
Physical disorders that cause loss of
function, such as
colon cancer,
uterine prolapse or
rectal prolapse, scarring (adhesions), or injury
caused by physical or sexual abuse.
Delaying bowel movements because of convenience issues or
because having a bowel movement causes pain.
Constipation is more common in people older than 65.
People in this age group are more likely to have poor dietary habits and
increased medicine use. Older adults also often have decreased muscular
activity of the intestinal tract, which increases the time it takes for stool
to move through the intestines. Physical problems, such as
arthritis, may make sitting on the toilet
uncomfortable or painful.
Constipation is also more common in
rural areas, cold climates, and among the poor.
Women report problems with constipation more often
than men.
If a stool becomes lodged in the rectum (impacted),
mucus and fluid may leak out around the stool, sometimes leading to leakage of
fecal material (fecal incontinence). You may experience this as constipation
alternating with episodes of diarrhea.
Review the Check Your
Symptoms section to determine if and when you need to see a doctor.
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review
health risks that may increase the seriousness of your
symptoms.
If you have any of the following
symptoms, evaluate those symptoms first.
Review
health risks that may increase the seriousness of your
symptoms.
Note:
Call 911 or other emergency services if you have blood in your stool and any
signs of shock, such as:
Passing out (losing
consciousness).
Feeling very dizzy or lightheaded, like you may
pass out.
Feeling very weak or having trouble standing
up.
Being less alert. You may suddenly be unable to respond to
questions, or you may be confused, restless, or fearful.
Certain foods and medicines can change
how the stool looks. Taking medicines that contain bismuth, such as
Pepto-Bismol, or iron tablets can make the stool black, and eating lots of
beets may turn the stool red. Some food colorings also can change the color of
your stool. Eating foods that contain black or dark blue food coloring can turn
your stool black.
Call your health professional immediately if you answer "Yes" to
the following question.
Have you had streaks of blood in your stools? Note: Streaks of blood in your stools occasionally is not
unusual, but talk to your doctor about what to expect.
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you
think that your constipation may be caused by a
medicine?
Note:
If you answered Yes:
Call the doctor who prescribed the
medicine to see whether you should stop taking the medicine or take a different
one. An appointment may not be needed.
If you are taking a
nonprescription medicine, stop taking it. Call your doctor if you feel you need
to still take the medicine.
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review
health risks that may increase the seriousness of your
symptoms.
If you have any of the following
symptoms, evaluate those symptoms first.
Review
health risks that may increase the seriousness of your
symptoms.
Note:
Call 911 or other emergency services if you have blood in your stool and any
signs of shock, such as:
Passing out (losing
consciousness).
Feeling very dizzy or lightheaded, like you may
pass out.
Feeling very weak or having trouble standing
up.
Being less alert. You may suddenly be unable to respond to
questions, or you may be confused, restless, or fearful.
Certain foods and medicines can change
how the stool looks. Taking medicines that contain bismuth, such as
Pepto-Bismol, or iron tablets can make the stool black, and eating lots of
beets may turn the stool red. Some food colorings also can change the color of
your stool. Eating foods that contain black or dark blue food coloring can turn
your stool black.
Call your health professional immediately if you answer "Yes" to
the following question.
Have you had streaks of blood in your stools? Note: Streaks of blood in your stools occasionally is not
unusual, but talk to your doctor about what to expect.
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you
think that your constipation may be caused by a
medicine?
Note:
If you answered Yes:
Call the doctor who prescribed the
medicine to see whether you should stop taking the medicine or take a different
one. An appointment may not be needed.
If you are taking a
nonprescription medicine, stop taking it. Call your doctor if you feel you need
to still take the medicine.
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment
Constipation can be treated at
home.
First:
Try gentle exercise. Take a short walk each
day. Gradually increase your walking time until you are walking for at least 20
minutes.
Make sure you drink enough fluids. Most adults should try
to drink between 8 and 10 glasses of water or noncaffeinated beverages each
day. Avoid alcoholic beverages and caffeine, which can increase
dehydration. If you have heart failure or kidney
failure, talk to your doctor about what amount of fluid is right for
you.
Include fruits, vegetables, and fiber to your diet each day.
Have a bran muffin or bran cereal for breakfast, and try eating a piece of
fruit for a mid-afternoon snack.
Schedule time each day for a bowel
movement (after breakfast, for example). Establishing a daily routine may help.
Take your time. Do not be in a hurry.
Support your feet with a small step stool [about
6 in. (15 cm)] when you sit on
the toilet. This will help flex your hips and place your pelvis in a more
normal "squatting" position for having a bowel movement.
If you are still constipated:
Add some processed or synthetic fiber-such as
Citrucel, Metamucil, or Perdiem-to your diet each day.
Try a stool
softener, such as Colace, if your stools are very hard.
Try a
rectal glycerin suppository. Follow the directions on the label. Do not use
more often than recommended on the label.
In difficult cases of constipation, it is better to try a saline
(osmotic)
laxative, such as Fleet Phospho-Soda or Milk of
Magnesia or Lactulose. You should not take these types of laxatives if you are
on a sodium-restricted diet or have kidney problems or high blood pressure.
Osmotic laxatives do not irritate the colon or cause dependence on laxatives
like stimulant laxatives can.
You may occasionally need to try a
stimulant
laxative, such as Ex-Lax or Feen-a-Mint. Use these
preparations sparingly. Overuse of stimulant laxatives decreases the tone and
sensation in the large intestine, causing dependence on using laxatives.
Regular use may interfere with your body's ability to absorb vitamin D and
calcium, which can weaken your bones. Do not use laxatives for longer than 2
weeks without consulting your doctor.
If you are
still constipated, use the Check Your Symptoms section to determine if and when
you need to see your doctor.
Talk to your doctor before using an
enema. Your doctor may need to check your symptoms or may suggest a different
way to treat your constipation.
Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to
evaluate your symptoms if any of the following occur during home
treatment:
New constipation occurs or other bowel habit
changes continue after one week of home treatment.
Ongoing
(chronic) constipation:
Is causing new problems.
Has
gotten worse.
Is accompanied by other bowel habit changes, such as
changes in the size, shape, or consistency of your stools.
Rectal pain develops or
increases.
Blood in the stool develops or
increases.
Abdominal pain develops.
Fever
develops.
Vomiting develops.
Uncontrolled leakage of
stool occurs.
Your symptoms become more severe or more
frequent.
If you have any of these symptoms, you need to be
evaluated by a doctor.
Prevention
You can prevent constipation.
Make sure you are drinking enough fluids.
Drink 2 to 4 extra glasses of water per
day, especially in the morning.
Drink
1.5 qt (1.4 L) to
2 qt (2 L) of water and other
fluids, such as noncaffeinated beverages, every day.
Add high-fiber foods to your diet. Doctors
recommend that you eat 20 to 30 grams of fiber every day. Packaged foods and
fiber supplements include the amount of fiber content in the nutrition
information. You should increase the amount of fiber in your diet slowly so
that your stomach can adjust to the change. Adding too much fiber too quickly
may cause stomach upset and gas.
Eat at least 2 servings of fruit, such as
apricots, peaches, pears, raisins, figs, prunes, dates, and other dried fruits,
each day.
Eat at least 3 servings of vegetables, such as cooked
dried beans or peas (legumes), broccoli, or cauliflower, each day.
Increase whole-grain foods, such as bran flakes,
bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Eat
brown rice, bulgur, or millet instead of white rice. Eat 6 to 11 servings of
grains (breads, cereals, rice, pasta) each day. For example, a serving is 1
slice of bread, half of a bagel, or ½ cup pasta or rice.
Use whole wheat bread instead of white
bread. Choose whole-grain breads and cereals; buy bread that lists whole wheat,
stone-ground wheat, or cracked wheat in the ingredients.
Eat a bowl
of bran cereal with
2 tsp (10 mL) of bran per
serving.
Snack on unbuttered, unsalted popcorn.
Add
2 Tbsp (30 mL) of wheat bran to
cereal or soup. If you do this, start slowly with
1 tsp (5 mL) a day. Gradually
increase the amount to
2 Tbsp (30 mL) a
day.
Mix
2 Tbsp (30 mL) of psyllium
(found in Metamucil and other bulk-forming agents) with a fluid, and drink it.
Avoid foods that are high in fat and
sugar.
Avoid alcoholic beverages and caffeine, which can increase
dehydration.
Exercise more. A walking program would be a good
start. For more information, see the topic
Fitness.
Set aside relaxing times for
having bowel movements. Urges usually occur sometime after meals. Establishing
a daily routine for bowel movements, such as after breakfast, may
help.
Go when you feel the urge. Your bowels send signals when a
stool needs to pass. If you ignore the signal, the urge will go away, and the
stool will eventually become dry and difficult to pass.
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