Constipation, Age 12 and Older
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:
- Feeling that you do not completely empty your bowels
- Hard stools, or stools that look like pellets
- A feeling of being blocked up
- You can't 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.
Constipation can mean the slow movement of stool through the intestines or problems releasing a stool.
Slow transit constipation
Lack of fiber is a common cause of constipation. Other causes include:
- Irritable bowel syndrome .
- Travel or other change in daily routine.
- Lack of exercise.
- Immobility caused by illness or aging.
- Medicine use.
- Overuse of laxatives.
Outlet delay constipation
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.
- Nervous system diseases, such as Parkinson's disease , multiple sclerosis , or stroke .
- Spinal cord injury.
- Pain from hemorrhoids or anal fissures.
- 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.
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.
Check your symptoms to decide if and when you should see a doctor.
Constipation can be treated at home.
- 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 in 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.
- Osmotic laxatives (such as Fleet Phospho-Soda, Milk of Magnesia, or Miralax) and nonabsorbable sugars (such as lactulose or sorbitol) hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.
- 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, check your symptoms 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
Call your doctor if any of the following occur during home treatment:
- Constipation occurs or continues after 1 week of home treatment.
- Rectal pain develops or increases.
- Blood in the stool develops or increases.
- 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.
You can prevent constipation.
- Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
- Add high-fiber foods to your diet. Try to get 20 to 35 grams of fiber a 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 1½ to 2 cups of fruit a day. Choose whole fruit instead of fruit juice.
- Eat at least 2 to 3 cups of vegetables a day.
- Increase the amount of high-fiber foods, such as bran flakes,
bran muffins, oatmeal, brown rice, beans, and lentils. Eat
brown rice, bulgur, or millet instead of white 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.
- Snack on unbuttered, unsalted popcorn.
- Add 2 Tbsp of wheat bran to cereal or soup. If you do this, start slowly with 1 tsp a day. Gradually increase the amount to 2 Tbsp a day.
- Mix 2 Tbsp of psyllium (found in Metamucil and other bulk-forming agents) with a fluid, and drink it.
- Avoid alcohol beverages. They 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.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- Is constipation an ongoing (chronic) problem for you, or is this a new or different problem? If it is chronic, when did it begin?
- When did this episode of constipation begin?
- When was your last normal bowel movement?
- Have you recently changed your diet or fluid intake, decreased your activity level, or started a new medicine?
- Have you recently changed your daily routine, such as a change in your job, school, or travel?
- What have you tried to correct your constipation? Did it work?
- Do you have any rectal bleeding?
- Do you have rectal pain before, during, or after a bowel movement? If so, how long does the pain usually last?
- Do you have any health risks?
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||David Messenger, MD|
|Last Revised||August 2, 2012|
Last Revised: August 2, 2012
Author: Healthwise Staff
Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD
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