- Severe Constipation
- Pain Relief
- Home Remedies
What to Know About Constipation in Adults
- Constipation is a decrease in the frequency of bowel movements or difficulty in passing stools.
- Constipation is a symptom of a disease or condition.
- Causes of constipation range from not drinking enough fluids to poor diet to mechanical issues such as an obstruction in the intestine.
- Symptoms of constipation are infrequent bowel movement, lower abdominal pain, and hard or small stools.
- Home and natural remedies to relieve constipation include gentle exercise, plenty of fluids, and a high-fiber diet.
- OTC (over-the-counter) medication to get rid of constipation includes synthetic fiber, stool softener, and laxatives
- Constipation during pregnancy can be managed by increasing your fluid intake, a high-fiber diet, and gentle exercise.
- Prevention of constipation includes a daily "toilet routine," drinking plenty of fluids, and a well-balanced diet.
What Are the Symptoms of Constipation in Adults?
An individual may exhibit a broad range of symptoms of constipation depending on his or her bowel habits, diet, and age. These are some common problems a person may have if he or she is constipated:
- Difficulty in starting or completing a bowel movement
- Infrequent and difficult passage of stool
- Passing hard stool after prolonged straining
- Irritable bowel syndrome (IBS):
- Intestinal obstruction:
- Distended abdomen:
- Loss of appetite
What Causes Constipation in Adults?
Constipation may result from several causes including a poor diet, poor bowel habits, or problems in the elimination of stool, whether physical, functional, or voluntary. It should be noted that although this is a long list of possibly worrisome causes of constipation, most chronic constipation is simply from inadequate intake of dietary fiber and water, and can be managed by substantially increasing the intake of both.
The following are some of the most common causes of constipation.
- Poor diet: Eating foods rich in animal fats (dairy products, meats, and eggs) or refined sugar but low in fiber (whole grains, fruits, and vegetables).
- Inadequate fluid intake: Not drinking enough water can lead to hard dry stools. Fluid is absorbed in the intestine, and people who don't drink enough water may not pass enough water into the colon to keep their stools soft.
- Caffeine and alcohol: These induce increased excretion and thus urination of water. This leads to (relative) dehydration because of an increase in water absorption from the intestine. This can in turn lead to constipation when not enough fluid is retained in the stool.
- Holding in stools: Ignoring the desire to have bowel movements may initiate a cycle of constipation. After a period of time, the person may stop feeling the desire to move the bowels. This leads to progressive constipation. For example, some people may avoid using public toilets or ignore going to the toilet because they are busy.
- Medications: Many medications can cause constipation:
- Antacids that contain aluminum hydroxide (Alternagel, Alu-Cap, Alu-Tab, Amphojel, Dialume) and calcium carbonate (Rolaids, Mylanta, Maalox, Tums, etc.)
- Antispasmodic drugs
- Iron tablets
- Anticonvulsant drugs
- Diuretics (because they can work like caffeine and alcohol as mentioned previously)
- Painkillers and narcotic-containing drugs (these may suppress bowel function)
- Laxative abuse: Habitually using laxatives will gradually produce dependency on these drugs. The person may eventually require increasing amounts of laxatives to move the bowels. In some instances, the bowel will become insensitive to laxatives and the person will not be able to move the bowels even with laxatives.
What Digestive Problems Are Associated With Constipation?
Because of changes in bowel function, if a person has this disorder, he or she may have:
- Crampy abdominal pain
- Excessive gas (flatulence)
- Constipation sometimes alternates with diarrhea
Mechanical compression and interference with the normal functions of the bowel may occur in the following conditions:
- Scarring of the intestine from inflammation due to diseases such as diverticulitis or Crohn's disease (an inflammatory bowel disease)
- Inflammatory adhesions and joining together of tissues
- Intestinal cancers
- Abdominal hernia, in which loops of the intestine become obstructed
- Gallstones that have become immovably wedged in the intestine
- Twisting of the intestine upon itself (volvulus)
- Foreign bodies (swallowed or introduced into the intestine from the anus)
- Intussusception refers to the "telescoping of the intestine" in which one part of the intestine is drawn into another part (occurs mainly in children.)
- Postoperative adhesions (internal scarring after previous abdominal surgery) can block the small intestine and cause the inability to pass gas or move the bowels, but relatively rarely blocks the large intestine (colon).
Mechanical problems of the anus and rectum
This includes the rectum pushing out of the anus (rectal prolapse) or into the vagina.
Damage to nerves within the intestine
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Does Pregnancy Cause Constipation?
Constipation is a common symptom during pregnancy and may be due to several factors. Some of the following conditions produce severe pain on defecation, which may trigger a reflex spasm of the anal sphincter muscle. The spasm may delay bowel movement and decrease the desire for bowel opening in order to avoid anal pain:
- Mechanical pressure on the bowel by the heavy womb
- Hormonal changes during pregnancy slow intestinal movement
- Changes in food and fluid intake
- Anal fissure (cracks in the lining of the anus)
- Painful hemorrhoids
- Iron in prenatal vitamins
Treatment for constipation during pregnancy is similar to non-pregnancy-related constipation. Drink plenty of fluids (maybe add some prune juice as it is also a mild laxative), eat a high-fiber diet, and do gentle exercise. Severe constipation might require a visit to your doctor to discuss which fiber supplements or laxatives are appropriate for you.
What Are Other Causes of Constipation?
- Connective tissue diseases (conditions such as scleroderma and lupus)
- Poor functioning of the thyroid gland (reduced production of thyroxin, a hormone produced by the thyroid gland, can lead to hypothyroidism, and therefore can cause constipation)
- Lead poisoning and other metabolic disorders
- Age (older adults are more likely to have constipation for the following reasons):
- Poor diet and insufficient intake of fluids
- Lack of exercise
- Side effects of prescription drugs used to treat other conditions
- Poor bowel habits
- Prolonged bed rest, for example after an accident or during an illness
- Habitual use of enemas and laxatives
When Should I Seek Medical Care for Constipation?
Call your health-care professional if you have these concerns:
- Symptoms are severe and last longer than three weeks
- Recent and significant change in bowel habits, for instance, if constipation alternates with diarrhea
- Severe pain in the anus during a bowel movement
- Symptoms of other diseases in addition to constipation (for example, tiredness, fatigue, poor tolerance to cold weather may suggest the need to assess thyroid function for hypothyroidism, an underactive gland.)
When to seek emergency medical care for constipation
Although constipation may be extremely uncomfortable, it is usually not serious. However, it may signal a serious underlying disorder such as cancer of the bowel. Because constipation may lead to complications, go to a hospital's emergency department for any of the following reasons:
- Rectal bleeding
- Anal pain and hemorrhoids
- Anal fissures or cracks in the mucous lining (severe pain during defecation in the anal area)
- Fecal impaction (immovable intestinal contents) in very young children and in older adults
- Rectal prolapse or sagging (occasionally, straining causes a small amount of the intestinal lining to push out from the rectal opening. This may lead to secretion of mucus that may stain the undergarments.)
- Recurrent vomiting with constipation and abdominal pain (This may suggest intestinal obstruction and needs urgent hospital treatment.)
- Severe abdominal pain with constipation that is constant and worsening, especially if it is accompanied with a fever.
How Is Constipation in Adults Diagnosed?
Your healthcare professional will ask you several questions, conduct a physical exam, and if necessary perform certain lab tests or X-rays to find out the possible causes of your constipation.
Answers to these questions will help your doctor assess your condition and plan the treatment options.
- What are your normal bowel habits?
- How long have you had difficulty in passing stool?
- When was the last time you passed stool?
- Are you able to pass gas?
- Do you experience any abdominal or anal pain?
- How would you describe your abdominal pain?
- Have you noticed any changes in your body temperature?
- Have you tried any medication? Did it help?
- Do you usually take laxatives or an enema? If yes, what type of laxatives and how many tablets per day do you usually take?
- Do you have any other symptoms?
- Any changes in your appetite?
- Do you feel better after passing stools?
- Do you feel sick? Have you thrown up?
- Are you pregnant?
- Do you drink alcohol? Coffee? Tea?
- How much?
- Do you use drugs? Any medications?
- Have you ever had surgery? What surgery? When?
- Any joint pain, eye problems, back or neck pain, or skin changes?
- Do you usually feel tired easily?
- Do you have a family history of constipation or bowel cancer?
- Have you ever been screened for colon cancer?
Your healthcare professional will examine your abdomen, anus, and other body systems including the nervous system, the thyroid gland (for any goiter), and the musculoskeletal system. What parts your healthcare professional examines will depend on your answers to the questions and any history that may suggest certain disorders.
Your healthcare professional will decide which tests you need based on your symptoms, history, and exam. These tests will help assess the actual cause of the problem. The most commonly used tests may include the following:
- Examining a stool sample under a microscope
- Complete blood count (CBC) and blood film
- Thyroid function tests if hypothyroidism is suspected
- Upright plain X-ray of the chest and abdomen may show free air from intestinal perforation or signs of intestinal obstruction
- Barium enema may reveal a disease of the colon
- Assessment of food movement may demonstrate a prolonged and delayed transit time
- Sigmoidoscopy may help to detect problems in the rectum and lower colon. The doctor will insert a flexible lighted instrument through the anus to visualize the rectum and the lower intestine.
- A colonoscopy involves the passage of a flexible tube (endoscope) into the colon; your doctor can suspect the diagnosis of irritable bowel syndrome by ruling out more serious disorders. The doctor also may take tissue biopsies for further studies to assess the cause underlying your symptoms.
What Is the Treatment for Constipation in Adults?
If the patient's bowel is not blocked, realistic goals of medical treatment must be established between the patient and the healthcare professional:
- Diet: All cases will require dietary advice. Treatment may be difficult, particularly in those with chronic constipation.
- Medications: Bulk-forming agents may be prescribed in addition to dietary changes.
- Exercise: Increased activity in the elderly and regular exercise in younger people will help.
What Home and Natural Remedies or Diet Changes Can Help With Constipation?
- Fiber: Get more fiber or bulk in the diet. If this cannot be done adequately by diet changes, consider adding a fiber supplement to the diet. There are many of these available, including psyllium (Metamucil) and methylcellulose (Citrucel). In general, these fiber supplements are safe and effective if taken together with sufficient water. They are not laxatives and must be taken regularly (whether you are constipated or not) in order for them to help you avoid future constipation. They are generally taken suspended in a glass of water 1-3 times daily. Start with once a day dose, and increase to twice daily after a week, and then to 3 times daily after another week if necessary.
- Exercise: Regular physical activity is an important component of bowel health. Try a daily exercise such as the knee-to-chest position. Such positions may activate bowel movements. Spend about 10-15 minutes in this position. Breathe in and out deeply.
- Hydration: Drink plenty of fluids, especially water and fruit juices. Drink 6 to 8 glasses of water daily in addition to beverages with meals.
- Alcohol and caffeine: Decrease alcohol intake and caffeinated beverages, including coffee, tea, or cola drinks. In general, it is a good idea to have an extra glass of water (over and above the 6-8 daily mentioned previously) for every cup of coffee, tea, or alcoholic drink.
- Bowel hygiene: Go to the toilet at the same time every day, preferably after meals, and allow enough time so as not to strain while having a bowel movement.
- Laxatives: Avoid using over-the-counter laxatives. Try to avoid laxatives containing senna (Senokot) or buckthorn (Rhamnus purshiana) because long-term intake may damage the lining of the bowel and injure nerve endings in the colon. Aloe juice and aloe latex have been used as laxatives, but should not be confused with aloe vera gel used for wound healing or sunburn. The FDA has indicated that aloe is not safe as a stimulant laxative. Rhubarb or any tonics containing it are also not proven to be safe as laxatives. NOTE: If you choose to use remedies involving homeopathy, herbs, dietary and nutritional supplements, acupressure, aromatherapy, and other alternative or complementary healing methods; keep your doctor informed about every medication or medicine-like substance you use and seek medical advice before taking any medication or remedy.
What OTC Medications Can Treat Constipation in Adults?
If these initial measures fail, the healthcare professional may try a number of laxatives on a short-term basis. The patient should consult with his or her doctor before using any of these agents, particularly on a long-term basis.
- Mineral oils can be very helpful in the short term but are associated with health risks with long-term use. They also can cause substantial diarrhea if too much is taken.
- Sodium docusate or calcium docusate may be useful when the patient must avoid straining for a short period of time, such as after a heart attack, during pregnancy, or after gastrointestinal surgery. They often will lose their effectiveness after several days.
- Fiber supplements as mentioned previously.
- Polyethylene glycol 3350 (Miralax) is an osmotic laxative that is not absorbed by the intestines. It holds water in the bowel, resulting in looser stools. It may be taken occasionally for constipation (up to 2 weeks). Miralax is a drink prepared by mixing a powder with 240 mL (8 oz) of water. Some physicians may prescribe it on a long-term basis.
- Lubiprostone (Amitiza) stimulates the bowel to secrete more fluid into the stool and therefore makes it softer. It is typically taken twice daily and should be taken on a regular basis whether or not constipation is present.
- Linaclotide (Linzess) stimulates receptors situated on the villi of the small intestine to produce an isotonic solution (fluid into small bowel) which makes the stool softer and initiates motility. It is taken as a capsule once daily on a regular basis.
- Nonabsorbable sugars such as lactulose and sorbitol may be useful. Furthermore, they may be acceptable for long-term use. However, they usually produce crampy abdominal pain, diarrhea, and electrolyte imbalance.
- Saline laxatives such as magnesium hydroxide (Phillips Milk of Magnesia) or sodium phosphate (Phospho-Soda, Fleet enema) are not recommended if the affected individual has renal insufficiency (an inability or reduced capacity of the kidney to remove waste). These laxatives may produce severe side effects if used on a long-term basis. A doctor may prescribe them on an occasional basis if the patient has normal kidney function.
- If the patient has irritable bowel syndrome (IBS), he or she should stop smoking and avoid coffee and milk-containing foods. A food diary may help to identify foods that seem to worsen the symptoms.
- Thyroxin will be prescribed if the doctor determines through clinical and laboratory tests that the patient has an underactive thyroid gland (hypothyroidism).
What Kind of Follow-up Should I Expect for Constipation?
- If the person has specific disorders such as hypothyroidism, scleroderma, and lupus, he or she may require regular follow-ups with a healthcare professional.
- Elderly people with a history of fecal impaction and fecal incontinence should be followed regularly to ensure that they do not develop further attacks.
How Can Constipation in Adults Be Prevented?
- Develop regular bowel habits. Set aside time before or after breakfast to use the toilet.
- Do not ignore the desire to defecate. Answer nature's call to empty your bowels as soon as possible.
- Eat a well-balanced diet that includes wheat grains, fresh fruits, and vegetables. Recent evidence suggests that increasing dietary fiber intake may help some people with hard stools, but is not necessarily of benefit to every person with constipation.
- Drink plenty of water and fruit juice.
- Exercise regularly. Walking is especially important.
- Avoid intake of medications that may cause constipation. Discuss the medications and OTC products you currently take with your doctor or pharmacist.
- The use of laxatives can make a constipation problem worse in the long term and should be avoided.
What Is the Prognosis for Constipation in Adults?
Most people with constipation have no physical disease of the digestive system nor any widespread disease associated with constipation. Most of the time, constipation is related to poor dietary habits, low fluid intake, and lack of exercise.
- For people with constipation caused by an illness, recovery will be determined by how sick the affected individual is.
- If the constipation is caused by painful hemorrhoids or anal fissures, the person will typically recover well.
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