Intestinal Disorders Constipation

Constipation is the most common gastrointestinal complaint in America. Some 4.5 million Americans report being constipated “all the time.” Millions of dollars in laxatives and stool softeners are purchased annually in an ongoing effort at constipation relief and regular bowel movements. Constipation in children and the elderly is commonplace, and constipation during pregnancy causes discomfort for many women.

What is Constipation?

The colon removes water from waste material before it passes into the rectum. If waste remains in the colon for too long, too much water is absorbed, causing constipation.

Constipation is the passage of small, hard stools, often less than three times a week. Bowel movements may be difficult or painful, and can leave constipated individuals feeling as if the bowels have not completely emptied. Other symptoms include feeling bloated and uncomfortable.

Causes of Constipation

Insufficient fiber and a lack of exercise are common causes of constipation. While recommended dietary fiber amounts range from twenty to fifty grams daily, the average American ingests only five to fifteen grams a day.

Fiber is essential for regular bowel movements. It’s a natural stool softener that prevents excessive water absorption. Diets high in processed foods and low in fluid intake are common causes of constipation.


Many medications are causes of constipation. Constipation in the elderly is common due, in part, to an increase in medication use as people age. Drugs known to cause constipation include:

  • aluminum-based antacids
  • anticonvulsants
  • antidepressants
  • antispasmodics
  • diuretics
  • hypertension drugs
  • iron supplements
  • laxatives and stool softeners (when overused)
  • narcotics
  • painkillers.

Not everyone who uses these medications becomes constipated. If you’re constipated, inform your doctor of all medications and supplements taken: Constipation relief may be as simple as changing a drug dosage or switching to an alternative medication.

Medical Causes of Constipation

Constipation may be due to underlying medical conditions. If this is the case, treating the condition may provide constipation relief. Medical causes include:

  • cancer
  • cerebral thrombosis
  • colon disorders
  • diabetes
  • hypercalcemia
  • hypothyroidism
  • infection
  • intestinal disorders
  • irritable bowel syndrome
  • lupus
  • multiple sclerosis
  • Parkinson’s disease
  • porphyria
  • rectal disorders
  • spinal cord injury
  • stroke
  • uremia.

Other Causes of Constipation

Resisting the urge to have a bowel movement often leads to constipation, as ignoring the need to defecate causes waste material to build up and become compacted.

Travel, which disrupts sleeping, eating and exercise habits, can also leave people constipated. This is especially true on long journeys, when physical constraints may require people to resist bowel movements.

Constipation in Children and the Elderly

Adults older than 65 and children often become constipated. Constipation in children is often due to ignoring the urge to defecate. A child may become constipated because she does not want to interrupt her play.

Constipation in children may indicate resistance to toilet training. Known as “stool withholding,” this behavior allows the child to control his body and environment. Severe cases of stool withholding and constipation in children can result in fecal impaction.

Constipation in the elderly is common for several reasons. As we age, the colon’s reflexes slow, increasing the risk of becoming constipated. Other causes of constipation in older people include:

  • a lack of exercise
  • a low fiber diet
  • medication
  • reduced mobility.

Constipation During Pregnancy

The most common explanation for increased constipation during pregnancy is that the growing uterus puts pressure on the intestines, slowing waste’s progression through the colon.

Some researchers have suggested that hormonal fluctuations are responsible for constipation during pregnancy. The use of iron supplements during pregnancy can also lead to constipation.

Am I Really Constipated?

While millions of Americans report being constipated and needing constipation relief, many are incorrectly self-diagnosing. They believe that being “regular” requires a daily bowel movement, and that they’re constipated if the daily event doesn’t occur.

This widely held belief is a myth. In fact, regularity differs widely among individuals. For some people, three bowel movements a day is normal, while others have only three a week. Neither extreme necessarily indicates a problem.

Stool Softeners, Laxative Abuse and Constipation Relief

Some people are hypersensitive to regularity, especially people suffering from obsessive compulsive disorder. If they don’t have a daily bowel movement they assume a need for constipation relief. This can lead to the overuse or abuse of over-the-counter laxatives and stool softeners.

Paradoxically, laxative and stool softener overuse is a leading constipation cause. Laxative abuse is habit-forming, slowly damages the colon and causes the body to rely on laxatives for bowel movements. Without the expected laxative dose, constipation occurs, which further convinces laxative abusers that they need constipation relief.

Diagnosing Constipation

A physical exam is usually sufficient to diagnose constipation. More involved diagnostics are usually unnecessary unless one of the following factors is an issue:

  • blood in the stool
  • over 65 years old
  • severe symptoms
  • sudden change in bowel movements.

Constipation Relief and Prevention

Constipation relief and constipation prevention are much the same. If a medication causes constipation, changing medications or dosage should provide constipation relief.

Severe cases of constipation may require limited laxative treatment, preferably with non-habit forming bulking agents such as bran or psyllium. Laxatives and stool-softeners should not be employed if the following disorders are present:

  • abdominal pain with no known cause
  • fecal impaction
  • gastrointestinal bleeding
  • inflammatory bowel disorders
  • intestinal obstructions
  • laxative or stool softener abuse
  • tumors.

Assuming no underlying cause, constipation relief is often achieved with lifestyle changes:

  • Drink plenty of water.
  • Exercise regularly.
  • Eat a high fiber diet (bran, fruits, vegetables).

Complications of Constipation

Chronic constipation or straining can have some uncomfortable and sometimes painful complications. These include:

  • hemorrhoids: treated with witch hazel, sitz baths, and sometimes surgery
  • anal fissures: often heal on their own, but may be treated with surgery or injections of botulinum toxin (BOTOX®)
  • rectal prolapse: treatment usually involves eliminating straining, severe cases may require surgical repair
  • fecal impaction.

Fecal Impaction

Fecal impaction is especially common in the bedridden, the elderly and after undergoing a barium swallow or enema. Fecal matter “impacts” into an impassable mass in the rectum, and attempts to defecate are unsuccessful.

Symptoms of fecal impaction include:

  • cramping
  • diarrhea (liquid fecal matter able to pass the obstruction)
  • inability to defecate
  • rectal pain.

Left untreated, fecal impaction can cause the colon to rupture, creating a medical emergency. Fecal impaction is treated with stool softeners to break down and move the obstruction. Severe cases of fecal impaction may require surgical intervention.


Beers, M.H.