Constipation

Is this your symptom?

  • Can't pass a stool or pain when passing a stool
  • 3 or more days without passing a stool
  • Caution: any stomach pain from constipation comes and goes. Most often, it is mild. Use the Stomach Pain care guide if there is sudden onset or constant stomach pain.

Causes of Constipation

  • Low Fiber Diet. A diet that is low in fiber can cause constipation. To increase the fiber in your diet, choose higher-fiber breakfast cereals or bread with whole grains. Choose whole wheat pasta and brown rice. Add beans, lentils or chickpeas to your diet and include plenty of fresh vegetables and fruit. Nuts and seeds are another good source of fiber and can be eaten as a snack. So can fresh fruit and raw vegetables.
  • Not Enough Fluids. Drinking 6-8 glasses of fluids a day (avoid alcohol) will help keep you healthy and prevent dehydration. It will also help keep your stools soft. If you have had diarrhea or vomiting, or had a prolonged fever and have become dehydrated, you may become constipated. The same can happen in hot weather. If you work in a hot environment and have been sweating a lot due to activity, drink more fluids.
  • Lack of Exercise. Lack of movement can make the bowels sluggish. Keep active to prevent this.
  • Limited Bathrooms or Bathroom Time. Not enough bathrooms at home or at work, or lack of privacy, can lead to delay in passing a stool. This can cause constipation, as the stool is harder to pass later.
  • Anorectal Disease. Diseases which affect the rectum and anus can lead to constipation. Painful stools are too hard to pass. These diseases include:
    • Anal Fissure. A crack in the skin at the anus caused by passing a large hard stool. This causes pain and bleeding when passing a stool.
    • Anal Stricture. Narrowing of the anus makes it is hard to pass a normal stool. Stools may appear narrow when passed. There may also be an anal fissure, with bleeding.
  • Irritable Bowel Syndrome (IBS). This causes bouts of diarrhea, constipation and abdominal pain. The exact cause is unknown. Factors may include stress, diet, lifestyle or hormones. Symptoms are similar to problems that inflame the bowel, such as ulcerative colitis and Crohn’s disease. They may need to be ruled out before a diagnosis of IBS is made.
  • Intestinal Obstruction (serious). Part of the bowel can get blocked for a number of reasons. This prevents the stools from passing along the length of the bowel. It can begin slowly or can come on suddenly. It may seem like constipation, but it is a more serious problem and needs urgent treatment. Obstruction can be caused by:
    • Strictures narrowing anywhere in the bowel
    • Colorectal Cancer can cause a growth which blocks the bowel.
    • Pelvic Mass. A large growth in the pelvis can press on the rectum and block stools from passing through that part of the bowel. Growths may include ovarian cysts and fibroids. The late stages of pregnancy have a similar effect. Constipation is common in pregnant women.
    • Diverticulosis means sacs form on the inner lining of the bowel. They can get large and inflamed or infected. It makes it hard for stools to pass through that part of the bowel. This issue gets more common with age.
    • Twisted Bowel. The bowel can twist and become blocked. This often causes severe abdominal pain, vomiting, an inability to pass wind and a bloated abdomen. Call 911 if you have these symptoms.
  • Other Medical Conditions. Some medical conditions are linked to constipation. These include underactive thyroid, low calcium or potassium levels, porphyria and lead poisoning. If you have constipation often, your doctor can order tests for these conditions.
  • Medicines. Some medicines can cause constipation. These include painkillers like morphine and codeine, iron and some antidepressants.
  • Nerve Damage: if there has been damage to the bowel nerves, the bowel may not be able to push the stools along. Damage could be due to injuries to the spine or pelvis, nerve damage due to poorly-controlled diabetes, or a congenital reason such as spina bifida.
  • Chronic Laxative Abuse caused by an attempt to lose or control weight.
  • Slow Passage of Food through the Intestines. Most often, this type runs in families. It's called slow transit time.

When to Call for Constipation

Call Doctor or Seek Care Now

  • Rectal pain lasts more than 1 hour (includes straining) after using care advice
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Leaking stool
  • Tried a suppository or enema but it did not work
  • Minor bleeding from the rectum when you pass a stool
  • Last normal stool was more than 5 days ago
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Suppository or enema was needed to get the stool out
  • Infrequent stools do not get better after changes to diet
  • You are taking a new drug which may be the cause
  • You are using stool softeners and have not talked to your doctor about the problem
  • You have lost weight and you are not dieting
  • Mucus in the stool (might see this on toilet paper)
  • Painful stools occur 3 or more times after changes to diet
  • Constipation is a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Mild constipation

Care Advice

Lifestyle Changes to Help with Constipation

  1. What You Should Know about Constipation:
    • Constipation is a common symptom, especially in the elderly.
    • The normal range is 3 stools per day to 1 stool every 2 days. Some people pass stools less often and that is normal for them.
    • Passing a stool should be free of pain.
    • If you have pain during stool passage or lots of straining, you may need treatment. At the very least, you may need to change your diet.
    • Most constipation does not need a doctor visit, especially if mild.
    • Most often, it follows a change in diet or a change in your routine, such as travel. It is often caused by not passing a stool when you have the urge to go. It makes the stool harder to pass later.
    • Here is some care advice that should help. Lifestyle changes are listed below. If these do not help, over-the-counter remedies may be needed.
  2. Fiber in the Diet. Add foods to your diet which have more fiber. These include: prunes, figs, apples, pears, citrus, green vegetables, sweet potatoes, beans, peas, lentils and oat bran. It is also helpful to eat less of the foods that tend to constipate. Eat fewer of these foods: bananas, rice, red meat, milk and dairy products and processed meats (deli meats).
  3. Drink Plenty of Fluids. Drink 6 to 8 glasses of fluids per day (not alcohol), to keep stools soft.
  4. Exercise. Keeping active can help prevent constipation.
  5. Stick to a routine. Your body gets used to eating, sleeping and exercising at certain times. A change in your routine can affect your bowel habits. Make time to go to the bathroom to pass a stool when you feel the need or urge to go.
  6. Positioning. While sitting on the toilet, relax the muscles that support you bowels and bladder. Do this by raising your knees with your legs slightly spread. You might try propping your feet up on a small step stool.
  7. Call Your Doctor If:
    • Constipation lasts more than 1 to 2 weeks after making these lifestyle changes
    • You have bleeding when you pass your stools
    • You develop a painful lump at the anus
    • You think you need to be seen
    • You get worse

Over-the-Counter Remedies for Constipation

  1. Overview. Try the following options one at a time for 1-2 weeks. If you do not get relief, then add the next option. Note: all of these products can cause you to have more gas. Follow the instructions on the package or the advice of your doctor.
  2. Fiber Supplements. Slowly add a fiber supplement such as Metamucil (Psyllium) or Benefiber.
  3. Osmotic agent. If adding fiber does not help, the next option is to add what is called an osmotic agent, such as Milk of Magnesia, magnesium citrate or Miralax (also called polyethylene glycol or PEG). These cause the stools to hold more water, which soften the stools.
  4. Stimulant Laxative. If you still have constipation, add a stimulant laxative such as Colace. It is a stool softener and stimulates the bowels to push the stool along. Other products are Dulcolax (bisacodyl) or a glycerol suppository. These should only be used for a week at the most.
  5. Call Your Doctor If:
    • You have questions about over-the-counter products for relieving constipation
    • You think you need to be seen
    • Your constipation gets worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.


Last Reviewed: 10/11/2023 1:00:42 AM
Last Updated: 4/13/2023 1:00:36 AM

Copyright 2023 Schmitt Decision Logic, LLC

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