Constipation, Age 12 and Older

Topic Overview

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 a sign of another health problem, such as diabetes, hypothyroidism, or hypercalcemia.

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:

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.

Psychological problems, such as severe anxiety, depression, eating disorders, or obsessive-compulsive disorder, also can cause constipation.

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.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

Check Your Symptoms

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.

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?

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Specialist Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Last Updated October 10, 2008

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