Constipation

CONSTIPATION

DEFINITION

  • Difficulty passing bowel movements: straining, hard stools, or rectal pressure.
  • Bowel movements do not occur frequently enough.

General Information

  • Normal bowel movement (BM) frequency varies from 3 times a day to 3 times a week.
  • Passage of a large bowel movement is not constipation, since the size of the bowel movement relates to the amount of food an individual eats and the bowel movement frequency. Large eaters have larger stools.
  • The passage of small, dry, rabbit-pellet-like stools is not constipation and instead reflects the desiccation (drying-out) mechanism and insufficient fluid intake.

Lifestyle Causes

  • Diet and fiber: Inadequate dietary fiber reduces intestinal motility and makes BMs hard and more difficult to pass. Fiber works by helping stools to retain water. Good sources of dietary fiber are fresh fruits and vegetables, beans, and bran. Fiber can also be taken via supplements (e.g. Metamucil).
  • Liquids: Insufficient liquid intake cause stools to be dry and harder to pass. Adults should drink 6-8 glasses of water daily.
  • Lack of exercise: Inactivity reduces bowel function, whereas exercise helps stimulate the bowels and improve regularity. Individuals who are bedridden have increased problems with constipation, and may develop a blockage of stool in their rectum (i.e. fecal impaction).
  • Postponing BM's: Some individuals ignore their body's signals to have a BM. This can lead to chronic problems with constipation.
  • Recent travel: Travel can cause constipation because it interferes with your diet and normal daily cycle.

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WHEN TO CALL YOUR DOCTOR

Call your doctor now (night or day) if:

  • You feel weak or very sick
  • Vomiting bile (bright yellow or green)
  • Vomiting and abdomen looks much more swollen than usual
  • Severe rectal pain not relieved by Sitz bath or glycerine suppository

Call your doctor within 24 hours (between 9am and 4pm) if:

  • Intermittent mild abdominal pain and there is a fever
  • Abdomen is more swollen than usual
  • Last BM was more than 3 days ago
  • Leaking stool

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Weight loss greater than 10 pounds and not dieting
  • Minor bleeding from rectum is a recurrent problem
  • Unable to have a BM without using a laxative, suppository, or enema
  • Taking new prescription medication
  • Constipation is a recurrent problem (i.e. less than 3 BM's / week or straining greater than 25% of the time)

Self care at home if:

  • Mild constipation and you don't think you need to be seen
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HOME CARE ADVICE

  • General Constipation Instructions:
    • Eat a high fiber diet.
    • Drink adequate liquids.
    • Exercise regularly (even a daily 15 minute walk!).
    • Get into a rhythm - try to have a BM at the same time each day.
    • Don't ignore your body's signals to have a BM.
    • Avoid enemas and stimulant laxatives.
  • High Fiber Diet: A high fiber diet will help improve your intestinal function and soften your BM's. The fiber works by holding more water in your stools.
    • Try to eat fresh fruit and vegetables at each meal (peas, prunes, citrus, apples, beans, corn).
    • Eat more grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread). Popcorn is a source of fiber.
  • Liquids: Adequate liquid intake is important to keep your BM's soft.
    • Drink 6-8 glasses of water a day. (Caution: certain medical conditions require fluid restriction.)
    • Prune juice is a natural laxative.
    • Avoid alcohol.
  • Get into a rhythm:
    • Try to have a BM at the same time every day. The best time is about 30-60 minutes after breakfast or another meal (Reason: natural increased intestinal activity).
    • Don't ignore your body's signals to have a BM.
  • Bulk-forming laxatives: This type of laxative is generally safe and works like fiber to help soften the stools and improve your intestinal function.
    • Metamucil - One tsp (5 cc) in a glass of water BID.
    • Occasional side effect: mild gas or bloating sensations.
  • Stimulant laxatives: Generally, you should try to avoid using these over the counter medications. Occasional use is probably OK. Read the package instructions carefully. Milk of Magnesia (MOM) is a mild stimulant laxative. The dosage is 2 tablespoons (30 cc) by mouth. Do not use if you have kidney disease.
  • Sitz Bath for Rectal Pain due to Constipation:Take a twenty-minute bath in warm water (2 oz baking soda per tub). This is also called a "Sitz bath." It often helps relax the anal sphincter and release the BM. If the Sitz bath doesn't work, try 1 or 2 glycerin rectal suppositories, which you can get over-the-counter.
  • Enemas: Should be used rarely and only after other measures have not worked.
  • Call Your Doctor If:
    • Constipation continues (i.e. less than 3 BM's / week or straining more than 25% of the time) after following care advice for constipation for 2 weeks
    • You become worse

And remember, contact your doctor if you become worse or develop any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S1-4.
  2. Bonapace ES, Fisher RS. Constipation and diarrhea in pregnancy. Gastr Clinics. 1998;27(1):197-211.
  3. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005; 100 Suppl 1: S5-S21.
  4. DiPalma JA, DeRidder PH, Orlando RC, Kolts BE, Cleveland MB. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol. 2000;95:446-50.
  5. Hsieh C. Treatment of constipation in older adults. Am Fam Physician. 2005; 72(11): 2277-84.
  6. Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005 Apr;100(4):936-71.
  7. Rao SSC. Constipation: evaluation and treatment. Gastroenterol Clin North Am. 2003;32(2):659-83.
  8. Wald A. Constipation. Med Clin North Am. 2000;84(5):1231-1246.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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