Nearly everyone becomes constipated at one time or another. Older people are more likely than younger people to become constipated, but most of the time it is not serious.
Constipation is a symptom, not a disease. You may be constipated if you are having fewer bowel movements than usual, it takes a long time to pass stools, and they are hard.
There is no right number of daily or weekly bowel movements. Being regular is different for each person. For some people, it can mean bowel movements twice a day. For others, movements just three times a week are normal.
Some doctors suggest asking these questions to decide if you are constipated:
- Do you often have fewer than three bowel movements a week?
- Do you often have a hard time passing stools?
- Are stools often lumpy or hard?
- Do you have a feeling of being blocked or of not having fully emptied your bowel?
The clinical definition of constipation is having any two of the following symptoms for at least 12 weeks—not always consecutive—in the previous 12 months:
- Straining during bowel movements
- Lumpy or hard stool
- Sensation of incomplete evacuation
- Sensation of anorectal blockage/obstruction
- Fewer than three bowel movements per week
How is the Cause of Constipation Identified?
The tests the doctor performs depend on the duration and severity of the constipation, the person’s age, and whether blood in stools, recent changes in bowel habits, or weight loss have occurred. Most people with constipation do not need extensive testing and can be treated with changes in diet and exercise.
To find out why you have constipation, your doctor may order one or more tests:
- Sigmoidoscopy. The doctor puts a thin, flexible tube called a sigmoidoscope into the rectum. This scope can show the last third of your large intestine.
- Colonoscopy. The doctor looks at the entire large intestine with a long, flexible tube with a camera that shows images on a TV screen. The tube is like a sigmoidoscope but longer. You receive medicine to help you sleep during a colonoscopy.
- Colorectal transit study. For this test, you swallow small capsules that can be seen on an x ray as they move through the large intestine and anus.
- Anorectal function test. The doctor inserts a small balloon into the anus to see if you are able to push it out.
- Defecography test. The doctor inserts a soft paste into the rectum. The doctor asks you to push out the paste while an x-ray machine takes pictures of the rectum and anus.
How to Help Constipation
Doctors do not always know what causes constipation. It may be a poor diet, not getting enough exercise, or using laxatives too often.
People may become constipated if they do not eat enough high-fiber foods like vegetables, fruits, and whole grains. Some research shows that high-fiber diets can help prevent constipation. Eating a lot of high-fat meats, dairy products and eggs, or rich desserts and sugary sweets also may cause constipation.
People who live alone sometimes lose interest in cooking and eating. As a result, they start using a lot of prepared foods. These foods tend to be low in fiber and may lead to constipation. In addition, if you have bad teeth, you may tend to choose soft, processed foods that contain small amounts of fiber.
People sometimes do not drink enough water and other fluids. This often is true when they are not eating regular meals. But water and other liquids may help some people stay regular.
Too Many Laxatives and Enemas
Many people think of laxatives as a cure for constipation. But if you use laxatives too often, your body may forget how to work on its own. Heavy use of laxatives is not needed and can cause diarrhea. For the same reason, if you use enemas too often, your body may begin to depend on them. Too many enemas may stop you from having normal bowel movements.
Lack of Exercise
Inactivity or long periods in bed, such as after an accident or illness, may cause constipation. Doctors sometimes suggest medicine for people who stay in bed and suffer from chronic constipation. But being more active, when possible, is best.
Holding Back Bowel Movements
People also can become constipated if they ignore their urge to have a bowel movement. Some people prefer to have bowel movements only at home. But holding in a bowel movement can cause constipation if the delay is too long.
Some problems, like stroke, diabetes, or a blockage in the intestines, can cause constipation. A condition called irritable bowel syndrome can also cause constipation. These disorders may affect the muscles or nerves used for normal bowel movements. A doctor can do tests to see if a medical problem is the cause. If so, the problem often can be treated.
Some medicines can lead to constipation. These include some drugs used to treat depression, antacids containing aluminum or calcium, some allergy medicines (anti-histamines), some high blood pressure drugs, including diuretics, and some drugs used to treat Parkinson's disease.
Problems with the Colon and Rectum
Intestinal obstruction, scar tissue—also called adhesions—diverticulosis, tumors, colorectal stricture, Hirschsprung disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.
Treatments for Constipation
If you think you are constipated, talk to your doctor to rule out a more serious problem. If tests show no disease or blockage, and if your doctor approves, try these changes:
- Add fiber to your diet by eating more fresh fruits and vegetables, either cooked or raw, and more whole-grain cereals and breads. Dried fruit such as apricots, prunes, and figs are high in fiber.
- Add small amounts of unprocessed bran ("miller's bran") to baked goods, cereals, and fruit. This may cause bloating and gas for a few weeks after you start. Make diet changes slowly to allow your system to adapt. If your diet is healthy and high in natural fiber, you may not need to add bran.
- Be sure to get enough fluids. If you don't get enough, constipation can get worse. Drinking lots of water and juices helps some people get back to regular bowel movements.
- Stay active. This is important for overall health, too. Do things that keep you moving and active. Go for walks. Take care of your yard. Find things you enjoy and make them a part of your everyday life.
If these measures don't work, talk to your doctor about laxatives. There are different kinds of laxatives, and each has its pros and cons. A doctor can tell you which is best for you.
If you are constipated all the time, your doctor may want to check to see if you have diverticular disease, another condition that sometimes goes along with constipation. This problem is common in Americans as they get older. Talk to your doctor if you are concerned about this condition.
Source: The National Institute on Aging (NIA), https://www.nia.nih.gov/health/concerned-about-constipation