Constipation Health Article

Definition

Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. Bowel habits vary, but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.

Description

Constipation is one of the most common medical complaints in the United States. Constipation can occur at any age, and is more common among individuals who resist the urge to move their bowels at their body's signal. This often happens when children start school or enter daycare and feel shy about asking permission to use the bathroom.

Constipation is more common in women than in men and is especially apt to occur during pregnancy. Age alone does not increase the frequency of constipation, but elderly people (especially women) are more likely to suffer from constipation.

Although this condition is rarely serious, it can lead to:

• bowel obstruction
• chronic constipation
• hemorrhoids (a mass of dilated veins in swollen tissue around the anus)
• hernia (a protrusion of an organ through a tear in the muscle wall)
• spastic colitis (irritable bowel syndrome, a condition characterized by alternating periods of diarrhea and constipation)
• laxative dependency

Chronic constipation may be a symptom of colorectal cancer, depression, diabetes, diverticulosis (small pouches in the muscles of the large intestine), lead poisoning, or Parkinson's disease.

In someone who is elderly or disabled, constipation may be a symptom of bowel impaction, a more serious condition in which feces are trapped in the lower part of the large intestine. A doctor should be called if an elderly or disabled person is constipated for a week or more or if a child seems to be constipated.

A doctor should be notified whenever constipation occurs after starting a new prescription, vitamin, or mineral supplement or is accompanied by blood in the stools, changes in bowel patterns, or fever and abdominal pain.

Causes and symptoms

Constipation usually results from not getting enough exercise, not drinking enough water, or from a diet that does not include an adequate amount of fiber-rich foods like beans, bran cereals, fruits, raw vegetables, rice, and whole-grain breads.

Other causes of constipation include anal fissure (a tear or crack in the lining of the anus); chronic kidney failure; colon or rectal cancer; depression; hypercalcemia (abnormally high levels of calcium in the blood); hypothyroidism (underactive thyroid gland); illness requiring complete bed rest; irritable bowel syndrome; and stress.

Constipation can also be a side effect of:

• aluminum salts in antacids
• antihistamines
• antipsychotic drugs
• aspirin
• belladonna (Atopa belladonna, source of atropine, a medication used to relieve spasms and dilate the pupils of the eye)
• beta blockers (medications used to stabilize irregular heartbeat, lower high blood pressure, reduce chest pain)
• blood pressure medications
• calcium channel blockers (medication prescribed to treat high blood pressure, chest pain, some types of irregular heartbeat and stroke, and some non-cardiac diseases)
• diuretics (drugs that promote the formation and secretion of urine)
• iron or calcium supplements
• narcotics (potentially addictive drugs that relieve pain and cause mood changes)
• tricyclic antidepressants (medications prescribed to treat chronic pain, depression, headaches, and other illnesses)

An adult who is constipated may feel bloated, have a headache, swollen abdomen, or pass rock-like feces; or strain, bleed, or feel pain during bowel movements. A constipated baby may strain, cry, draw the legs toward the abdomen, or arch the back when having a bowel movement.

Diagnosis

Everyone becomes constipated once in a while, but a doctor should be notified if significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber and fluid intake.

The patient's observations and medical history help a primary care physician diagnose constipation. The doctor uses his fingers to see if there is a hardened mass in the abdomen, and may perform a rectal examination. Other diagnostic procedures include a barium enema, which reveals blockage inside the intestine; laboratory analysis of blood and stool samples for internal bleeding or other symptoms of systemic disease; and a sigmoidoscopy (examination of the sigmoid area of the colon with a flexible tube equipped with a magnifying lens).

Physical and psychological assessments and a detailed history of bowel habits are especially important when an elderly person complains of constipation.