Constipation: Key Q&A

What is constipation?

Constipation is the painful or difficult passage of food product waste (stool) through the anus. Stool may be hard, dry and painful to pass, or a person may need to strain in order to have a bowel movement. It may feel as if the bowels still need to be emptied, even after stool has been passed. Constipation may be accompanied by other symptoms, including gas, nausea, rectal pressure and abdominal pain, cramping or distention.

How common is constipation?

At some point in their lives, most people will experience constipation. It is one of the most common gastrointestinal complaints. About 3 million Americans have frequent constipation, according to the National Institutes of Health.

Constipation is reported most often among adults age 65 and over. Seventy-five percent of elderly hospitalized patients and nursing home residents use laxatives to help regulate their bowel movements. Older people may be overly concerned with a daily bowel movement, leading them to believe they have constipation when they do not. Older people also are likely to take constipation-causing medications, have decreased levels of physical activity, and low-fiber, high-fat diets. All of these factors can contribute to constipation.

What causes constipation?

Constipation may be caused by a number of medical conditions, lifestyle choices or certain medicines. Poor diet and a lack of exercise are the most common causes of occasional constipation. Irritable bowel syndrome, which includes alternating episodes of constipation and diarrhea, is one of the most common causes of chronic constipation in the United States. Tumors, inflammation and scar tissue can put pressure on the intestines and lead to constipation. Medicines that treat depression, high blood pressure or Parkinson's disease may also cause constipation.

How dangerous is constipation?

In most cases, constipation is occasional and temporary and it not a cause for concern. However, frequent, chronic or severe constipation can lead to numerous complications, including hemorrhoids, anal fissures, rectal prolapse, fecal impaction and diverticular disease. These complications can also cause or worsen constipation, leading to a vicious cycle of constipation and complications.

How is constipation diagnosed?

Doctors often rely on a patient's report of symptoms in diagnosing and determining treatment for constipation. A medical history will include questions about the duration and severity of symptoms. Medications, eating habits and levels of physical activity may also be discussed. A physical examination may include a digital rectal examination. This involves use of a doctor's gloved, lubricated finger to evaluate the strength of anal sphincter, and to detect any tenderness, obstruction or blood in the area.

Most people with occasional constipation will not need extensive testing. However, testing is usually required in cases of severe or sudden constipation, when blood is found in the stool, or for older adults. Such testing is necessary to determine any possible underlying cause of the constipation.

How is uncomplicated constipation treated?

Constipation that occurs without fecal impaction and no underlying medical condition is commonly treated with an increase in fluids, fiber and exercise. If changes in diet or physical activity are not effective, laxatives may be used. People should consult with their doctor before using laxatives, which can interfere with the absorption of various medicines. In addition, overuse of laxatives can destroy the colon's natural ability to contract and lead to dependence on laxatives.

Laxatives can be taken by mouth in liquid, pill, chewing gum or powder form. They are also available in suppository form for insertion into the anus, or can be used in an enema. In general, suppositories and enemas work more quickly than pills to restore normal bowel movement.

How are other forms of constipation treated?

When constipation is a symptom of another medical condition, it is important to treat the underlying condition. Some conditions may not have a cure and may require continuing treatment to manage symptoms, including constipation. In general, however, when the underlying condition is treated, the constipation will go away.

If constipation occurs with fecal impaction, the most common treatment is a tap-water enema. A doctor or nurse may also use a gloved finger to manually remove the stool. When constipation occurs with the inability to relax muscles around the rectum and anus, biofeedback may be used to help regain the ability to contract and release the anal sphincter.

The surgical removal of all or part of the colon may be necessary with severe constipation caused by colonic inertia. Colonic inertia occurs when stool fails to be pushed through the large intestine and remains stored in the colon.