- not enough fibre in the diet
- lack of physical activity
(especially in the elderly)
- irritable bowel syndrome
- changes in life or routine such as
pregnancy, aging, and travel
- abuse of laxatives
- ignoring the urge to have a bowel
- specific diseases or conditions,
such as stroke (most common)
- problems with the colon and rectum
- problems with intestinal function
(chronic idiopathic constipation)
- pain medications (especially
- antacids that contain aluminium
- blood pressure medications
(calcium channel blockers)
- antiparkinson drugs
- iron supplements
- Neurological disorders
- multiple sclerosis
- Parkinson's disease
- chronic idiopathic intestinal
- spinal cord injuries
- Metabolic and endocrine conditions
- poor glycemic control
- Systemic disorders
- straining during bowel movements
- lumpy or hard stool
- sensation of incomplete evacuation
- sensation of ano-rectal
- fewer than three bowel movements
- a colorectal transit study
- ano-rectal function tests
- a defecography
- barium enema x ray
- sigmoidoscopy or colonoscopy
- Anorectal manometry evaluates anal sphincter muscle
function. For this test, a catheter or air-filled balloon is inserted into
the anus and slowly pulled back through the sphincter muscle to measure
muscle tone and contractions.
- Balloon expulsion tests consist of filling a balloon with
varying amounts of water after it has been rectally inserted. Then the
patient is asked to expel the balloon. The inability to expel a balloon
filled with less than 150 ml of water may indicate a decrease in bowel
- Bulk-forming laxatives generally are considered the
safest, but they can interfere with absorption of some medicines. These
laxatives, also known as fibre supplements, are taken with water. They
absorb water in the intestine and make the stool softer. Brand names
include Metamucil, Fiberall, Citrucel, Konsyl, and Serutan. These agents
must be taken with water or they can cause obstruction. Many people also
report no relief after taking bulking agents and suffer from a worsening
in bloating and abdominal pain.
- Stimulants cause rhythmic muscle
contractions in the intestines. Brand names include Correctol, Dulcolax,
Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in
some stimulant laxatives, might increase a person’s risk for cancer. The
Food and Drug Administration has proposed a ban on all over-the-counter
products containing phenolphthalein. Most laxative makers have replaced,
or plan to replace, phenolphthalein with a safer ingredient.
- Osmotics cause fluids to flow in a special
way through the colon, resulting in bowel distension. This class of drugs
is useful for people with idiopathic constipation. Brand names include
Cephulac, Sorbitol, and Miralax. People with diabetes should be monitored
for electrolyte imbalances.
- Stool softeners moisten the stool and prevent
dehydration. These laxatives are often recommended after childbirth or
surgery. Brand names include Colace and Surfak. These products are
suggested for people who should avoid straining in order to pass a bowel
movement. The prolonged use of this class of drugs may result in an
- Lubricants grease the stool, enabling it to
move through the intestine more easily. Mineral oil is the most common example.
Brand names include Fleet and Zymenol. Lubricants typically stimulate a
bowel movement within 8 hours.
- Saline laxatives act like a sponge to draw water
into the colon for easier passage of stool. Brand names include Milk of
Magnesia and Haley’s M-O. Saline laxatives are used to treat acute
constipation if there is no indication of bowel obstruction. Electrolyte
imbalances have been reported with extended use, especially in small
children and people with renal deficiency.
- Chloride channel activators increase intestinal fluid and
motility to help stool pass, thereby reducing the symptoms of
constipation. One such agent is Amitiza, which has been shown to be safely
used for up to 6 to 12 months. Thereafter a doctor should assess the need
for continued use.
- Constipation affects almost
everyone at one time or another.
- Many people think they are
constipated when, in fact, their bowel movements are regular.
- The most common causes of
constipation are poor diet and lack of exercise.
- Other causes of constipation
include medications, irritable bowel syndrome, abuse of laxatives, and
- A medical history and physical
exam may be the only diagnostic tests needed before the doctor suggests
- In most cases, following these
simple tips will help relieve symptoms and prevent recurrence of
- Eat a well-balanced, high-fibre
diet that includes beans, bran, whole grains, fresh fruits, and
- Drink plenty of liquids.
- Exercise regularly.
- Set aside time after breakfast or
dinner for undisturbed visits to the toilet.
- Do not ignore the urge to have a
- Understand that normal bowel
- Whenever a significant or
prolonged change in bowel habits occurs, check with a doctor.
- Most people with mild constipation
do not need laxatives. However, a doctor may recommend laxatives for a
limited time for people with chronic constipation.
bowel movement for several days or daily bowel movements that are hard and
or solid, clay-like stool in the child's underwear—a sign that stool is
backed up in the rectum
of constipation last longer than 3 weeks
child is unable to participate in normal activities
painful tears appear in the skin around the anus
small amount of the intestinal lining is pushed out of the anus (haemorrhoids)
pushing is not enough to expel stool
or soft stool leaks out of the anus