What are Some of the Causes
Constipation is a symptom, not a disease. Like a
fever, constipation can be caused by many different conditions. Most people
have experienced an occasional brief bout of constipation that has corrected
itself with diet and time. The following is a list of some of the most
common causes of constipation:
- Poor Diet - A main cause of constipation
may be a diet high in animal fats (meats, dairy products, eggs) and
refined sugar (rich desserts and other sweets), but low in fiber
(vegetables, fruits, whole grains). Some studies have suggested that high
fiber diets result in larger stools, more frequent bowel movements, and
therefore less constipation.
- Imaginary Constipation - This is very
common and results from misconceptions about what is normal and what is
not. If recognized early enough, this type of constipation can be cured by
informing the sufferer that the frequency of his or her bowel movements is
- Irritable Bowel Syndrome (IBS)- Also
known as spastic colon, IBS is one of the most common causes of
constipation in the United States. Some people develop spasms of the colon
that delay the speed with which the contents of the intestine move through
the digestive tract, leading to constipation.
- Poor Bowel Habits - A person can initiate
a cycle of constipation by ignoring the urge to have a bowel movement.
Some people do this to avoid using public toilets, others because they are
too busy. After a period of time a person may stop feeling the urge. This
leads to progressive constipation.
- Laxative Abuse - People who habitually
take laxatives become dependent upon them and may require increasing
dosages until, finally, the intestine becomes insensitive and fails to
- Travel - People often experience
constipation when traveling long distances, which may relate to changes in
lifestyle, schedule, diet, and drinking water.
- Hormonal Disturbances - Certain hormonal
disturbances, such as an underactive thyroid gland, can produce
- Pregnancy - Pregnancy is another common
cause of constipation. The reason may be partly mechanical, in that the
pressure of the heavy womb compresses the intestine, and may be partly due
to hormonal changes during pregnancy.
- Fissures and Hemorrhoids - Painful
conditions of the anus can produce a spasm of the anal sphincter muscle,
which can delay a bowel movement.
- Specific Diseases -Many diseases that
affect the body tissues, such as scleroderma or lupus, and certain
neurological or muscular diseases, such as multiple sclerosis, Parkinsonís
disease, and stroke, can be responsible for constipation.
- Loss of Body Salts - The loss of body
salts through the kidneys or through vomiting or diarrhea is another cause
- Mechanical Compression - Scarring,
inflammation around diverticula, tumors, and cancer can produce mechanical
compression of the intestine and result in constipation.
- Nerve Damage - Injuries to the spinal
cord and tumors pressing on the spinal cord can produce constipation by
affecting the nerves that lead to the intestine.
- Medications - Many medications can cause
constipation. These include pain medications (especially narcotics),
antacids that contain aluminum, antispasmodic drugs, antidepressant drugs,
tranquilizers, iron supplements, anticonvulsants for epilepsy,
antiparkinsonism drugs, and antihypertensive calcium channel blockers.
- Colonic Motility Disorders - The
peristaltic activity of the intestine may be ineffective resulting in
colonic inertia or outlet obstruction.
What Causes Constipation in Older
Older adults are five times more likely than
younger adults to report problems with constipation. Poor diet, insufficient
intake of fluids, lack of exercise, the use of certain drugs to treat other
conditions and poor bowel habits can result in constipation. Experts agree,
however, that too often older people become overly concerned with having a
bowel movement and that constipation is frequently an imaginary ailment.
Diet and dietary habits can play a role in
developing constipation. Lack of interest in eating - a problem common to
many single or widowed older people - may lead to heavy use of convenience
foods, which tend to be low in fiber. In addition, loss of teeth may force
older people to choose soft, processed foods, which also tend to be low in
Older people sometimes cut back on fluids,
especially if they are not eating regular or balanced meals. Water and other
fluids add bulk to stools, making bowel movements softer and easier to pass.
Prolonged bedrest, for example, after an accident
or during an illness, and lack of exercise may contribute to constipation.
Also, drugs prescribed for other conditions, such as antidepressants,
antacids containing aluminum or calcium, antihistamines, diuretics, and
antiparkinsonism drugs, can produce constipation in some people.
The preoccupation with bowel movements sometimes
leads older people to depend heavily on laxatives, which can be
habit-forming. The bowel begins to rely on laxatives to bring on bowel
movements, and over time, the natural mechanisms fail to work without the
help of drugs. Habitual use of enemas also can lead to a loss of normal
What Diagnostic Tests Can
Help Determine the Causes of Constipation?
Constipation may be caused by abnormalities or
obstructions of the digestive system in some people. A doctor can perform
tests to determine if constipation is the symptom of an underlying disorder.
In addition to routine blood, urine, and stool
tests, a sigmoidoscopy may help detect problems in the rectum and lower
colon. In this procedure, which can be done in the doctorís office, the
doctor inserts a flexible, lighted instrument through the anus to examine
the rectum and lower intestine. The doctor may perform a colonoscopy to
inspect the entire colon. In colonoscopy, an instrument similar to the
sigmoidoscopy, but longer and able to follow the twists and turns of the
entire large intestine, is used. A barium enema X-ray will provide similar
information. If bleeding is present, a double-contrast barium enema is
Other highly specialized techniques are available
for measuring pressures and movements within the colon and its sphincter
muscles, but these are used only in unusual cases.
Is Constipation Serious?
Although it may be extremely bothersome,
constipation itself usually is not serious. However, it may signal and be
the only noticeable symptom of a serious underlying disorder such as cancer.
Constipation can lead to complications, such as hemorrhoids caused by
extreme straining or fissures caused by the hard stool stretching the
sphincters. Bleeding can occur for either of these reasons and appears as
bright red streaks on the surface of the stool. Fissures may be quite
painful and can aggravate the constipation that originally caused them.
Fecal impactions tend to occur in very young children and in older adults
and may be accompanied by a loss of control of stool, with liquid stool
flowing around the hard impaction.
Occasionally, straining causes a small amount of
intestinal lining to push out from the rectal opening. This condition is
known as rectal prolapse and may lead to secretion of mucus that may stain
underpants. In children, mucus may be a feature of cystic fibrosis.
When Is Medical Attention
The doctor should be notified when symptoms are
severe, last longer than three weeks, are disabling, or when any of the
complications listed above occur. The doctor should be informed whenever a
significant and prolonged change of usual bowel habits occurs.
The symptoms of constipation are key to helping the
physician determine a diagnosis and treatment. They include: infrequency of
bowel movements, straining, pain, or unsatisfied defecation. In addition, a
full record of prescription and over-the-counter medications should be
provided to the physician.
What Is The Treatment For
The first step in treating constipation is to
understand that normal frequency varies widely, from three bowel movements a
day to three a week. Each person must determine what is normal to avoid
becoming dependent on laxatives.
For most people, dietary and lifestyle improvements
can lessen the chances of constipation. A well-balanced diet that includes
fiber-rich foods, such as unprocessed bran, whole-grain bread, and fresh
fruits and vegetables, is recommended. Drinking plenty of fluids and
exercising regularly will help to stimulate intestinal activity. Special
exercises may be necessary to tone up abdominal muscles after pregnancy or
whenever abdominal muscles are lax.
Bowel habits are also important. Sufficient time
should be set aside to allow for undisturbed visits to the bathroom. In
addition, the urge to have a bowel movement should not be ignored.
If an underlying disorder is causing constipation,
treatment will be directed toward the specific cause. For example, if an
underactive thyroid is causing constipation, the doctor may prescribe
thyroid hormone replacement therapy.
In most cases, laxatives should be the last resort
and taken only under a doctorís supervision. A doctor is best qualified to
determine when a laxative is needed and which type is best. There are
various types of oral laxatives, and they work in different ways.
Above all, it is necessary to recognize that a
successful treatment program requires persistent effort and time.
Constipation does not occur overnight, and it is not reasonable to expect
that constipation can be relieved overnight.
The frequency of bowel movements among healthy
people varies from three movements a day to three a week. Individuals must
determine what is normal. As a rule, constipation should be suspected if
more than three days pass between bowel movements or if there is difficulty
or pain when passing a hardened stool. Most people experience occasional
short bouts of constipation, but if a laxative is necessary for longer than
three weeks, check with a doctor.
Doctors agree that prevention is the best approach
to constipation. While there is no way to ensure never experiencing
constipation, the following guidelines should help:
- Know what is normal and do not rely
unnecessarily on laxatives.
- Eat a well-balanced diet that includes
unprocessed bran, whole-wheat grains, fresh fruits and vegetables.
- Drink plenty of fluids.
- Exercise regularly.
- Set aside time after breakfast or dinner for
undisturbed visits to the toilet.
- Donít ignore the urge to defecate.
- Whenever there is a significant or prolonged
change in bowel habits, check with a doctor.