Considerations: Constipation is a relative term. There is wide variability is what is considered normal patterns of bowel elimination. While some healthy people may have consistently soft or near runny stools others may have consistently hard firm stools but no difficulty in passing them.

When the stool is hard, infrequent, and requires significant effort to pass, the person has constipation. Constipation may cause discomfort with passage of stools, and passage of large caliber stools may tear the mucosal membrane of the anus, especially in children, causing bleeding and the possibility of an anal fissure.

Constipation can be caused by changes in diet, decrease in physical activity, lack of toilet facilities, behavior and psychological problems, dehydration, diseases of the bowel, neurological diseases, congenital diseases, medications, and many other causes.

Common Causes:

• meconium plug (as seen in infants and children with cystic fibrosis)
• cow’s milk ingestion (infants and children)
• congenital megacolon (Hirschsprung’s disease)
• functional ileus
• meningomyelocele
• mental retardation
• cerebral palsy
• neurological disorders
• depression
• painful defecation (anal fissure, skin irritation, hemorrhoids)
• dietary changes
• medications especially narcotics
• dehydration
• low-fiber diet
• infrequent physical exercise
• immobility (elderly or bedridden patients)
• endocrine disorders such as hypothyroidism
• endometriosis
• pelvic tumors

Home Care: DIET
Dietary measures such as increasing fiber intake from whole-wheat grains, fresh fruits, vegatables and bran may help add bulk to the stool, thus promoting normal bowel movements. Special efforts should be made toward increasing the daily intake of fluids. See also diet for constipation.

EXERCISE
Regular exercise is also very important in establishing regular bowel movements. People who are confined to a wheelchair or bed should be taught to change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend a program of exercises appropriate for your physical abilities.

MEDICATIONS
Stool softners such as ducosate, may be recommended to aid in the passage of soft, formed stools. Additionally, bulk laxatives, such as Metmucil, may be used to add fluid and bulk to the stool, thus promoting soft, moist, formed stools. Suppositories or gentle laxatives may be used in conjunction with a bowel retraining program to establish a pattern of regular, bowel movements. However, enemas or laxatives (such as milk of magnesia) should be reserved for severe cases only--laxatives should not be used over a long period of time because laxative dependence may occur.

Call If:

• there is sudden constipation with abdominal cramps, and an inability to pass gas or stool. (In this case, do not take any laxatives. Call your health care provider immediately!)
• there are very thin, pencil-like stools.
• there is also abdominal pain and bloating.
• there is also unexplained weight loss.
• there is blood in the stool.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting constipation in detail may include:

• TIME PATTERN:
  • How long have you had constipation?
  • Has it been persistent? How long (for at least how many months)?
  • How many days between two spontaneous bowel movements?
• AGGRAVATING FACTORS:
  • Is it worse when you are stressed?
• CHARACTERISTICS:
  • What is the frequency of stools?
  • What is the color, shape, and consistency of the stools?
  • Is there any bleeding with the passage of stools?
  • Are you experiencing any abdominal pain?
• ASSOCIATED FACTORS:
  • What surgeries have you had?
  • What injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
• OTHER:
  • What other symptoms are also present?

• barium enema
• blood tests such as a CBC, PT, or PTT
• proctosigmoidoscopy (an examination of the lower bowel)
• stool studies
• upper GI series
• X-rays of the abdomen