constipation

(kŏn'stə-pā'shən)
n.

1. Difficult, incomplete, or infrequent evacuation of dry hardened feces from the bowels.
2. Obstruction; stultification.

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Difficulty in passing stools or infrequent passage of hard stools. In the absence of intestinal disease, frequently a result of a diet low in non-starch polysaccharide, and treated by increasing the intake of fruits, vegetables, and especially wholegrain cereal products.

Contrary to popular opinion, you are not constipated if you do not pass faeces once a day. Constipation exists only when bowel movements are difficult or accompanied by discomfort, and if there is failure to empty the bowels at least three days in succession. Many people who are not constipated, but who believe that daily bowel movements are important, resort to using laxatives to achieve their objective. Laxatives, however, may disrupt normal bowel reflexes and cause true constipation. Fluid losses associated with laxatives may also contribute to dehydration and induce abdominal cramps which restrict physical activity.

Changes of environment and diet, or inactivity can lead to intermittent bouts of constipation. Chronic constipation is often linked to low dietary fibre. It can affect physical performance and make a person feel unwell. Risk of constipation can be reduced by:

• eating high fibre foods, such as fruits, vegetables (especially legumes), and unrefined cereals
• drinking plenty of fluids, at least eight glasses or cups a day
• exercising regularly.

Constipation lasting more than a week warrants seeking medical advice, because it can be a symptom of an underlying disorder.

Constipation is a widely used term usually referring to decreased bowel frequency, although it is sometimes used when the stools are hard or when there is pain or difficulty with bowel evacuation. A clear definition of the term is difficult because of the wide range of ‘normal’ bowel frequency in the general population, which ranges from two or three times a day to less than two per week. Constipation has many causes, the majority of which are not serious and for which there are simple remedies. However, as it may be the presenting feature of a serious condition such as large bowel cancer, in selected circumstances constipation requires further investigation to enable specific treatment to be given. There are a number of important groups of disorders which present as constipation.

Causes of constipation

When the structure of the bowel is apparently normal Most individuals fall into this group, and the most common cause is usually dietary. Low fibre diets result in low faecal residues, which can reduce the frequency of bowel action. In some individuals constipation may be a behavioural problem, possibly related to a life-long suppression of the normal ‘signals’ to defecate. Other situations like pregnancy and old age and infirmity also slow intestinal transit and can result in constipation. Some patients with irritable bowel syndrome complain of constipation which may alternate with increased bowel frequency.

Structural abnormalities in the colon and rectum Minor anal problems such as ‘anal fissure’ — a tear in the lining of the anal canal — can result in constipation because of voluntary inhibition of defecation due to the associated pain. Inflammation in the rectum, proctitis, can have the same effect. In addition, there are some important disorders in which there is a developmental or acquired abnormality of the nerves within the bowel wall; examples include Hirschsprung's disease (congenital ‘megacolon’ described by this Danish physician in 1888) and infection with the parasite Trypanosoma cruzi, which causes Chagas' disease (named after the Brazilian physician who noted it in 1909). Abnormalities of colonic muscle produce a myopathy which can also lead to constipation.

Neurological diseases A number of generalized neurological disorders, such as Parkinson's disease and multiple sclerosis, can damage the nerve supply to the colon and rectum and produce constipation. Similar damage to the autonomic nerves can also occur in diabetes mellitus. Colonic function may also be impaired in patients with reduced levels of consciousness and mental retardation.

Endocrine and metabolic causes Reduced activity of the thyroid gland (hypothyroidism) and raised concentrations of calcium in the blood (hypercalcaemia) are the most common disorders in this group.

Psychological disorders Depression and anorexia nervosa are both often associated with constipation.

Adverse drug effects Many drugs can cause constipation, in particular potent painkillers (opiates and opioid analgesics), some anti-depressants, and drugs used to reduce high blood pressure.

Investigation and management of constipation

Investigation of constipation which has no simple explanation may require exclusion of a structural problem in the colon; this usually involves a radiological examination (barium enema) or an endoscopic examination using a flexible instrument called a colonoscope. Nerve and muscle disorders sometimes require investigation using methods to measure transit time through the colon, and measurement of pressure within the bowel and electrophysiological tests to study nerve and muscle function.

Simple constipation, in which there is no obvious disease or disorder of the colon, is best remedied by dietary measures such as increasing the fibre content of the diet. Commercially-prepared bulking agents are also available. If bulking agents fail then osmotic laxatives such as magnesium sulphate (Epsom salts) may be required, though there is some evidence that prolonged use can damage the colonic nerves and ultimately make the condition worse.

When constipation is due to colon cancer or an endocrine or metabolic disturbance, then appropriate specific treatment is required. If constipation occurs as an adverse effect of drug therapy for another condition, then it is usually appropriate to try an alternative preparation.

— Michael Farthing, Anne Ballinger

See also alimentary system; defecation; toilet practices.

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. Although constipation is a relative term, with normal patterns of bowel movements varying widely from person to person, generally 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. Infants who are still exclusively breastfed may go seven days without a stool.

Description

The colon (the large intestine) absorbs water while forming waste products (the stool) from digested food. Muscle contractions in the colon (peristalsis) push the stool toward the rectum. By the time the stool reaches the rectum, it is solid because most of the water has been absorbed. However, hard, dry stools and constipation occur when too much water is absorbed by the colon from the stool, which can result from the muscle of the colon contracting too slowly. Constipation is also referred to as irregularity of bowels or lack of regular bowel movements.

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. They may feel shy about asking permission to use the bathroom, they may be involved in more enjoyable activities and may not want to stop, or they may be rushed when using the bathroom and not have time to complete the bowel movement. Once constipation has developed and bowel movements become painful or more difficult, the child will attempt to go even less often, and the constipation will worsen.

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

• tearing of the mucosal membrane of the anus (especially in children), which can cause bleeding and the development of an anal fissure
• 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

Less commonly, 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 adults) and should be investigated by a doctor.

Demographics

Constipation is a common complaint in children, occurring in up to 10 percent of youngsters. It accounts for approximately 3 percent of pediatric outpatient visits and 25 percent of visits to a pediatric gastroenterologist.

Causes and Symptoms

Constipation usually results from not getting enough exercise, not drinking enough fluids (especially water), delays in going to the bathroom when there is the urge to defecate, or from a diet that does not include an adequate amount of fiber-rich foods such as beans, bran cereals, fruits, raw vegetables, rice, and whole-grain breads. Eating too many dairy products such as milk, cheese, yogurt, and ice cream may also result in harder stools. Constipation in children often occurs when they hold back bowel movements for various reasons, such as when they are not ready for toilet training or are afraid of toilet training.

Other less common 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; and irritable bowel syndrome. Stress and travel can also contribute to constipation, as well as other changes in bowel habits.

Constipation can also be a side effect of the use of the following medications, many of which are not commonly used by children:

• aluminum salts in antacids
• antihistamines
• antipsychotic drugs
• aspirin
• belladonna (Atopa belladonna, a 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, and 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)

A child 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. Newborns and young infants may also strain, turn red in the face, grunt and draw legs up when passing normal, soft stool. If the stool is not hard (rabbit pellet in consistency), then these infants are not considered constipated.

When to Call the Doctor

Most people become constipated once in a while, but a doctor should be contacted 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.

In addition, a doctor should be called if an infant younger than two months is constipated, or if an infant (except those that are exclusively breastfed) goes three days without a stool. If vomiting or irritability is also present, then the doctor should be called immediately. A doctor should also be consulted if a child is holding back bowel movements (in order to resist toilet training) or whenever constipation occurs after starting a new prescription, vitamin, or mineral supplement or is accompanied by blood in the stools, changes in bowel patterns, fever, and rectal or abdominal pain.

Diagnosis

The child's symptoms and medical history help a primary care physician to 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).

Treatment

Constipation is usually a temporary problem in children and no cause for concern. A child with constipation should be instructed to drink an adequate amount of water each day (six to eight glasses), exercise on a regular basis, and eat a diet high in soluble and insoluble fibers. Soluble fibers include pectin, flax, and gums; insoluble fibers include psyllium and brans from grains like wheat and oats. Fresh fruits and vegetables contain both soluble and insoluble fibers. Dietary fiber intake should be increased gradually, along with an increase in water consumption, in order to produce soft, bulky stools.

Constipation in infants may be treated by the following:

• if over two months of age, feeding the infant 2–4 ounces (60–120 ml) of fruit juice (grape, pear, apple, cherry, or prune) twice a day
• if over four months of age and the infant has begun solid foods, feeding the baby foods with high fiber content (such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach) twice a day

If changes in diet and activity fail to relieve occasional constipation, an over-the-counter laxative may be used for a few days. Preparations that soften stools or add bulk (bran, psyllium) work more slowly but are safer than Epsom salts and other harsh laxatives or herbal laxatives containing senna (Cassia senna) or buckthorn (Rhamnus purshianna), which can harm the nerves and lining of the colon. A child who is experiencing abdominal pain, nausea, or vomiting should not use a laxative. Laxatives should not be used for a long period, because the child can become dependent on them.

A warm-water or mineral oil enema can relieve constipation in children with severe or stubborn cases of constipation. However, laxatives or enemas should not be given to children without instruction from a doctor.

If a child has an impacted bowel, the doctor can insert a gloved finger into the rectum and gently dislodge the hardened feces.

Alternative Treatment

Castor oil, applied topically to the abdomen and covered by a heat source (a heating pad or hot water bottle) can help relieve constipation when used nightly for 20 to 30 minutes.

Acupressure

This needleless form of acupuncture is said to relax the abdomen, ease discomfort, and stimulate regular bowel movements when diet and exercise fail to do so. After lying down, the child closes his or her eyes and takes a deep breath. For two minutes, the child or parent applies gentle fingertip pressure to a point about 2.5 in (14 cm) below the navel.

Acupressure can also be applied to the outer edges of one elbow crease and maintained for 30 seconds before pressing the crease of the other elbow. This should be done three times a day to relieve constipation.

Aromatherapy

Six drops of rosemary (Rosmarinus officinalis) and six drops of thyme (Thymus spp.) diluted by one ounce of almond oil, olive oil, or another carrier oil can relieve constipation when used to massage the abdomen.

Herbal Therapy

A variety of herbal therapies can be useful in the treatment of constipation. Several herbs, including chamomile (Matricaria recutita), dandelion (Taraxacum mongolicum), and burdock (Arctium lappa), act as bitters, stimulating the movement of the digestive and excretory systems.

Homeopathy

Homeopathy also can offer assistance with constipation. There are acute remedies for constipation that can be found in one of the many home remedy books on homeopathic medicine. A constitutional prescription also can help rebalance someone who is struggling with chronic constipation.

Massage

Massaging the leg from knee to hip in the morning, at night, and before trying to move the bowels is said to relieve constipation. There is also a specific Swedish massage technique that can help relieve constipation.

Yoga

The knee-chest position, said to relieve gas and stimulate abdominal organs, involves the following:

• standing straight with arms at the sides
• lifting the right knee toward the chest
• grasping the right ankle with the left hand
• pulling the leg as close to the chest as possible
• holding the position for about eight seconds
• repeating these steps with the left leg

The cobra position, which can be repeated as many as four time a day, involves the following:

• lying on the stomach with legs together
• placing the palms just below the shoulders, holding elbows close to the body
• inhaling, then lifting the head (face forward) and chest off the floor
• keeping the navel in contact with the floor
• looking as far upward as possible
• holding this position for three to six seconds
• exhaling and lowering the chest

Prognosis

Changes in diet and exercise can often eliminate constipation. However, childhood constipation can sometimes be difficult to treat when a child, after having a painful experience, makes a decision to resist and delay going to the bathroom. These cases often require prolonged support, explanation, and medical treatment.

Prevention

Avoiding constipation by making lifestyle changes is easier than treating it. Most American adults only consume between 11 to 18 grams of fiber a day, but to prevent constipation, consumption of 30 to 35 grams of fiber (an amount equal to five servings of fruits and vegetables, and a large bowl of high-fiber cereal) and between six and eight glasses of water each day can generally prevent constipation. A suggested goal for dietary fiber intake during childhood and adolescence is consumption in grams equivalent to the age of the child plus 5 grams per day.

Sitting on the toilet for 10 minutes at the same time every day, preferably after a meal, can induce regular bowel movements. This may not become effective for a few months, and it is important to defecate whenever necessary.

Fiber supplements containing psyllium (Plantago psyllium) usually become effective within about 48 hours and can be used every day without causing dependency. Powdered flaxseed (Linium usitatissimum) works the same way. Insoluble fiber, like wheat or oat bran, is as effective as psyllium but may give the child gas at first.

Parental Concerns

Constipation can be a frustrating problem for both children and their parents. Parents need to work closely with the doctor to determine why the child is constipated and to develop an appropriate treatment strategy.

Resources

Books

Bernard, H. The Homoeopathic Treatment of Constipation. New Delhi, India: B. Jain Publishers Pvt. Limited, 2003.

Peiken, Steven R. Gastrointestinal Health: The Proven Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome (IBS), Ulcers, Gas, Constipation, Heartburn, and Many Other Digestive Disorders. London: Harper Trade, 2005.

Whorton, James C. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. Collingdale, PA: DIANE Publishing Co., 2003.

Web Sites

"Constipation." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/constipation.html (accessed December 9, 2004).

[Article by: Judith Sims Maureen Haggerty]

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Infrequent and difficult evacuation of the faeces, usually accompanied by abdominal discomfort. Chronic constipation is generally deemed to occur if there is failure to evacuate the bowels for three days in succession. Intermittent bouts of constipation may occur with changes in environment and diet. Constipation can affect athletic performance adversely. However, it is unwise for athletes to use laxatives to relieve constipation because these often result in the loss of body fluid and dehydration, which impairs physical performance. Regular physical activity can play a part in avoiding constipation especially in the disabled and elderly. Chronic constipation is often linked to low dietary fibre.

KEY TERMS Anus—The opening from the rectum to the outside of the body through which stools pass. The opening and closing of the anus is controlled by a strong ring of muscles under somewhat voluntary control. Dietary fiber—Also known as roughage or bulk. Insoluble fiber moves through the digestive system almost undigested and gives bulk to stools. Soluble fiber dissolves in water and helps keep stools soft. Idiopathic—Occurring from unknown causes. Laxative—A substance that stimulates movement of food through the bowels. Laxatives are used to treat constipation. Rectum—The last few inches of the large intestine.

    Demographics
    Causes and symptoms
    Treatment
    Nutrition concerns
    Therapy
    Prognosis
    Prevention
    Resources

What is Constipation?

Constipation is a symptom characterized by either having fewer than three bowel movements a week or having difficulty passing stools that are often hard, small, and dry.

Description of Constipation

Food in the process of being digested moves through the intestines in as a slurry or watery mush. In the small intestine, nutrients are absorbed from this material. After most of the nutrients have been absorbed, the material passes into the colon, or large intestine. Here much of the water in the slurry is absorbed back into the

bloodstream, and the remaining solid material is eliminated as waste or stool. Constipation occurs when too much water is removed from the slurry, and it becomes difficult or painful to eliminate the stool. The most common reason why too much water is removed is that the material stays too long in the colon.

The frequency of bowel movements varies greatly from person to person and is influenced by age, health, diet, and lifestyle. It is a common misperception that a daily bowel movement is necessary for health. This is not true. For some healthy people, it is normal to have three bowel movements a day, while other healthy people have only three a week. Determining whether an individual is constipated must start with knowing what frequency of bowel movements is normal for that person.

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A condition in which the alimentary transit time is prolonged in view of the amount and type of food being ingested in the preceding day or two. This means usually that the feces are hard, dry and of small bulk and are passed less frequently than expected. They may also be difficult to pass and this may cause some straining; on rectal examination the rectum will be full of hard, dry feces. In some cases a small amount of very thin, soupy feces will be passed even though there is a sizable mass in the rectum; this is soft contents being passed around an impacted fecal mass, and obstipation is said to be present.

• dietary c. — caused by ingestion of large amounts of foreign material such as bones, hair or fiber that mixes with feces to form hard, dry masses which are difficult or impossible to pass.
• drug-induced c. — may result from treatment with antimotility drugs.
• endocrine c. — may accompany some disorders of endocrine glands causing reduced gastrointestinal motility, e.g. hypothyroidism and hypercalcemia of hyperparathyroidism.
• environmental c. — conditions of management, particularly in dogs and cats, that inhibit freedom for defecation or present unsuitable conditions, such as soiled litter trays or restriction of a house-trained animal to a cage, may cause retention of feces with eventual drying and increased size of the fecal mass.
• neurogenic c. — disorders of innervation to the colon or hindquarters may cause an atonic colon or prevent an animal from assuming normal posture for defecation, thereby inhibiting the desire to defecate. This is seen particularly in painful intervertebral disk lesions or musculoskeletal injuries or lesions.
• obstructive c. — any impediment to the passage of feces, either within the colon, rectum or anus, or from compression by surrounding tissues can cause drying and enlargement of the fecal mass.
• spastic c. — see irritable colon syndrome.

n

Difficulty passing stools or incomplete or infrequent passage of hard stools.

For a list of words related to constipation, see:

• Signs and Symptoms - constipation: infrequent, difficult, often painful bowel movements with hard feces; irregularity

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This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - forstoppelse, blokerende tilstand

Nederlands (Dutch)
constipatie, geblokkeerde toestand

Français (French)
n. - constipation

Deutsch (German)
n. - Verstopfung

Ελληνική (Greek)
n. - δυσκοιλιότητα

Italiano (Italian)
stitichezza, costipazione, stipsi

Português (Portuguese)
n. - constipação (f) (Med.)

Русский (Russian)
запор

Español (Spanish)
n. - estreñimiento, constipación

Svenska (Swedish)
n. - förstoppning, konstipation (med.)

中文（简体）(Chinese (Simplified))
便秘

中文（繁體）(Chinese (Traditional))
n. - 便秘

한국어 (Korean)
n. - 변비 중, 침체

日本語 (Japanese)
n. - 便秘

العربيه (Arabic)
‏(الاسم) أمساك, قبض‏

עברית (Hebrew)
n. - ‮עצירות‬

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