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Constipation

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Does this describe your symptoms?

Definition
  • Difficulty passing bowel movements: straining, hard stools, or rectal pressure
  • Bowel movements do not occur frequently enough

General Information

  • Normal bowel movement (BM) frequency varies from 3 times a day to 3 times a week.
  • Passage of a large bowel movement is not constipation, since the size of the bowel movement relates to the amount of food an individual eats and the bowel movement frequency. Large eaters have larger stools.
  • The passage of small, dry, rabbit-pellet-like stools is not constipation and instead reflects the desiccation (drying-out) mechanism and insufficient fluid intake.

Lifestyle Causes

  • Inadequate fiber in diet: Inadequate dietary fiber reduces intestinal motility and makes BMs hard and more difficult to pass. Fiber works by helping stools to retain water. Good sources of dietary fiber are fresh fruits and vegetables, beans, and bran. Fiber can also be taken via supplements (e.g., Metamucil).
  • Insufficient liquids: Insufficient liquid intake cause stools to be dry and harder to pass. Adults should drink 6-8 glasses of water daily.
  • Lack of exercise: Inactivity reduces bowel function, whereas exercise helps stimulate the bowels and improve regularity. Patients who are bedridden have increased problems with constipation and may develop fecal impaction.
  • Postponing bowel movements (BMs): Some individuals ignore their body's signals regarding having a BM. This can lead to chronic problems with constipation.
  • Recent travel: Travel can cause constipation because it interferes with your diet and normal daily cycle.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Vomiting bile (bright yellow or green)
  • Vomiting and abdomen looks much more swollen than usual
  • Severe rectal pain not relieved by Sitz bath or glycerine suppository
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • Intermittent mild abdominal pain and there is a fever
  • Abdomen is more swollen than usual
  • Last BM was more than 3 days ago
  • Leaking stool
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Weight loss greater than 10 pounds and not dieting
  • Minor bleeding from rectum is a recurrent problem
  • Unable to have a BM without using a laxative, suppository, or enema
  • Taking new prescription medication
  • Constipation is a recurrent problem (i.e. less than 3 BM's / week or straining greater than 25% of the time)
Self Care at Home If
  • Mild constipation and you don't think you need to be seen
HOME CARE ADVICE FOR MILD CONSTIPATION

  1. General Constipation Instructions:
    • Eat a high fiber diet.
    • Drink adequate liquids.
    • Exercise regularly (even a daily 15 minute walk!).
    • Get into a rhythm - try to have a BM at the same time each day.
    • Don't ignore your body's signals to have a BM.
    • Avoid enemas and stimulant laxatives.
  2. High Fiber Diet: A high fiber diet will help improve your intestinal function and soften your BM's. The fiber works by holding more water in your stools.
    • Try to eat fresh fruit and vegetables at each meal (peas, prunes, citrus, apples, beans, corn).
    • Eat more grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread). Popcorn is a source of fiber.
  3. Liquids: Adequate liquid intake is important to keep your BM's soft.
    • Drink 6-8 glasses of water a day (Caution: certain medical conditions require fluid restriction).
    • Prune juice is a natural laxative.
    • Avoid alcohol.
  4. Get into a rhythm:
    • Try to have a BM at the same time every day. The best time is about 30-60 minutes after breakfast or another meal (Reason: natural increased intestinal activity).
    • Don't ignore your body's signals to have a BM.
  5. Bulk Laxatives:
    • Metamucil (psyllium fiber): One teaspoon (5 cc) in a glass of water twice daily.
    • Bulk-forming agents works like fiber to help soften the stools and improve your intestinal function. Long-term use of this type of laxative is generally safe.
    • Side Effects: Mild gas or a bloating sensation may occur.
    • Read the package instructions thoroughly on all medications that you use.
  6. Osmotic Laxatives:
    • Miralax (polyethylene glycol 3350): Miralax is an "osmotic" agent which means that it binds water and causes water to be retained within the stool. You can use this laxative to treat occasional constipation. Do not use for more than 2 weeks without approval from your doctor. Generally, Miralax produces a bowel movement in 1 to 3 days. Side effects include diarrhea (especially at higher doses). If you are pregnant, discuss with your doctor before using. Available in the United States.
    • Milk of Magnesia (magnesium hydroxide): This is a mild and generally safe laxative. You can use Milk of Magnesia for short-term treatment of constipation. (Research suggests that Miralax may be more effective.) Dosage is 2 tablespoons (30 ml) PO. Do not use if you have kidney disease.
    • Read the package instructions thoroughly on all medications that you use.
  7. Sitz Bath for Rectal Pain due to Constipation:
    • Take a twenty-minute bath in warm water (2 oz baking soda per tub). This is also called a "Sitz bath."
    • A Sitz Bath may help relax the anal sphincter and release the bowel movement.
    • If the Sitz bath does not work, try 1 or 2 glycerin rectal suppositories, which you can get over-the-counter.
  8. Enemas: Should be used rarely and only after other measures have not worked.
  9. Call Your Doctor If:
    • Constipation continues (i.e., less than 3 BM's / week or straining more than 25% of the time) after following care advice for constipation for 2 weeks
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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