Constipation

Constipation occurs when bowel movements become less frequent or difficult to pass. While normal bowel movement frequency varies widely between individuals - from three times daily to three times weekly - constipation is generally defined as having fewer than three bowel movements per week.

The condition results from slow movement of stool through the colon, allowing more water to be absorbed and making stools hard and dry. This can create a cycle where hard stools become increasingly difficult to pass, leading to straining and potential complications.

Constipation can be acute (sudden onset) or chronic (lasting three months or more). While often related to diet and lifestyle factors, persistent constipation may signal underlying medical conditions that require evaluation and treatment.

Primary Constipation

• Normal transit: Stool moves at normal rate but still difficult to pass
• Slow transit: Delayed movement through colon
• Dyssynergic defecation: Problems with pelvic floor muscles

Secondary Constipation

• Medication-induced: Side effect of various drugs
• Medical conditions: Result of underlying disease
• Structural problems: Physical blockages or abnormalities

IBS with Constipation (IBS-C)

• Alternating constipation and normal stools
• Abdominal pain relieved by bowel movements
• Bloating and gas
• Mucus in stool

Lifestyle Factors

• Low fiber diet: Insufficient fruits, vegetables, whole grains
• Dehydration: Not drinking enough water
• Lack of exercise: Sedentary lifestyle
• Ignoring urge: Delaying bowel movements
• Travel or routine changes: Disrupted schedule
• Stress: Can affect gut motility

Medications

• Pain medications: Especially opioids
• Antacids: Containing calcium or aluminum
• Iron supplements: Common side effect
• Antidepressants: Some types
• Blood pressure medications: Calcium channel blockers
• Anti-seizure drugs: Various types
• Antihistamines: Can slow digestion

Medical Conditions

• IBS: Common functional disorder
• Diabetes: Nerve damage affects bowels
• Hypothyroidism: Slows metabolism
• Pregnancy: Hormonal changes and pressure
• Neurological disorders: Parkinson's, MS, spinal cord injury
• Colorectal cancer: Can cause obstruction
• Diverticular disease: Affects colon function
• Anal fissures: Pain causes withholding
• Hemorrhoids: Make defecation painful

Age-Related Factors

• Slower metabolism: Natural aging process
• Reduced mobility: Less physical activity
• Multiple medications: Polypharmacy effects
• Weakened pelvic muscles: Affects elimination
• Decreased thirst sensation: Leading to dehydration

Medical History

• Bowel movement frequency and consistency
• Duration of symptoms
• Diet and fluid intake
• Physical activity level
• Medications and supplements
• Family history
• Associated symptoms

Physical Examination

• Abdominal examination
• Digital rectal exam
• Check for hemorrhoids or fissures
• Assess muscle tone
• Look for masses

Diagnostic Tests

• Blood tests: Thyroid function, electrolytes
• Colonoscopy: For red flag symptoms
• X-ray: Show stool buildup
• Transit study: Track movement through colon
• Anorectal manometry: Muscle function test
• Defecography: Imaging during defecation

• Warm liquids: Coffee or tea in the morning
• Probiotics: Support gut health
• Flaxseed: Ground seeds add fiber
• Aloe vera juice: Natural laxative effect
• Magnesium supplements: Help draw water to intestines
• Abdominal massage: Stimulate bowel movement
• Squatting position: Use footstool on toilet
• Castor oil: Traditional remedy (use sparingly)
• Senna tea: Natural stimulant laxative
• Exercise: Walking, yoga, swimming

• Maintain high-fiber diet: Gradual increase to avoid gas
• Stay hydrated: Water, herbal teas, clear soups
• Exercise regularly: 30 minutes daily
• Establish bathroom routine: Same time daily
• Respond to urges: Don't delay
• Manage stress: Relaxation techniques
• Limit constipating foods: Processed foods, excessive dairy
• Review medications: Discuss alternatives with doctor
• Proper toilet posture: Feet elevated
• Avoid straining: Be patient

Schedule an Appointment If:

• Constipation lasts more than 3 weeks
• Home remedies don't help
• Chronic laxative dependence
• Significant lifestyle impact
• Unexplained weight loss
• Persistent abdominal pain
• Blood in stool
• Alternating constipation and diarrhea
• Family history of colon cancer
• New onset after age 50