Constipation means infrequent or difficult bowel movements. It often occurs when digested food moves too slowly through the digestive tract. As a result, the body removes (absorbs) too much water from the stools, causing them to become hard, dry and difficult to pass.
Constipation is very common: one in 4 Canadians has symptoms of constipation. It can affect the young and elderly and everyone in between. For some people, constipation develops suddenly and lasts for a short time. For others, particularly older people, it may begin gradually and last for an extended period of time.
Constipation in children doesn’t necessarily signal the same problems as it does in adults: children often develop constipation when they deliberately or subconsciously prevent themselves from passing stool. They may be reluctant to interrupt playtime, embarrassed to use a public washroom, or afraid to have an unpleasant bowel movement (a particular concern for kids at the potty-training stage).
Of course, some of the causes of adult constipation also apply to kids, such as:
Constipation arises if you have a problem that affects your colon in one or more of three key areas:
Even if you can’t prevent all constipation, you may be able to reduce its frequency or severity by eating enough fibre, drinking enough fluids, exercising, and maintaining good toilet habits.
The following small changes in your daily habits may help relieve constipation:
For best general health and colon function, aim to consume about 20 to 30 grams of fibre every day. Derived from plants, fibre is the indigestible portion of food. Fibre may cause bloating and discomfort, especially if you’re not used to it, so be sure to “fibre up” over several days or weeks by gradually increasing your intake of:
Note: If you have narrowings (strictures) or scar tissue in your digestive tract, significantly increasing your fibre intake can cause a bowel obstruction; if you have had any previous surgeries or blockages (e.g. due to adhesions), discuss this with your doctor before making any big changes in your diet.
Such as yogurt, kefir, bananas, whole-grain breads and honey, which help soften stool and ease its passage through the colon.
Foods that are greasy, fried, or high in animal fat or contain refined sugar, such as candy and rich desserts can contribute to constipation.
Aim for 8-10 glasses a day of liquid which can include water, juices, milk, soup or other beverages. Avoid liquids with caffeine, alcohol or are rich with lots of sugar or artificial sweeteners.
A sedentary lifestyle can lead to sluggish bowels. Regular exercise – even walking – can help boost bowel activity.
Try to find a consistent time every day to relax and have a bowel movement, your body will become accustomed to this pattern over time. Remember to avoid straining.
Regular use of certain stimulant laxatives may decrease your “bowel tone,” resulting in poor bowel function. Watch for herbal laxatives, which may contain stimulants. Other laxatives that help you retain more water and are safe for regular use. Always check with your doctor before using any laxatives on a regular basis.
Don’t smoke, limit alcohol, and adopt strategies to manage time and cope with stress.
Good communication with your doctor is an important part of managing your digestive health, regardless of your diagnosis. To ensure that all doctors have the most accurate information about you, it’s a good idea to keep a journal in which you:
When you are constipated, you have to strain to defecate and you typically pass small, hard stools. You may also have a feeling that your rectum has not been completely emptied.Other signs and symptoms of constipation may include:
Most people don’t need extensive testing to identify constipation: you know it when you have it. Still, understanding what’s normal can help you identify constipation earlier and explain it to your doctor.
(shown below) classifies human feces into 7 categories based on shape and consistency.
|Type 1||Separate hard lumps,
like nuts (hard to pass)
|Type 2||Sausage-shaped but
|Type 3||Like sausage but with
cracks on its surface
|Type 4||Like a sausage or
snake, smooth and
|Type 5||Soft blobs with clearcut
|Type 6||Fluffy pieces with
ragged edges, a
|Type 7||Water, no solid pieces.
When it comes to frequency of bowel movements, it’s a little harder to draw the line between what’s healthy and what’s not because every individual has a different pattern of bowel movements: some people have bowel movements three or more times a day, while others only defecate a few times per week. Both patterns can still be normal.
Alarm symptoms are not typical constipation symptoms and may signal other, possibly more serious health issues. Consult your doctor if you experience any of the following:
As a rough guideline, you probably have a chronic (long-term) constipation problem if you’ve experienced 2 or more of the following symptoms for at least 3 months:
If you have constipation for more than 2 weeks, be sure to see a doctor to find out why you have developed this problem and how you can treat it.
At the start, your doctor will generally ask you about your eating and drinking habits, your stress levels, your medications and any symptoms that may suggest that your constipation has a specific, treatable cause. Depending on your symptoms, your doctor may also perform a blood test to find out if you have anemia.
Colon cancer is an important but uncommon cause of constipation. If you are over 50 years of age, have a first-degree relative (parent, sibling, or child) who has had colon cancer or if you’ve had a positive stool test in a provincial colorectal cancer screening program, you will be offered a colonoscopy.
Constipation can usually be prevented or treated successfully. It is best to start with simple strategies and move on to stronger measures when necessary.
Although most of us will suffer from constipation at some point in our lives, chronic constipation is not normal. If you continue to be constipated after unsuccessfully trying the lifestyle changes suggested below it is important to speak with your doctor about treatment options.
If dietary and other lifestyle changes do not relieve constipation, you have several options for over-the-counter and prescription products.
Products such as psyllium or methylcellulose help hold water in the stool and add bulk to it, which stimulates normal bowel contractions.
Also known as stool softeners, these products contain a wetting agent that helps water penetrate and mix with the stool, so it becomes softer and easier to pass. It may take a week or longer for stool softeners to take effect. Examples include docusate sodium and docusate calcium.
This type of laxative may contain mineral oil, which coats the particles of stool to prevent water from escaping. Because fat-soluble vitamins (A, D, E and K) dissolve in the oil, they will not be absorbed as well by the intestine. For this reason, lubricant laxatives should only be used short-term.
These medications help retain the water in the stool, making it softer. Products in this class contain polyethylene glycol, undigestible sugars (lactulose, sorbitol) or ions such as magnesium, sulfate, phosphate or citrate; some require a prescription but many are available, ‘over-the-counter’, without a prescription. Osmotic laxatives are not absorbed or are poorly absorbed by the bowel, have few side effects, and are generally safe for long-term use with your health care provider’s recommendation.
As a general rule, try gentler products such as those listed above first. If they fail to provide relief move on to those that follow below.
This group of laxatives causes the bowel muscles to propel their contents more rapidly and also increases the amount of water in the stool. While very effective, using them can lead to diarrhea, dehydration and intestinal cramping.
Although there is no proof that chronic use damages the colon or worsens constipation, most experts agree that these products should be used sparingly. Common stimulant laxatives contain cascara, senna, bisacodyl, or aloe.
Enemas expand or irritate the rectum, which stimulates the colon to contract and eliminate stool. Especially useful when the stool is hardened and blocked (impacted) in the rectum, they are meant for occasional use and can disrupt the balance of fluids and electrolytes in the body if used regularly or in access. Suppositories also trigger bowel movements by stimulating or “irritating” the rectum.
These medications, available by prescription only, improve the motility (movement) and contraction of the bowel which speeds up the passage of stool through the bowel and increases stool frequency to relieve constipation.
Below are some FAQ's on constipation:
How often should I have a bowel movement?
It is important to realize that the frequency of bowel movements varies from person to person. Some people may empty their bowels several times a day while others may only have a bowel movement once every few days. Whatever is normal for you, is fine. You should take note however, when your bowel patterns change.
Will a cleansing enema program help me?
There is no evidence that there is a build-up of harmful toxins in the bowel when one has an irregular bowel pattern. The most important factor in treating irritable bowel syndrome is what you do on a daily basis including eating, physical exercise and stress management.