Overview
Constipation is a common digestive issue in which bowel movements are infrequent (fewer than 3 per week), difficult, or incomplete. It affects 15-20% of adults and up to 30% of the elderly.
Constipation is usually not related to serious illness and improves with lifestyle changes. However, chronic constipation may signal an underlying condition.
Symptoms
- Fewer than 3 bowel movements per week
- Hard, dry, lumpy stools
- Straining during bowel movements
- Feeling of incomplete evacuation
- Sensation of blockage in the anus
- Need to manually assist evacuation
- Abdominal pain and bloating
- Loss of appetite, weakness
- Nausea
Causes
Diet and lifestyle:
- Insufficient fiber intake
- Insufficient water intake
- Sedentary lifestyle
- Postponing the urge to defecate
- Changes in diet and routine (travel)
Medications:
- Pain relievers (especially opioids)
- Antidepressants
- Iron supplements
- Calcium-, aluminum-containing antacids
- Some blood pressure medications (calcium channel blockers)
- Anticholinergics
Medical conditions:
- Hypothyroidism
- Diabetes
- Irritable bowel syndrome
- Neurological diseases like Parkinson's, MS
- Pregnancy
- Hemorrhoids, anal fissures (delay in defecation due to pain)
- Bowel obstruction (emergency)
- Colon cancer
- Depression, anxiety
- Eating disorders
Risk Factors
- Old age
- Being female
- Being bedridden
- Insufficient fiber and water intake
- Sedentary lifestyle
- Some medications
- Mental health issues
Complications
- Hemorrhoids
- Anal fissure (tear)
- Rectal prolapse
- Fecal impaction (stool blockage)
- Pelvic floor dysfunction
- Urinary incontinence
When to See a Doctor
- Constipation lasting more than 3 weeks
- Severe abdominal pain
- Bloody stools
- Unexplained weight loss
- Persistent fatigue
- Thin, pencil-like stools
- New-onset constipation (especially after age 50)
- Family history of colon cancer
- Alternating diarrhea-constipation
Diagnosis and Treatment
Diagnosis:
- Patient history and physical examination
- Rectal examination
- Blood tests (thyroid, calcium, glucose)
- Colonoscopy (in people over 50, with alarm symptoms)
- Bowel transit test
- Defecography
Treatment:
1. Lifestyle changes (first step):
- High-fiber diet (25-30 g of fiber per day)
- Plenty of water (2-2.5 L per day)
- Regular exercise
- Establishing toilet habits
- Stress management
2. Medications:
- Fiber supplements: Psyllium, methylcellulose
- Osmotic laxatives: Lactulose, polyethylene glycol (PEG)
- Stimulant laxatives: Bisacodyl, sennosides (short-term)
- Stool softeners: Docusate sodium
- Lubiprostone, linaclotide (chronic cases)
- Enemas (when needed)
Prevention
- Consume 25-30 g of fiber per day
- Drink plenty of water (2-2.5 L per day)
- Engage in regular physical activity
- Do not delay the urge to defecate
- Maintain regular meal habits
- Prefer whole grain products
- Increase fruit, vegetable, and legume consumption
- Probiotics may help
- Manage your stress
- Avoid excess caffeine and alcohol