Constipation

Constipation is common and it affects people of all ages. You can usually treat it at home with simple changes to your diet and lifestyle.
This page is about constipation in adults.
It’s likely to be constipation if:
• you have not had a poo at least 3 times during the last week
• the poo is often large and dry, hard or lumpy
• you are straining or in pain when you have a poo

Causes:
Constipation in adults has many possible causes. Sometimes there’s no obvious reason.
The most common causes include:
• not eating enough fibre – such as fruit, vegetables and cereals
• not drinking enough fluids
• not moving enough and spending long periods sitting or lying in bed
• being less active and not exercising
• often ignoring the urge to go to the toilet
• changing your diet or daily routine
• a side effect of medicine
• stress, anxiety or depression
• we should to exclude anal canal problem (hemorrhoids ,piles, anal fissure ,prolaps tumors…).

Constipation is also common during pregnancy and for 6 weeks after giving birth.

Medical and health conditions that can cause constipation include:
• Endocrine problems, like underactive thyroid gland hypothyroidism), diabetes uremia, hypercalcemia.
• Colorectal cancer
• IBS
• Diverticular disease
• Outlet dysfunction constipation. (A defect in the coordination of pelvic floor muscles. These muscles support the organs within the pelvis and lower abdomen. They are needed to help release stool.)
• Neurologic disorders including spinal cord injury multiple sclerosis MS, Parkinson D, and stroke.
• Lazy bowel syndrome. The colon contracts poorly and retains stool.
• Intestinal obstruction
• Structural defects in the digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus, or malrotation.)
• Pregnancy

Medications that can cause constipation include:
• Strong pain medicines, like the narcotics containing codeine, oxycodone.
• Nonsteroidal anti-inflammatory drugs, like naproxen.
• Antidepressant: including the selective serotonin reuptake inhibitors (like fluoxetine [Prozac®]) or tricyclic antidepressants (like amitriptyline.
• Antacids containing calcium or aluminum.
• Iron pills.
• Allergy medications, such as antihistamines (like diphenhydramine).
• Certain blood pressure medicines, including calcium channel blockers (like verapamil, diltiazem and nifedipine and beta-blockers (like atenolol).
• Psychiatric medications, like clozapine and olanzapine (Zyprexa).
• Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
• Antinausea medications, like ondansetron (Zofran).

Can constipation cause internal damage?
There are a few complications that could happen if you don’t have soft, regular bowel movements. Some complications include:
• Swollen, inflamed veins in your rectum (a condition called haemorrhoids or piles).
• Tears in the lining of your anus from hardened stool trying to pass through (called anal fissure).
• An infection in pouches that sometimes form off the colon wall from stool that has become trapped and infected (a condition called diverticulitis)
• A pile-up of too much stool/poop in the rectum and anus (a condition called fecal impaction).
• Damage to your pelvic floor muscles from straining to move your bowels. These muscles help control your bladder. Too much straining for too long a period of time may cause urine to leak from the bladder (a condition called stress urinary incontinence.

Diagnosis:
What should I expect when I talk to my doctor about my constipation?
Talking to your doctor – or anyone – about your bowel movements (or lack of them) is not the most pleasant of topics. Know that your doctor is there for you. Doctors are trained health professionals who have discussed just about every health topic you can think of with their patients.
Your doctor will first ask you questions about your medical history, bowel movements, and your lifestyle and routines.

Medical history
These questions may include:
• What are your current and past diseases/health conditions?
• Have you lost or gained any weight recently?
• Have you had any previous digestive tract surgeries?
• What medications and supplements do you take for other disorders and for the relief of constipation?
• Does anyone in your family have constipation or diseases of the digestive tract or a history of colon cancer?
• Have you had a colonoscopy?

Bowel movement history
These questions may include:
• How often do you have a bowel movement?
• What do your stools look like?
• Have you noticed any blood or red streaks in your stool?
• Have you ever seen blood in the toilet bowl or on the toilet paper after you wipe?

Lifestyle habits and routines
• What food and beverages do you eat and drink?
• What is your exercise routine?
Your doctor will also perform a physical exam, which includes a check of your vital signs (temperature, pulse, blood pressure). He or she will use a stethoscope to listen to the sounds in your abdomen. Your abdomen will also be touched to check for pain, tenderness, swelling, and lumps.
Be aware that your doctor will also perform a rectal exam. This is a finger exam of the inside of your rectum. It’s a quick check for any masses or problems that can be felt by finger.
What lab tests and other medical tests may be done to find the cause of my constipation?
Your doctor can order no tests or many types of tests and procedures. The decision of which ones your doctor might order for you depends on your symptoms, medical history, and overall health.
Lab tests: Blood and urine tests reveal signs of hypothyroidism, anemia, and diabetes. A stool sample checks for signs of infection, inflammation, and cancer.
Imaging tests: Computed tomography (CT), magnetic resonance imaging (MRI) or lower gastrointestinal tract series may be ordered to identify other problems that could be causing your constipation.
Colonoscopy: A colonoscopy or sigmoidoscopy– an internal view of your colon with a scope – may be performed. During this procedure, a small sample of tissue (biopsy) may be taken to test for cancer or other problems and any found polyps will be removed.
Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines.
Other bowel function tests: Your doctor may order tests that check how well your anus and rectum hold and release stool. These tests include a certain type of x-ray (defecography), done to rule out causes of outlet dysfunction constipation, and the insertion of a small balloon into the rectum (balloon expulsion test and anorectal manometry).

How is constipation treated?
Self-care
Most cases of mild to moderate constipation can be managed by you at home. Self-care starts by taking an inventory of what you eat and drink and then making changes.
Some recommendations to help relieve your constipation include:
• Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration.
• Add fruits, vegetables whole grains and other high-fiber foods to your diet. Eat fewer high-fat foods, like meat, eggs and cheese.
• Eat prunes and/or bran cereal.
• Keep a food diary and single out foods that constipate you.
• Get moving, exercise.
• Check how you sit on the toilet. Raising your feet, leaning back or squatting may make having a bowel movement easier.
• Add an over-the-counter supplemental fiber to your diet (like Metamucil®, Citrucel®, and Benefiber®).
• If needed, take a very mild over-the-counter stool softener or laxative (such as docusate [Colace®] or Milk of Magnesia®). Mineral oil enemas, like Fleet®, and stimulant laxatives, like bisacodyl (Dulcolax®) or senna (Senokot®), are other options. There are many laxative choices. Ask your pharmacist or doctor for help in making a choice. Do not use laxatives for more than two weeks without calling your doctor. 

Overuse of laxatives can worsen your symptoms.
• Do not read, use your phone or other devices while trying to move your bowels.

Medication/supplement review
In addition to self-care methods, your doctor will review your medications and supplements (if you take any). Some of these products can cause constipation. If they do, your doctor may change the dose, switch to another drug and/or ask that you stop taking the supplement. Never stop taking your medications or supplements before talking with your doctor first.

Prescription medications
A few prescription drugs are available to treat constipation. These include lubiprostone (Amitiza®), prucalopride (Prudac®, Motegrity®), plecanatide (Trulance®), lactulose (Cephulac®, Kristalose®) and linaclotide (Linzess®). Your doctor will pick the drug that might work best for you based on the results of your tests.

Surgery
Surgery is rarely needed to treat constipation. Your doctor may, however, recommend surgery if constipation is caused by a structural problem in the colon. Examples of these problems include a blockage in the colon (intestinal obstruction), a narrowing in a portion of the intestine (intestinal stricture), tear in the anus (anal fissure) or the collapse of part of the rectum into the vagina (rectal prolapse). Some causes of outlet dysfunction constipation may be treated with surgery. This is best discussed after testing. You may also need surgery if cancer was found in your colon, rectum or anus.

How can I prevent constipation?
Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem:
• Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber. Eat bran cereal or add bran cereal to other foods, like soup and yogurt. People with constipation should eat between 18 and 30 grams of fiber every day.
• Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, can dehydrate you. You may need to stop drinking these products until your bowel habits return to normal.
• Exercise regularly.
• Treat mild constipation with a dietary supplement like magnesium. (Not everyone should take magnesium. Check with your doctor before taking.)
• Move your bowels when you feel the urge. Do not wait.
• like strawberries, have the most fiber. Bran is a great source of fiber. Eat bran cereal or add bran cereal to other foods, like soup and yogurt. People with constipation should eat between 18 and 30 grams of fiber every day.
• Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, can dehydrate you. You may need to stop drinking these products until your bowel habits return to normal.
• Exercise regularly.
• Treat mild constipation with a dietary supplement like magnesium. (Not everyone should take magnesium. Check with your doctor before taking.)
• Move your bowels when you feel the urge. Do not wait.

When should I call my doctor?
• Constipation is a new problem for you.
• You see blood in your stool.
• You are losing weight unintentionally.
• You have severe pain with bowel movements.
• Your constipation has lasted more than three weeks.
• You have symptoms of outlet dysfunction constipation.