What constipation is and how it shows
Constipation is when stool becomes less frequent, harder or harder to pass than usual. Doctors speak of constipation when bowel movements come fewer than three times a week, the stool is dry and lumpy, you have to strain a lot, or you feel the bowel has not emptied fully. What is normal differs from person to person: some do fine with a stool every other day, others need one daily. Most often constipation comes from lifestyle and diet, and it can be eased without medicine. But sometimes it signals illness, so it matters to notice the warning signs.
Constipation in adults: why it happens
Common causes are too little fiber and water in the diet, a sedentary life, the habit of holding back the urge ("I will go later"), stress and changes of place and routine. Some medicines (strong painkillers, iron supplements, for example), thyroid disease, diabetes and irritable bowel syndrome can also cause it. If constipation appeared suddenly and differs a lot from your usual pattern, especially after age 50, be sure to see a doctor.
Constipation and bloating
Stool building up in the bowel is often accompanied by bloating, rumbling and heaviness. This is covered on the page Bloating. If constipation alternates with loose stools, see Diarrhea: that picture occurs with irritable bowel syndrome.
Constipation with abdominal pain
Mild dull pain and cramps with constipation usually pass once the bowel empties. But severe, building pain, vomiting, being unable to pass gas, and a tight, hard belly point to a dangerous condition, possibly a bowel obstruction: you need urgent help. For more on pain, see Abdominal pain, and on vomiting Nausea and vomiting.
Constipation with blood
Bright red blood on the paper or on the surface of the stool is often linked to an anal fissure or hemorrhoids, which come from straining. But blood in the stool, black stool, or blood together with a change in bowel habits and weight loss should not be put down to hemorrhoids without an examination. See a doctor.
Constipation in a child
Constipation is very common in children: when they move to solid food, during potty training, with too little fluid and fiber, and from fear of painful stool. A child may hold back, and then the hard stool becomes even more painful. Show the child to a pediatrician if constipation lasts more than two weeks, the stool has blood, there is severe pain, vomiting or weight loss, or if it began in a baby. It is better not to give children laxatives without a doctor's advice.
Constipation in pregnancy and in older people
In pregnancy constipation is common because of hormones and pressure from the uterus on the bowel. It is also frequent in older age because of inactivity, medicines and a slower bowel. Start with diet, fluids and walks; take any laxative in pregnancy, or in older people with chronic illness, only after talking to a doctor.
What you can do before the visit
- Add fiber gradually: vegetables, fruit, whole grains, oats. A sudden jump can increase bloating.
- Drink enough fluid through the day.
- Move: a daily walk stimulates the bowel.
- Build a routine: go to the toilet at the same time, preferably after a meal, and do not hold back the urge. A small footstool that raises your knees above your hips makes emptying easier.
- If you still need a laxative, ask a pharmacist: such products are for short-term, not constant, use.
- If a prescribed medicine is causing it, do not stop it yourself but discuss it with your doctor.
- Note how often you go, what the stool is like, and what you eat and drink.
How a doctor finds the cause
The doctor asks about how often and what kind of stool, diet, medicines, weight and other illnesses, examines the belly and, if needed, the anal area. Blood and stool tests may follow, an ultrasound, and for warning signs a colonoscopy. If diet is behind it, a dietitian can help. Treatment depends on the cause: first routine and diet, then medicines prescribed by a doctor if needed.