• Basics

    Constipation, the most common gastrointestinal complaint in the U.S., is characterized by infrequent bowel movements. “Normal” bathroom habits can mean different things to different people. A daily bowel movement is not a regular event in everybody’s life. Some people may have three a day while others may have three a week. In general, you are considered to be constipated if you defecate fewer than three times in a week and pass hard, dry stools. However, some constipation sufferers are more bothered by straining and discomfort during defecation than by the reduced frequency of bowel movements.

    Changing your diet and getting more exercise are usually enough to alleviate constipation. However, if you have made lifestyle changes and are still constipated several weeks later, you may wish to consult your doctor. Replacing processed foods with those rich in fiber, drinking more water, and getting more exercise usually relieves constipation. About 80% of people experience constipation at some point in their lives, and brief periods of constipation may be normal. Most people who are mildly constipated do not need laxatives.

    Constipation commonly occurs in children, accounting for as much as 5% of visits to a pediatrician’s office. Infants and children have more frequent bowel movements than adults. Breast-fed infants typically pass three stools/day at age 3 months, and bottle-fed infants pass two stools/day at the same age. Two-year-olds average slightly less than two stools/day, and by the time a child is 4 years old, he or she usually has about one bowel movement/day.

    Constipation in children can present as hard stools, infrequent stools, painful bowel movements, or stool incontinence (loss of bowel control).

    If your child has constipation, most likely your pediatrician will not be able to identify an underlying physical or medical cause. Doctors call this functional constipation. A small percentage of babies and children have an underlying disorder causing constipation. Your child’s doctor should examine your child and do standard tests to exclude any obvious cause, though it is unlikely that your pediatrician will find an underlying medical disorder.

    If you are concerned that your child has constipation, it is important to contact your pediatrician without delay. Prompt diagnosis and treatment improves the overall prognosis of this common condition.

  • Causes

    Constipation is caused by irregular or slowed movement of contents through the lower intestine. For many patients, peristalsis—the intestinal contractions that push contents along—slows and causes partially digested food and other materials to stagnate in the colon or rectum. This allows extra time for the bowel to remove water from wastes, making stools hard, dry, and more difficult to pass.

    Constipation is a consequence of many things, including diet, lifestyle choices, various illnesses, and certain medications Table 01. Inadequate fiber and fluid intake and not getting enough exercise are the main reasons people get constipated. Dietary fiber passes through the intestines without getting digested. It adds bulk to the stool, which stimulates peristalsis. Fiber also soaks up water, which softens the stool and makes it easier to pass. This is why doctors encourage diets rich in fiber. Most people, however, do not get the recommended 20 to 30 grams a day. Drinking water and exercising—other things many Americans do not do regularly enough—softens stool and stimulates contractions in the colon.

    Certain medical problems can also cause constipation.

    Metabolic disorders, such as an underactive thyroid gland, endocrine problems such as diabetes, and neurological illnesses such as Parkinson's disease, are all known to cause constipation. Psychological distress and depression are other recognized offenders. Medications for these and other illnesses can also have a constipating effect. Many drugs used to lower blood pressure include constipation as a side effect, as do antacids that contain aluminum or calcium. Calcium supplements and iron supplements have been known to cause constipation as well.

    Not using the bathroom when you need to can result in impacted stool, and the overuse of laxatives can impair normal bowel function.

    Most children have functional constipation. If the pediatrician cannot find an obvious cause for constipation in your child, then he or she probably has this type of constipation.

    In a small percentage of children, an underlying physical disorder causes constipation. These include a narrow anus or another anatomic defect of the anus; a general medical problem such as thyroid disease, diabetes, cystic fibrosis, nerve damage in the spinal cord, or Hirschsprung’s disease and other disorders of the intestinal muscles; certain medications such as antacids; lead intoxication; and cow's milk intolerance. Your pediatrician may perform a physical exam and appropriate tests to determine if your child has any of these rare causes of constipation.

    Table 1.  Factors That Disturb Bowel Function

    Diet and lifestyle
    Too little fiber in diet
    Inadequate fluid intake
    Laxative abuse
    Sedentary lifestyle
    Not going to the bathroom when urge strikes
    Intestinal obstruction
    Multiple sclerosis
    Parkinson's disease
    Spinal cord injury
    Hypothyroidism (underactive thyroid gland)
    Hypercalcemia (high levels of calcium in blood)
    Hypocalcemia (low levels of calcium in blood)
    Drugs and supplements
    Antacids containing aluminum or calcium
    Anticholinergics (used in treatment of Parkinson?s disease)
    Anti-Parkinson's drugs
    Calcium channel blockers (used in treatment of hypertension)
    Calcium supplements
    Diuretics (used to eliminate water from the body)
    Iron supplements
    Opiates (used to alleviate pain)

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