Constipation, Age 12 And Older

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Topic Overview

Constipation occurs when stools are difficult to pass. Some people are overly concerned with the frequency of their bowel movements because they have been taught that a healthy person has a bowel movement every day. This is not true. Most people pass stools anywhere from 3 times a day to 3 times a week. If your stools are soft and pass easily, you are not constipated.

Constipation is present if you have 2 or fewer bowel movements each week or you do not take laxatives and have 2 or more of the following problems at least 25% of the time:

• Straining
• Feeling that you do not completely empty your bowels
• Hard stools, or stools that look like pellets
• A feeling of being blocked up
• You cannot pass stools unless you put a finger in your rectum or use manual pressure to pass a stool.

Constipation may occur with cramping and pain in the rectum caused by the strain of trying to pass hard, dry stools. You may have some bloating and nausea. You may also have small amounts of bright red blood on the stool or on the toilet tissue, caused by bleeding hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. This should stop when the constipation is controlled.

There are three types of constipation: normal movement (transit) of stool through the intestines, slow transit constipation, and outlet delay.

Normal and slow transit constipation

Two of the most common types of constipation are normal and slow transit (functional) constipation. Lack of fiber is a common cause of functional constipation. Other causes include:

• Irritable bowel syndrome.
• Travel or other change in daily routine.
• Lack of exercise.
• Immobility caused by illness or aging.
• Medication use.
• Overuse of laxatives.
• Pregnancy.

Constipation is sometimes a sign of another health problem, such as diabetes, hypothyroidism, or hypercalcemia.

Outlet delay constipation

Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Excessive straining, needing manual pressure on the vaginal wall, or feelings of incomplete emptying may be a symptom of this type of constipation. Outlet delay constipation is caused by:

• Physical disorders that cause loss of function, such as colon cancer, uterine prolapse or rectal prolapse, scarring (adhesions), or injury caused by physical or sexual abuse.
• Nervous system diseases, such as Parkinson's disease, multiple sclerosis, or stroke.
• Spinal cord injury.
• Pain from hemorrhoids or anal fissures.
• Delaying bowel movements because of convenience issues or because having a bowel movement causes pain.

Constipation is more common in people older than 65. People in this age group are more likely to have poor dietary habits and increased medication use. Older adults also often have decreased muscular activity of the intestinal tract, which increases the time it takes for stool to move through the intestines. Physical problems, such as arthritis, may make sitting on the toilet uncomfortable or painful.

Constipation is also more common in rural areas, cold climates, and among the poor.

Psychological problems, such as severe anxiety, depression, eating disorders, or obsessive-compulsive disorder, also can cause constipation.

Women report problems with constipation more often than men.

If a stool becomes lodged in the rectum (impacted), mucus and fluid may leak out around the stool, sometimes leading to leakage of fecal material (fecal incontinence). You may experience this as constipation alternating with episodes of diarrhea.

Review the Check Your Symptoms section to determine if and when you need to see a health professional.

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Last updated:	December 14, 2006
Author:	Jan Nissl, RN, BS
Reviewed By:	William M. Green, MD - Emergency Medicine, Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Editors:	Susan Van Houten, RN, BSN, MBA, Tracy Landauer