Constipation

Constipation is very common in children and adults. Symptoms vary from person to person but can include

• Stools that are too hard or too small

• Stools that are hard to pass

• Stools that are too infrequent (less than 3 times per week)

• A sense that the bowels are not completely empty

Constipation has no single cause. Some people do not get enough fiber in their diet. For others, constipation may be caused by certain medicines, such as opiates (used to control pain) or ondansetron (used to control nausea and vomiting). Constipation can also be caused by certain medical conditions, such as multiple sclerosis or Parkinson disease. Constipation can come and go. Sometimes it can last for weeks, months, or years. This is called chronic constipation.

Constipation can be diagnosed based on symptoms and a physical examination.

You should see your health care provider if you have

• Severe constipation

• Unexplained weight loss

• Blood in your stool

• A change in bowel habits for more than 2 to 3 weeks

You should tell your health care provider which medicines you take. Your provider may do a rectal examination to check for abnormalities. Other tests may include blood tests or x-rays. Your provider also might suggest sigmoidoscopy or colonoscopy to view the inside of your bowels.

If possible, you should stop taking medicines that can produce constipation, but you should discuss this with your provider first.

Changing your bowel habits might be helpful. Your bowels are most active in the morning, when you wake up. They are also active after meals. You should not ignore your body’s signals to have a bowel movement. Having a bowel movement is often most convenient after breakfast, but trying to have a bowel movement after any meal might help.

Increasing fiber in your diet may improve or eliminate constipation. Recommended fiber intake is about 1 ounce per day. You can get this by eating fruits and vegetables. You can also use fiber products such as psyllium, methylcellulose, calcium polycarbophil, and wheat dextrin. You should increase these supplements a little at a time to avoid bloating or gas. Not all people can tolerate fiber supplements.

Changing your bowel habits and increasing dietary fiber are simple things you can try first. Other specific treatments or medicines will be covered in a forthcoming JAMA Patient Page.