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OVERVIEW

What is constipation?

Constipation is a common condition that makes it difficult to have a bowel movement. A bowel movement occurs when the food you eat passes through your digestive tract.  Your body takes the nutrients and water it needs from that food. What’s leftover is called stool.  Your stool can be hard or soft.  Bowel movements usually happen on a regular basis.

Everyone has a bowel movement schedule (how often, how consistent, and what time of day it occurs). However, if your bowel movements become less frequent (based on your history), are hard (and difficult to pass), and you are physically uncomfortable, you may be constipated. People of all ages experience constipation occasionally. Usually, it goes away and is not serious.  See your healthcare provider if your constipation is chronic (frequent). It may be a symptom of a problem with your diet or a health problem.

SYMPTOMS

Symptoms of constipation

Basic symptoms of constipation may include:

• Feeling like you still need to have a bowel movement even after you’ve had one
• Having hard, dry stool that is difficult to pass
• Having fewer than 3 bowel movements in a week
• Straining to have a bowel movement

You should contact your healthcare provider if these symptoms do not go away. You should also contact a healthcare provider if you have any of the following symptoms:

• Bleeding from your rectum or blood in your stool
• Constant pain in your abdomen
• Inability to pass gas
• Vomiting
• Fever
• Lower back pain
• Weight loss without trying

Chronic (ongoing) constipation can lead to complications, including:

• Anal fissure (a tear in the skin around the anus)
• Stool impaction (when stool becomes too large for you to pass on your own)
• Hemorrhoids
• Rectal prolapse (when a small piece of your intestine comes out of your anus from straining to have a bowel movement)
• Encopresis (when your bowels are so backed up that only liquid can pass through). Many people mistake this for diarrhea take anti-diarrheal medicine, making constipation even worse

Complications of constipation can become serious if left untreated. They may require surgery.

CAUSES & RISK FACTORS

What causes constipation?

You may be constipated for many different reasons. It may have more than one cause at a time, including:

• diet (too many processed foods and not enough fibre)
• certain medications (opioid medicines given for pain and even too many laxatives, which usually help you have a bowel movement)
• dehydration (especially not enough water)
• too little physical activity
• intestinal problems
• major life changes, such as pregnancy

Constipation may become more common as you age. Certain diseases and disabilities can also cause constipation. These include multiple sclerosis, stroke, diabetes, hypothyroidism, and lupus.

Dehydration (not enough fluids) and dietary changes are the most common causes of constipation in babies. For example, changing from breast milk to cow’s milk or from baby food to solids can cause constipation.

DIAGNOSIS AND TESTS

How is constipation diagnosed?

Your healthcare provider will ask about your symptoms and medical history.  This will include asking you about any medicines you take. Your healthcare provider may also ask when you had your last bowel movement and how often you have them. It might be helpful to write it down for before your appointment. During the visit, your healthcare provider may examine your rectum (the end of your large intestine near your anus). The healthcare provider will insert their finger (while wearing rubber gloves) into your rectum to feel for blockages.

Depending on the frequency and severity of your symptoms, your healthcare provider may order additional tests, including a blood test and X-ray. A more thorough test is a colonoscopy. This is an invasive procedure done with anesthesia. During this test, a healthcare provider will examine your colon with a long, flexible scope attached to a camera.

Can constipation be prevented or avoided?

There are things you can do to reduce constipation. These include:

• Add more fibre to your diet.  Health Canada recommends that women eat 25 grams of fibre and men eat 38 grams of fibre each day. Foods, such as beans, whole grains, fruits, and vegetables are high in fiber.
• Drink more water.   Being dehydrated causes your stool to dry out. This makes having a bowel movement more difficult and painful.
• Don’t wait. When you have the urge to have a bowel movement, don’t hold it in. This causes the stool to build up.
• Get physical. Exercise is helpful in keeping your bowel movements regular.
• Be aware of medicines. Certain prescription medicines (especially pain medicines) can slow your digestive system.
• Talk to your healthcare provider if you are being treated for certain diseases that are related to constipation.  They may have additional guidance for lowering your risks

TREATMENT

How is constipation treated?

Most cases of constipation are easy to treat at home with diet and exercise. Some cases require healthcare provider recommendations, prescription medicine, or a medical procedure.

At home treatment includes:

Diet: Eating a healthy diet with fibre and drinking plenty of fluids (water is the most helpful) can usually clear up constipation.

High fibre foods include beans, dried fruits, fresh fruits and vegetables, whole-grain foods (choose brown rice or whole wheat bread instead of white), flaxseed meal, and powdered products containing psyllium. For example, 3 cups of popped popcorn has a little more than 3 grams of fibre. One cup of oatmeal has 4 grams of fibre. Adding fibre to each meal and snack will help you reach your goal for the day. Fiber supplements are helpful. Processed foods, such as desserts and sugary drinks, only make constipation worse.

Bowel training: Teach your children to go to the bathroom when they have to. Holding it can lead to constipation. This also may be necessary for your elderly parents, if you are caring for them.

Laxatives. This is over-the-counter medicine that helps you have a bowel movement. Laxatives should only be used in rare instances. Do not use them on a regular basis. If you have to use a laxative, bulk-forming laxatives are best (two brands: Metamucil and Benefiber). These work naturally to add bulk and water to your stools so they can pass easily. Bulk-forming laxatives can cause some bloating (when your stomach feels full) and gas.

There are other treatments that require consulting with your healthcare provider:

Enema: This is a liquid medicine. It is inserted into your anus to help with constipation. It is often used after a surgery or before some medical procedures.

Prescription medicine: Your healthcare provider may prescribe a medicine based on the reason for your constipation.

Surgery: This is rare. It might involve removing a damaged intestine for serious reasons.

Living with constipation

Living with constipation can be uncomfortable and miserable. This is true when it’s just for just a couple of days. Routine (chronic) constipation can be so uncomfortable that it influences how your clothes fit, what foods you eat, and your everyday activities. Keep a journal of your bowel movements to see what a normal bowel movement schedule is for you or your child. A normal schedule is between 3 times per day to 3 times per week. Try to keep your diet and lifestyle as routine as possible to prevent constipation.

FOR MORE INFORMATION

Health Canada website at:

https://www.canada.ca/en/services/health/food-nutrition.html

https://www.canada.ca/en/services/health/healthy-eating.html