is the infrequent and difficult passage of stool. The frequency
of bowel movements among healthy people varies greatly, ranging
from three movements a day to three a week. As a rule, if
more than 3 days pass without a bowel movement, the intestinal
contents may harden, and a person may have difficulty or even
pain during elimination. Stool may harden and be painful to
pass even after shorter intervals between bowel movements.
Bowel Syndrome (IBS).
of Body Salts.
Diet and dietary habits can play a role in developing constipation. Lack of interest in eating, a problem common to many single or widowed older people, may lead to heavy use of convenience foods, which tend to be low in fiber. In addition, loss of teeth may force older people to choose soft, processed foods, which also tend to be low in fiber.
Older people sometimes cut back on fluids, especially if they are not eating regular or balanced meals. Water and other fluids add bulk to stools, making bowel movements softer and easier to pass.
Prolonged bedrest, for example, after an accident or during an illness, and lack of exercise may contribute to constipation. Also, drugs prescribed for other conditions, such as antidepressants, antacids containing aluminium or calcium, antihistamines, diuretics, and antiparkinsonism drugs, can produce constipation in some people.
preoccupation with bowel movements sometimes leads older people
to depend heavily on laxatives, which can be habit forming.
The bowel begins to rely on laxatives to bring on bowel movements,
and over time, the natural mechanisms fail to work without
the help of drugs. Habitual use of enemas also can lead to
a loss of normal function.
addition to routine blood, urine, and stool tests, a sigmoidoscopy
may help detect problems in the rectum and lower colon. In
this procedure, which can be done in the doctor's office,
the doctor inserts a flexible, lighted instrument through
the anus to examine the rectum and lower intestine. The doctor
may perform a colonoscopy to inspect the entire colon. In
colonoscopy, an instrument similar to the sigmoidoscope, but
longer and able to follow the twists and turns of the entire
large intestine, is used. A barium enema x-ray will provide
similar information. If bleeding is present, a double-contrast
barium enema is preferred. Other highly specialized techniques
are available for measuring pressures and movements within
the colon and its sphincter muscles, but these are used only
in unusual cases.
straining causes a small amount of intestinal lining to push
out from the rectal opening. This condition is known as rectal
prolapse and may lead to secretion of mucus that may stain
underpants. In children, mucus may be a feature of cystic
The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives.
For most people, dietary and lifestyle improvements can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain breads, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.Bowel habits also are important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored.
If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an underactive thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy.
In most cases, laxatives should be the last
resort and taken only under a doctor's supervision. A doctor
is best qualified to determine when a laxative is needed and
which type is best. There are various types of oral laxatives,
and they work in different ways. Above all, it is necessary
to recognize that a successful treatment program requires
persistent effort and time. Constipation does not occur overnight,
and it is not reasonable to expect that constipation can be
Stimulants cause rhythmic muscular contractions in the small or large intestine. These agents can lead to dependency and can damage the bowel with prolonged daily use. These products include phenolphthalein (Correctol, Ex-Lax), bisacodyl (Dulcolax), castor oil (Purge, Neoloid), and senna (Senokot, Fletcher's Castoria).
Stool softeners, or wetting agents, provide moisture to the stool and prevent excessive dehydration. These laxatives often are recommended after childbirth or surgery. Products include those with docusate (Colace, Dialose, and Surfak).
Osmotics are salts or carbohydrates that cause water to remain in the intestine for easier movement of stool. Laxatives in this group include milk of magnesia, citrate of magnesia, lactulose, and Epsom salts.
Doctors agree that prevention is the best approach to constipation. While there is no way to ensure never experiencing constipation, the following guidelines should help:
Diet, Nutrition, & Cancer Prevention: The Good News (NIH Publication No. 87-2878). Pamphlet available from the Cancer Information Service, Office of Cancer Communications, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892. 1-800-4-CANCER. Discusses high-fiber diet and fiber-rich foods.
Larson DE, Editor-in-chief. Mayo Clinic Family Health Book. New York: William Morrow and Company, Inc., 1990. General medical guide that includes a section on constipation. Available in libraries and bookstores.
Marshall JB. Chronic constipation in adults: how far should evaluation and treatment go? Postgraduate Medicine 1990; 88(3): 49-51, 54-59, 63. This article for primary care physicians offers advice on diagnosis and treatment of constipation.
Murray FE, Bliss CM. Geriatric constipation: brief update on a common problem. Geriatrics 1991; 46(3): 64-68. This article for health professionals discusses the causes and management of constipation in older adults.National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, under the U.S. Public Health Service. The clearinghouse was authorized by Congress to focus a national effort on providing information to the public, patients and their families, and doctors and other health care professionals. The clearinghouse works with organizations to educate people about digestive health and disease. The clearinghouse answers inquires; develops, reviews, and distributes publications; and coordinates informational resources about digestive diseases.