in pregnancy, and it is a common problem following childbirth

or surgery. Most constipation is temporary and not serious. Un-
derstanding its causes, prevention and treatment will help most
people find relief.
What causes constipation?
CONSTIPATION To understand constipation, it helps to know how the colon, or
large intestine, works (see Fig. 1). The goodness and nutrients
from food will have been absorbed higher in the gut, mostly in
A G u i d e fo r Wo m e n the small intestine, before the food moves into the colon. As
food moves through the colon, the colon absorbs water from
1. What is constipation? the food and forms it into stool. Mass waves of muscle contrac-
2. Who gets constipated? tions in the colon occur at intervals through the day and push the
3. What causes constipation? stool toward the rectum. By the time stool reaches the rectum
most of the water has been absorbed, and it should be formed
4. How is constipation diagnosed?
and sausage-shaped so it is easy to pass. Constipation occurs
5. How can constipation be treated? when the colon absorbs too much water or if the colon’s muscle
6. Can constipation be serious? contractions are slow or sluggish. This means the stool moves
7. Points to remember through the colon too slowly and as a result, stools can become
hard and dry.
8. Glossary of terms
9. Amount of Fiber in Different Foods Common causes of constipation are:
• Irregular meals and not • anticonvulsants
enough fiber in the diet • irritable bowel
• lack of physical activity syndrome
What is constipation?
(especially in the • changes in life or
Constipation is a symptom, not a disease. Constipation means
elderly) routine such as
the bowel does not move easily or regularly. This may mean
having a bowel movement fewer than every three days and the • medications e.g. pregnancy, aging, and
stools (bowel motion) may be hard and difficult to pass. Some • pain medications traveling
people who are constipated find it painful to have a bowel move- (especially narcotics) • abuse of laxatives
ment and often experience straining, bloating, the sensation of a
full bowel or a sense that the bowels are not empty. • antacids that contain • ignoring the urge to
aluminum and calcium have a bowel movement
Some people think they are constipated if they do not have a
bowel movement every day. However, normal bowel movements • some blood pressure • dehydration
may vary from three times a day to once every three days de- medications (calcium • specific diseases or
pending on the person. channel blockers) conditions, such as
Who gets constipated? • anti-parkinson drugs stroke (most common)
Almost everyone experiences constipation at some point in their • antispasmodics • problems with the colon
life. It is more common in women and adults ages 65 and older. and rectum
• antidepressants
Pregnant women may have constipation as the gut slows down
• iron supplements • problems with intestinal
Fig 1. Digestive System function (chronic
• diuretics idiopathic constipation)
How is constipation diagnosed?
Constipation can usually be diagnosed based on your symptoms
Stomach and a physical examination. Your doctor may also use these cri-
teria as a guide; the presence of any two of the following symp-
toms for at least 12 weeks (not always consecutive) in the previ-
Large intestine (colon) ous 12 months:
• fewer than three bowel movements per week
• straining during bowel movements
Small intestine
• lumpy or hard stool
• sensation of incomplete emptying of your bowel
Sigmoid Colon
• sensation of anorectal blockage/obstruction
For most people a medical history and physical examination may
be all that is needed for diagnosis and treatment. You should
mention any medications you take regularly since some medica-
Rectum tions can cause constipation. You may need a rectal examination
as part of a physical examination. A rectal examination involves
Anus inserting a gloved lubricated finger inside the rectum to feel for
lumps or abnormalities. It can also check for blood in the stool.

I U G A O f f i c e | o f f i c e @ i u g a . o r g | w w w. i u g a . o r g ©2011, 2017

Around $725 million is spent on laxative products each year in America. for a ‘squatting’ type position on the toilet using the following Bulk-forming fibers technique: They are generally considered the safest. particularly after grams of fiber per serving (see Table 2). commercial fiber preparations. They include natural and width apart. in the morning may stimulate the contractions stipation drink between 1. liquorice and readily. The correct position will changes will help relieve symptoms and prevent them from re- improve the angle of the rectum (back passage). They absorb water in the intes- tine and make the stool softer. 2017 . presence of blood in the stools. Your doctor will explain a test to you if you need one but you can also see the glossary of terms at the end of this leaflet. i u g a . weight loss or a family history of colon cancer. Go to the toilet when you get the first sensation you need molasses. Pay close attention to these signals and allow little or no fiber. laxatives can • Do not sit for longer than ten minutes. I U G A O f f i c e | o f f i c e @ i u g a . lead to the bowel becoming less responsive. Brand names include Metamucil.0 L of water or other liquids of the gut and encourage a bowel movement. cial at improving stool consistency and so making stool easier to nals to have a bowel movement. daily exercise.e. However for some people consuming large amounts • Lasts longer than three weeks of fiber can cause abdominal bloating or gas. plenty of water or they can cause obstruction. By reading the product information panel on Lifestyle Changes the side of the food package. your age. gas and cramping. stopping laxatives restores the colon’s natural ability to • Use your abdominal muscles as a pump to push gently contract. and Serutan. It is important you speak with your doctor if the problem: • Is new (i.g. and processed yourself enough time to have a bowel movement. kiwi fruit. If these simple changes do not relieve your constipation. recent changes in bowel habits. Correctol. They must be taken with high. limiting foods that have weaker over time. In general. For people prone to constipation. and The way you sit on the toilet can make a big difference to the duration of the problem. cles to work efficiently and prevent straining. colorectal transit study. • Relax and breathe normally. For most • Relax your anus. o r g ©2011. Adding cracked linseeds to the diet may be benefi- to open your bowels. Dulcolax). laxative use should be for occasional use only. but they can interfere • Sit comfortably on the toilet with your legs more than hip with the absorption of some medicines. pendent on laxatives need to stop using them gradually. figs. A doctor or dietitian can help plan an Behavioral treatment appropriate diet. Testing may include blood tests. You should avoid most important factors for good bowel function. Choice is based upon how they work. you should not hold your Laxatives breath. is also important. sigmoidoscopy. people. vegeta- • Is severe ble and oats) rather than insoluble (bran type fiber). Start with • Is associated with any other concerning features such as a small amount and slowly increase until your stools become blood on the toilet paper. o r g | w w w.g. Citrucel. how safe the treat- ment is. a change in your normal pattern) bulky stool. help your mus. weight loss. Medical Treatment Sitting properly on the toilet Treatment for constipation depends on the cause. If your bowels be categorized into the following groups: have not opened try again later. curring. as does regular such as fruit/vegetable juices every day. without seeing a health- care provider. such as ice cream. cheese. defecography. A hot drink.5 and 2. or more specialized tests (barium enema. colonoscopy. Self-treatment of constipation with over-the- counter laxatives is by far the most common aid. How can constipation be treated? Most people treat constipation at home. Try to increase your fiber if needed by using more soluble fiber (fruit. To prevent dehydration and to help con- e. People who are de- cles outwards. • Stimulant laxatives: cause rhythmic muscle contractions Diet in the intestines. fever or weakness softer and more frequent. • Place your feet flat on a footstool approximately 20cm Fiberall. may • Make your waist wide by bulging your abdominal mus. A diet with overusing stimulant laxatives as taking them regularly or enough fiber (20 to 35 grams each day) helps the body form soft. the signals become weaker and pass. If you ignore your body’s sig. and your doctor’s preferences. x-rays. your thighs. don’t wait. tea or coffee. A variety of laxatives are available for treating consti- but firmly backwards and downwards towards your anus. In most cases dietary and lifestyle ease with which your bowel empties. severity. You should aim you may try the following treatments. foods. Long term use of laxatives. particularly the stimulant laxatives. Some foods have natural breakfast and this is often the time when stools will pass most laxative properties such as prunes. meat. The tests your doctor performs depend on the duration and se- verity of the constipation. pation. you can determine the number of The bowels are most active following meals. Konsyl. You should in- • Lean forward from the hips and rest your forearms on crease the dose of fiber supplements slowly to prevent bloating. In general. anorectal func- tion tests). Examples include senna (Senokot) and Eating regularly and having an adequate fluid intake are the bisacodyl (e. in large amounts can cause side effects.Most people with constipation do not need extensive testing.

a chalky liquid that makes the area visible. Many people do not like using them but they cal impaction. in fact. o r g | w w w. work more quickly than oral laxatives. • Osmotic laxatives: cause fluids to flow in a special way sible complications. Sometimes straining causes a rectal • Saline laxatives: act like a sponge to draw water into the prolapse to push out from the anal opening. This condition may colon for easier passage of stool similar to the osmotic lead to secretion of mucus from the anus. constipation. respond to other treatments. and lower part of the small intestine to locate prob- lems. thereby reducing the symptoms of fruits. Whenever a significant or prolonged change in bowel volves the use of a sensor to monitor muscle activity. tablet. Understand that normal bowel habits vary. One such agent is Lubiprostone (Amitiza). recommended after childbirth or surgery and for people who • Other causes of constipation include medications. Exercise regularly. which is habits occurs. on the surface of the stool. Thereafter. tions should be avoided. • Many people think they are constipated when. or two fingers into the anus. laxatives are also tum so tightly that the normal pushing action of the colon is available as suppositories or enemas that you insert into no longer enough to expel the stool. People with diabe. Usually eliminating laxatives. following these simple tips will help re- Other drugs lieve symptoms and prevent recurrence of constipation: Chloride channel activators increase fluid and movement in the 1. Surgery may be used to correct anorectal problem such as rectal Once the mixture coats the inside of the colon and rectum. i u g a . The patient outward. result. abuse of laxatives. powder and granule). and specific softener brand names include Colace and Surfak. do. Set aside time after breakfast or dinner for undisturbed other agents. As a lactulose and is much less expensive. Used at the break up and remove part of the hardened stool by inserting one same time of day they may also encourage a more regu. incontinence. o r g ©2011. 7. However. Sa. Other treatments Biofeedback 6. called fe- the rectum. their bowel movements are regular. They typically stimulate a bowel • A medical history and physical exam may be the only movement within 8 hours but prolonged use of these prepara. eral oil is the most common example of lubricant (brand names include Fleet and Zymenol). only treatment necessary. caused by hard stool stretching the sphincter muscle. displayed on a computer screen. Examples include magnesium hydroxide (Milk the cause of the prolapse. ple with no underlying cause for their constipation (id. After softening the impaction. ever. a doctor should 3. Occasionally prepackaged enema kits Points to remember containing sodium phosphate / biphosphate (Fleet) may • Constipation affects almost everyone at one time or an- be recommended if you have not responded to other treat. Polyethylene glycol is plications include hemorrhoids. tum. colon. unlike lactulose and sorbitol. Biofeedback is a behavioral approach used by therapists and in. Eat a well-balanced. The colon does not show up well on x-rays. caused by straining to have a generally preferred since. Stool Softeners / Lubricants: Stool softeners moisten the stool to make it soft and easy to pass • The most common causes of constipation are lifestyle as it to moves through the intestine more easily. diseases. and anal fissures (tears in the skin around the does not cause gas or bloating. • Suppositories and enemas: Apart from oral preparations Constipation may cause hard stool to pack the intestine and rec- (liquid. some people with severe chronic constipation who involuntarily squeeze (rather than relax) their muscles while having a bowel Barium enema: This involves using x-rays to view the rec- movement. Do not ignore the urge to have a bowel movement. It may help ing your condition. check with your doctor. This shows an accurate assess- Glossary of Terms ment of the muscle function and the therapist can help you to Your doctor may use the following medical terms when discuss- retrain the muscles controlling bowel movements. occurs most often in children and older adults. Stool table bowel syndrome. it may be recommended if you do not visits to the toilet. An impaction can be softened with mineral oil taken by mouth When inserted into the rectum they soften the stools and and by an enema. • In most cases. They are often factors including poor diet and lack of exercise. is the of Magnesia) and magnesium citrate (Evac-Q-Mag). rectal bleeding may occur. Sorbitol works as well as anus). which include abdominal pain. Surgical removal of the colon may also be an option for may feel some abdominal cramping when the barium fills the people with severe symptoms caused by colonic inertia. tests needed before the doctor suggests treatment. Can constipation be serious? iopathic constipation). Drink plenty of liquids. Examples are polyethylene glycol Sometimes constipation can lead to complications. This condition. it bowel movement. and vegetables. while min. These com- (MiraLax). These are not recommended if you have problems with your heart or kidneys unless directed by your doctor. repair the prolapsed lining. assess the need for continued use. the benefits of this surgery must be weighed against pos- I U G A O f f i c e | o f f i c e @ i u g a . a condition in which the lining of the rectum bulges rays are taken that show their shape and condition. x- prolapse. It is expensive compared to 4. ments. irri- should avoid straining in order to pass a bowel movement. Lactulose and Sorbitol. scription medication that treats severe constipation and can be safely used for up to 6– 12 months. a pre. so the doctor Surgery fills it with barium. in general. 2. Severe or chronic prolapse requires line laxatives are used to treat acute constipation if there surgery to strengthen and tighten the anal sphincter muscle or to is no evidence of bowel obstruction. other. such as straining or coughing. the doctor may cause the walls of the rectum to contract. How- colon but usually feels little discomfort after the procedure. 5. soluble-fiber diet that includes fresh intestine to help stool pass. diarrhea and through the colon and these are especially useful for peo. lar bowel pattern. appearing as bright red streaks tes should be monitored carefully. 2017 .

Tomato 1 medium tomato 1. cooked Macaroni 1 cup 2.4 Peanuts 1 cup 12.1 expel the paste as in a normal bowel movement. which should only be done by a qualified physician or other health care professional. Grams of Food Serving Defecography: An x-ray of the anorectal area to check how Fiber well stool is expelled.5 Nuts Almonds 1 cup 17. boiled 1 cup 15. The patient eats a high-fiber diet during the course of this test. Vegetables Cooked Colorectal transit study: This test shows how well food moves through the colon. Apple (with skin) 1 medium apple 4. Carrots . inserted through the anus.5 Rice. Breads. then relaxes and tries to Oranges 1 orange 3.6 Spaghetti (regular) 1 cup 2. the doctor uses a Grape. The inabil- ity to expel a balloon filled with less than 150 mls of Lentils.5 tion.5 • A norectal manometry shows anal sphincter muscle func.2 Oatmeal. canned. It will show the contraction and relax. A catheter or air-filled balloon is inserted into Spinach 1 cup .4 The information contained in this brochure is intended to be used for educational purposes only. Fruits ation of the rectal muscles to check if they work correctly.5 Anorectal function tests: These tests diagnose constipation caused by abnormal functioning of the anus or rectum. unsweetened with added ascor- long.4 Sigmoidoscopy or colonoscopy: A camera examination of Juices the rectum and sigmoid (lower colon) is called a sigmoidosco. sweetened 1 cup .5 py while examination of the rectum and entire colon is called Grapefruit. Apple. canned. brown 1 cup 3. the doctor fills the rectum with a soft paste Banana 1 medium banana 3.3 ment of the markers through the colon is monitored by abdom.7 the anus and slowly pulled back through the sphincter Legumes muscle to measure muscle tone and contractions. The patient is usually lightly Orange 1 cup . The patient sits on a toilet positioned inside an x-ray machine. The patient swallows capsules con. Flour Bran muffins 1 medium muffin 5. canned 1 cup 11. Lettuce 1 cup shredded .5 scope.8 swallowed. Raw Cucumber (with peel) 1 cucumber 1.6 patient is then asked to expel the balloon. The same procedure is used for colo- noscopy. called a sigmoido. 2017 . no salt added 1 cup 13. The move.2 a colonoscopy. unsweetened with ascorbic acid 1 cup . It is not intended to be used for the diagnosis or treatment of any specific medical condition. o r g ©2011.1 that is the same consistency as stool. The Lima beans. except the colonoscope tube is longer.7 sedated before the exam.4 During the test.0 taining small markers that are visible on an x-ray.5 Rice. flexible tube with a light on the end. canned 1 cup 13. Green Beans 1 cup 4. Stools may be white in color for a few days after the test.9 Pasta and rice. Peas 1 cup 8. I U G A O f f i c e | o f f i c e @ i u g a .9 • Balloon expulsion tests consist of filling a balloon in. To perform a sigmoidoscopy. Kidney beans. white 1 cup . i u g a . cooked 1 cup 4.6 serted in the anus with varying amounts of water. Baked beans.5 cup sliced 2.0 Table 1: Amount of Fiber in Different Foods Created using data from the USDA National Nutrient Database White bread 1 slice .8 inal x-rays taken several times 3 to 7 days after the capsule is Potato (baked with skin) 1 medium potato 3. o r g | w w w. Prunes 1 cup. white.6 Whole-wheat bread 1 slice 1. pitted 12.6 water may indicate a decrease in bowel function. bic acid 1 cup .