Constipation

Inadequate fiber in the diet

People who eat a high fiber diet are less likely to become constipated. A diet low in fiber or a diet high in fats is commonly associated with constipation. Fiber–both soluble and insoluble–is the part of fruits, vegetables and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that may be difficult to pass. Americans eat an average of 5–14 grams of fiber daily, which is short of the 25–35grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed. A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy. These fast foods or prepared foods are typically low in fiber and high in fat. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and consequently low in fiber. Fiber intake from food and fiber supplements should be assessed and customized to the individual. The type of or quantity of fiber can be utilized to influence bowel function and management. Intake of fiber from food or supplement should be titrated carefully to assess tolerance or intolerance, or possible problems with the use of fiber.

Inadequate hydration

Research has not yet demonstrated that low fluid intake causes constipation or that an increase in orally ingested fluids alone effectively treats constipation. Nonetheless, many individuals report relief of their constipation with an increase intake of oral fluids. Orally ingested liquids are believed to add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. However, caution must be exercised as beverages containing caffeine, such as coffee and soft drinks, are likely to worsen one’s symptoms by promoting dehydration. Alcohol is another beverage that causes dehydration and may worsen constipation in the long run. It is important to drink fluids that hydrate the body, especially in the heat or when consuming large quantities of caffeine-containing or alcoholic beverages.

Decreased physical activity

A decrease in physical activity can lead to constipation. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise. Lack of physical activity is thought to be one of the reasons constipation is more common in older people or in people with disabilities. Moreover, increased physical activity is more likely to stimulate bowel motility and improve the symptoms of constipation.

Medications

Many medications can cause constipation, including prescription and non-prescription drugs. The list below includes commonly prescribed drugs and common over-the-counter drugs that may promote constipation. Be aware that there are many other drugs not listed below that may cause constipation. If you notice the development of constipation with the use of a medication, this should be brought to the attention of your physician.

Changes in life or routine such as pregnancy, aging and travel

During pregnancy, people may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging also may affect bowel regularity possibly due to slowing metabolism, decreased intestinal motor activity or decreased muscle tone and strength. Finally, people may become constipated when traveling because their normal diet and daily routine are disrupted.

Ignoring the urge or having decreased urge to havea bowel movement

People who ignore the urge to have a bowel movement may eventually stop feeling the need to have one, which can lead to constipation. Some people delay having a bowel movement because they do not find it convenient to use toilets outside the home. Others ignore the urge because of emotional stress or because they are simply too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play. People also may have the lack of urge to have a bowel movement related to neurologic and muscle impairments, which can result in significant constipation and fecal loading.

Irritable Bowel Syndrome (IBS)

IBS is a common chronic disorder causing alteration in one’s bowel habits as well as abdominal discomfort, although pain is usually relieved with bowel movement. Bowel habit alterations can include constipation, diarrhea, and a mixed pattern in which the bowels alternate between that of diarrhea and constipation. IBS is believed to occur due to disruption in the proper function of the connection between the brain and the bowels. This may include alterations in normal bowel motility, bowel secretion or bow pain sensation. IBS is therefore referred to as a functional bowel disorder. There are specific therapies for IBS that also may help the associated symptom of constipation including cognitive therapies administered by behavioral therapists with specialized training for bowel disorders.

Mechanical or functional obstruction of the colon and/or rectum 

There are a number of disorders that can physically compress, squeeze or narrow the intestines. There are other disorders that affect the nerves and muscles of the sphincter and the pelvic floor which leads to discoordinated movement and can result in afunctional obstruction. This may result in a physical barrier to the easy passage of the stool through the bowels. Such conditions may present with constipation.

Systemic diseases and other medical conditions

A number of systemic diseases and conditions also may cause constipation. These include neurologic disorders, myopathies and metabolic and endocrine disorders. These disorders can slow the movement of stool through the colon, rectum or anus and/or can cause discoordinated defecation.