Constipation in adults

Official reprint from UpToDate® www.uptodate.com Patient information: Constipation in adults Constipation refers to a change in bowel habits, but it has varied meanings. Stools may be too hard or too small, difficult to pass, orinfrequent (less than three times per week). People with c onstipation may also notic e a frequent need to strain and a sense that thebowels are not empty.
Constipation is a very common problem. Eac h year more than 2.5 million Americans visit their healthcare provider for relief from thisproblem. Many fac tors can contribute to or cause constipation, although in most people, no single cause can be found. In general,constipation occ urs more frequently as you get older. (See "Etiology and evaluation of chronic c onstipation in adults".) Constipation c an usually be diagnosed based upon your symptoms and a physic al examination. You should also mention anymedications you take regularly since some medic ations can cause c onstipation.
You may need a rectal examination as part of a physic al examination. A rectal examination involves inserting a gloved finger insidethe rectum to feel for any lumps or abnormalities. This test c an also check for blood in the stool.
Further testing may be ordered in some situations, for example, if you have had a recent c hange in bowel habits, blood in the stool,weight loss, or a family history of colon cancer. Testing may include blood tests, x-rays, sigmoidosc opy, colonosc opy, or morespec ialized testing if needed. (See "Patient information: Flexible sigmoidoscopy" and "Patient information: Colonoscopy".) When to seek help — Most people can treat constipation at home, without seeing a healthc are provider. However, you should speakwith a healthc are provider if the problem: Is new (ie, represents a change in your normal pattern)Lasts longer than three weeksIs severe uptodate.com/…/patient-information-constipation-in-… Is assoc iated with any other concerning features such as blood on the toilet paper, weight loss, fevers, or weakness.
Treatment for constipation inc ludes changing some behaviors, eating foods high in fiber, and using laxatives or enemas if needed.
You can try these treatments at home, before seeing a healthcare provider. However, if you do not have a bowel movement within afew days, you should call your healthc are provider for further assistance. (See "Management of chronic c onstipation in adults".) Behavior changes — The bowels are most active following meals, and this is often the time when stools will pass most readily. Ifyou ignore your body's signals to have a bowel movement, the signals bec ome weaker and weaker over time.
By paying c lose attention to these signals, you may have an easier time moving your bowels. Drinking a c affeine-containing beveragein the morning may also be helpful.
Increase fiber — Increasing fiber in your diet may reduce or eliminate c onstipation. The rec ommended amount of dietary fiber is 20to 35 grams of fiber per day. By reading the product information panel on the side of the pac kage, you can determine the number ofgrams of fiber per serving (figure 1).
Many fruits and vegetables can be particularly helpful in preventing and treating c onstipation (table 1). This is espec ially true ofcitrus fruits, prunes, and prune juice. Some breakfast cereals are also an exc ellent source of dietary fiber. (See "Patient information:High fiber diet".) Fiber side effects — Consuming large amounts of fiber can c ause abdominal bloating or gas; this can be minimized by starting with a small amount and slowly increasing until stools become softer and more frequent.
If behavior changes and increasing fiber does not relieve your constipation, you may try taking a laxative. A variety of laxatives areavailable for treating c onstipation. The choice between them is based upon how they work, how safe the treatment is, and yourhealthc are provider's preferences.
In general, laxatives c an be categorized into the following groups: Bulk forming laxatives — These include natural fiber and c ommercial fiber preparations such as: Psyllium (Konsyl®; Metamucil®; Perdiem®)Methylc ellulose (Citrucel®)Calcium polycarbophil (FiberCon®; Fiber-Lax®; Mitrolan®).
Wheat dextrin (Benefiber®) uptodate.com/…/patient-information-constipation-in-… You should increase the dose of fiber supplements slowly to prevent gas and cramping, and you should always take the supplementwith plenty of fluid.
Hyperosmolar laxatives — Hyperosmolar laxatives inc lude: Polyethylene glyc ol (MiraLax®, Glyc olax®)LactuloseSorbitol Polyethylene glyc ol is generally preferred sinc e it does not c ause gas or bloating and is available in the United States without aprescription. Lac tulose and sorbitol can produc e gas and bloating. Sorbitol works as well as lactulose and is much less expensive.
Saline laxatives — Saline laxatives suc h as magnesium hydroxide (Milk of Magnesia®) and magnesium c itrate (Evac-Q-Mag®) actsimilarly to the hyperosmolar laxatives.
Stimulant laxatives — Stimulant laxatives include senna (eg, Blac k Draught, ex-lax®, Fletcher's® Castoria®, Senokot®) andbisac odyl (eg, Correc tol®, Doxidan®, Dulcolax®).
Some people overuse stimulant laxatives. Taking stimulant laxatives regularly or in large amounts c an cause side effects, includinglow potassium levels. Thus, you should take these drugs c arefully if you must use them regularly.
However, there is no convincing evidenc e that using stimulant laxatives regularly damages the c olon, and they do not inc rease therisk for c olorec tal c ancer or other tumors.
New treatments — Lubiprostone (Amitiza®) is a prescription medication that treats severe constipation. It is expensive comparedto other agents. However, it may be rec ommended if you do not respond to other treatments.
Pills, suppositories, or enemas? — Laxatives are available as pills that you take by mouth or as suppositories or enemas that youinsert into the rectum. In general, suppositories and enemas work more quic kly c ompared to pills, but many people do not like usingthem.
Healthcare providers occ asionally rec ommend prepac kaged enema kits c ontaining sodium phosphate/biphosphate (Fleet®) if you havenot responded to other treatments. These are not recommended if you have problems with your heart or kidneys, and should not beused more than onc e unless direc ted by your healthcare provider.
Emollients — Emollient laxatives, principally mineral oil, soften stools by moisturizing them. However, other treatments havefewer risks and equal benefit.
Natural produc ts — A wide variety of natural products are advertised for constipation. Some of them contain the activeingredients found in c ommercially available laxatives. However, their dose and purity may not be c arefully c ontrolled. Thus,these products are not generally recommended.
uptodate.com/…/patient-information-constipation-in-… A variety of home-made enema preparations have been used throughout the years, such as soapsuds, hydrogen peroxide, andhousehold detergents. These can be extremely irritating to the lining of the intestine and should be avoided.
Biofeedback is a behavioral approach that may help some people with severe chronic c onstipation who involuntarily squeeze (ratherthan relax) their muscles while having a bowel movement [1].
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed every four months on our web site (www.uptodate.c om/patients).
Related topics for patients, as well as selec ted articles written for healthc are professionals, are also available. Some of the mostrelevant are listed below.
Patient information: Flexible sigmoidosc opyPatient information: Colonosc opyPatient information: High fiber diet Etiology and evaluation of chronic c onstipation in adultsMotility testing: When does it help?Management of chronic c onstipation in adultsTreatment of irritable bowel syndrome The following organizations also provide reliable health information.
(www.nlm.nih.gov/medlineplus/c onstipation.html, available in Spanish) National Institute on Diabetes and Digestive and Kidney Diseases (http://digestive.niddk.nih.gov/ddiseases/pubs/c onstipation/) uptodate.com/…/patient-information-constipation-in-… The American Gastroenterological Association (http://www.gastro.org/patient-c enter/digestive-conditions/constipation) (www.acg.gi.org/patients/gihealth/c onstipation.asp) Last literature review version 19.1: January 2011 This topic last updated: August 24, 2010 The co nte nt o n the UpToDate we bsite is no t intended no r re co m m ende d a s a substitute fo r m edica l a dvice, dia gnosis, or tre a tm ent. Always se ek the advice ofyo ur own physicia n o r o ther qua lifie d he a lth ca re pro fessiona l re ga rding any m e dica l questio ns o r conditions. The use o f this we bsite is go ve rne d by theUpToDate Te rm s of Use (click here ) 2011 UpTo Da te , Inc.
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Source: http://www.ucgastro.net/docs/constipation2.pdf