Kale with fruit and nuts in bowl

Constipation is a symptom and can be a side effect of many diseases.

Patients interpret this symptom as a subjective perception of altered defecation. There is no agreement as to what constitutes normal bowel habits.

Among Western populations, the range for “normal” bowel evacuation is as often as two times a day to once every two days. While most subjects of studies defecate daily, too many people believe that if one does not have a bowel movement every day, they are constipated. This is not correct if your personal pattern is consistent. As a generalization, five stools weekly may be considered normal. Other means used to express the presences of constipation are straining at the stool, incomplete evacuation, or stools that are too hard or too small.

Constipation affects approximately 20 percent of the general population. Women complain of constipation more than men. Complaints of constipation tend to increase with age.

What causes constipation?

There are several major causes of constipation, depending on your stage in life.

Constipation among the general population

  • Not drinking enough water
    The average person should drink six to eight full (8 oz) glasses of water daily. It is important not to count caffeinated drinks (coffee, tea, cola) as a part of this total.
  • Not eating enough fiber
    The average person should consume 25-35 grams of fiber daily. Most Americans consume 10-15 grams of fiber daily.
  • Not exercising enough
    Most people do not get enough exercise daily. Increasing your exercise level increase your regularity.
  • Use of prescription or over-the-counter drugs.
    Some medications tend to cause constipation as a side effect.

Constipation during pregnancy

Constipation may be caused, in part, by an enlarging uterus applying pressure on the abdominal and back muscles from prior pregnancies, pressure of the fetal head on the rectum, or the presence of painful anorectal lesions (hemorrhoids), may contribute to constipation. Gastrointestinal transit time appears to be longer in the second and third trimesters than in the first trimester, or the postpartum period.

The use of iron supplements during pregnancy may also promote constipation.

Constipation among the elderly

Studies show that approximately 20 percent of individuals over the age of 65 experience constipation, affecting more women than men. As many as 40 percent of individuals who reside in geriatric communities experience constipation. The greater increase seems to be the result of reduced mobility, chronic illness, or drug ingestion rather than than the aging process.

Medical and diagnostic solutions

During a visit to your doctor, a thorough history should reveal the cause of constipation complaint and validate the circumstances surrounding your symptoms.

Your doctor will also take a complete medical history paying particular attention to the time of onset, progression of symptoms, your age, the presence or absence of rectal bleeding, use of laxatives, alteration in appetite and weight.

Often times, constpiation is a symptom of another disease, such as thyroid, diabetes, colonic diseases or neurologic disease. Therefore, your doctor will perform several screening tests to determine if other diseases are present. These tests may include a rectal examination, flexible sigmoidoscopy, a barium enema X-ray or a colonoscopy.

If a physical exam, and appropriate diagnostic tests do not indicate other causes of constipation, your doctor may advise you to:

  • Increase fluid (water) intake to six to eight glasses (8 oz) per day
  • Increase your fiber intake to reach 25-35 grams daily
    This may be accomplished through an improved daily diet of vegetables and fruits that have a high fiber content. Most often, individuals need a fiber supplement such as psyllium.