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Constipation

Constipation
Other namesCostiveness,[1] dyschezia[2]
Constipation in a young child seen on X-ray. Circles represent areas of fecal matter (stool is white surrounded by black bowel gas).
SpecialtyGastroenterology
SymptomsInfrequent or hard to pass bowel movements, abdominal pain, bloating[2][3]
ComplicationsHemorrhoids, anal fissure, fecal impaction[4]
CausesSlow movement of stool within the colon, irritable bowel syndrome, celiac disease, non-celiac gluten sensitivity, pelvic floor disorders[4][5][6]
Risk factorsHypothyroidism, diabetes, Parkinson's disease, gluten-related disorders, colon cancer, ovarian cancer, diverticulitis, inflammatory bowel disease, certain medications[4][5][6]
TreatmentDrinking enough fluids, eating more fiber, exercise[4]
MedicationLaxatives of the bulk forming agent, osmotic agent, stool softener, or lubricant type[4]
Frequency2–30%[7]

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass.[2] The stool is often hard and dry.[4] Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement.[3] Complications from constipation may include hemorrhoids, anal fissure or fecal impaction.[4] The normal frequency of bowel movements in adults is between three per day and three per week.[4] Babies often have three to four bowel movements per day while young children typically have two to three per day.[8]

Constipation has many causes.[4] Common causes include slow movement of stool within the colon, irritable bowel syndrome, and pelvic floor disorders.[4] Underlying associated diseases include hypothyroidism, diabetes, Parkinson's disease, celiac disease, non-celiac gluten sensitivity, vitamin B12 deficiency, colon cancer, diverticulitis, and inflammatory bowel disease.[4][5][6][9][10] Medications associated with constipation include opioids, certain antacids, calcium channel blockers, and anticholinergics.[4] Of those taking opioids about 90% develop constipation.[11] Constipation is more concerning when there is weight loss or anemia, blood is present in the stool, there is a history of inflammatory bowel disease or colon cancer in a person's family, or it is of new onset in someone who is older.[12]

Treatment of constipation depends on the underlying cause and the duration that it has been present.[4] Measures that may help include drinking enough fluids, eating more fiber, consumption of honey[13] and exercise.[4] If this is not effective, laxatives of the bulk-forming agent, osmotic agent, stool softener, or lubricant type may be recommended.[4] Stimulant laxatives are generally reserved for when other types are not effective.[4] Other treatments may include biofeedback or in rare cases surgery.[4]

In the general population rates of constipation are 2–30 percent.[7] Among elderly people living in a care home the rate of constipation is 50–75 percent.[11] People spend, in the United States, more than US$250 million on medications for constipation a year.[14]

  1. ^ "Costiveness – Definition and More from the Free Merriam-Webster Dictionary". Archived from the original on 11 April 2010.
  2. ^ a b c Chatoor D, Emmnauel A (2009). "Constipation and evacuation disorders". Best Pract Res Clin Gastroenterol. 23 (4). Baillière Tindall: 517–30. doi:10.1016/j.bpg.2009.05.001. PMID 19647687.
  3. ^ a b Bharucha AE, Dorn SD, Lembo A, Pressman A (January 2013). "American Gastroenterological Association medical position statement on constipation". Best Practice & Research: Clinical Gastroenterology (Review). 144 (1). Baillière Tindall: 211–217. doi:10.1053/j.gastro.2012.10.029. PMID 23261064.
  4. ^ a b c d e f g h i j k l m n o p q "Constipation". National Institute of Diabetes and Digestive and Kidney Diseases. February 2015. Archived from the original on 15 March 2017. Retrieved 14 March 2017.
  5. ^ a b c "Symptoms & Causes of Celiac Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. June 2016. Archived from the original on 24 April 2017. Retrieved 24 April 2017.
  6. ^ a b c Cite error: The named reference MakhariaCatassi2015 was invoked but never defined (see the help page).
  7. ^ a b Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006). "Constipation of anorectal outlet obstruction: Pathophysiology, evaluation and management". Journal of Gastroenterology and Hepatology. 21 (4): 638–646. doi:10.1111/j.1440-1746.2006.04333.x. PMID 16677147. S2CID 30296908.
  8. ^ Colombo JM, Wassom MC, Rosen JM (1 September 2015). "Constipation and Encopresis in Childhood". Pediatrics in Review. 36 (9): 392–401, quiz 402. doi:10.1542/pir.36-9-392. ISSN 1526-3347. PMID 26330473. S2CID 35482415.
  9. ^ Bharucha AE, Pemberton JH, Locke GR 3rd (January 2013). "American Gastroenterological Association technical review on constipation". Gastroenterology. 144 (1): 218–38. doi:10.1053/j.gastro.2012.10.028. PMC 3531555. PMID 23261065.
  10. ^ "Pernicious Anemia Clinical Presentation: History, Physical Examination". emedicine.medscape.com. Retrieved 6 April 2023.
  11. ^ a b Canadian Agency for Drugs and Technologies in Health (26 June 2014). Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness. PMID 25520993.
  12. ^ Brenner DM, Shah M (June 2016). "Chronic Constipation". Gastroenterology Clinics of North America. 45 (2): 205–16. doi:10.1016/j.gtc.2016.02.013. PMID 27261894.
  13. ^ Li Y, Long S, Liu Q, Ma H, Li J, Xiaoking W, Yuan J, Li M, Hou M (8 August 2020). "Gut microbiota is involved in the alleviation of loperamide-induced constipation by honey supplementation in mice". Food Science & Nutrition. 8 (8). NIH: 4388–4398. doi:10.1002/fsn3.1736. PMC 7455974. PMID 32884719. The results of this study suggested that honey can improve the symptoms of constipation by elevating fecal water content and intestinal transit rate in loperamide‐induced constipation model.
  14. ^ Avunduk C (2008). Manual of gastroenterology: diagnosis and therapy (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 240. ISBN 978-0-7817-6974-7. Archived from the original on 11 September 2016.