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Constipation
National Digestive Diseases Information Clearinghouse

Constipation is defined as having a bowel

Large intestine
movement fewer than three times per week.
(colon)
With constipation stools are usually hard,
dry, small in size, and difficult to eliminate.
National Stomach
Institute of Some people who are constipated find it
Diabetes and painful to have a bowel movement and
Digestive
and Kidney
often experience straining, bloating, and
Small
Diseases the sensation of a full bowel. intestine
NATIONAL Some people think they are constipated if
INSTITUTES
OF HEALTH
they do not have a bowel movement every
day. However, normal stool elimination
Illeum
may be three times a day or three times a
week, depending on the person.
Constipation is a symptom, not a disease. Rectum
Almost everyone experiences constipation Sigmoid
Anus colon
at some point in their life, and a poor diet
typically is the cause. Most constipation is Lower digestive system.
temporary and not serious. Understanding
its causes, prevention, and treatment will Self-treatment of constipation with over-
help most people find relief. the-counter (OTC) laxatives is by far the
most common aid. Around $725 million
Who gets constipated? is spent on laxative products each year
in America.
Constipation is one of the most common
gastrointestinal complaints in the United
States. More than 4 million Americans What causes constipation?
have frequent constipation, accounting To understand constipation, it helps to
for 2.5 million physician visits a year. know how the colon, or large intestine,
Those reporting constipation most often works. As food moves through the colon,
are women and adults ages 65 and older. the colon absorbs water from the food while
Pregnant women may have constipation, it forms waste products, or stool. Muscle
and it is a common problem following child- contractions in the colon then push the
birth or surgery. stool toward the rectum. By the time stool
reaches the rectum it is solid, because most
of the water has been absorbed.

U.S. Department
of Health and
Human Services
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Constipation occurs when the colon absorbs Americans eat an average of 5 to 14 grams
too much water or if the colon’s muscle con- of fiber daily,* which is short of the 20 to
tractions are slow or sluggish, causing the 35 grams recommended by the American
stool to move through the colon too slowly. Dietetic Association. Both children and
As a result, stools can become hard and dry. adults often eat too many refined and
Common causes of constipation are processed foods from which the natural
fiber has been removed.
• not enough fiber in the diet
• lack of physical activity (especially in A low-fiber diet also plays a key role in con-
the elderly) stipation among older adults, who may lose
interest in eating and choose foods that are
• medications
quick to make or buy, such as fast foods, or
• milk prepared foods, both of which are usually
• irritable bowel syndrome low in fiber. Also, difficulties with chewing
• changes in life or routine such as preg- or swallowing may cause older people to
nancy, aging, and travel eat soft foods that are processed and low
in fiber.
• abuse of laxatives
• ignoring the urge to have a bowel Not Enough Liquids
movement Research shows that although increased
• dehydration fluid intake does not necessarily help
relieve constipation, many people report
• specific diseases or conditions, such as
some relief from their constipation if they
stroke (most common)
drink fluids such as water and juice and
• problems with the colon and rectum avoid dehydration. Liquids add fluid to the
• problems with intestinal function colon and bulk to stools, making bowel
(chronic idiopathic constipation) movements softer and easier to pass. People
who have problems with constipation should
Not Enough Fiber in the Diet try to drink liquids every day. However, liq-
People who eat a high-fiber diet are less uids that contain caffeine, such as coffee and
likely to become constipated. The most cola drinks will worsen one’s symptoms by
common causes of constipation are a diet causing dehydration. Alcohol is another
low in fiber or a diet high in fats, such as beverage that causes dehydration. It is
cheese, eggs, and meats. important to drink fluids that hydrate the
body, especially when consuming caffeine
Fiber—both soluble and insoluble—is the containing drinks or alcoholic beverages.
part of fruits, vegetables, and grains that the
body cannot digest. Soluble fiber dissolves *National Center for Health Statistics. Dietary Intake
easily in water and takes on a soft, gel-like of Macronutrients, Micronutrients, and Other Dietary
texture in the intestines. Insoluble fiber Constituents: United States, 1988–94. Vital and
Health Statistics, Series 11, Number 245. July 2002.
passes through the intestines almost
unchanged. The bulk and soft texture of
fiber help prevent hard, dry stools that are
difficult to pass.

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Lack of Physical Activity Abuse of Laxatives

A lack of physical activity can lead to The common belief that people must
constipation, although doctors do not know have a daily bowel movement has led to
precisely why. For example, constipation self-medicating with OTC laxative products.
often occurs after an accident or during Although people may feel relief when they
an illness when one must stay in bed and use laxatives, typically they must increase
cannot exercise. Lack of physical activity is the dose over time because the body grows
thought to be one of the reasons constipa- reliant on laxatives in order to have a bowel
tion is common in older people. movement. As a result, laxatives may
become habit-forming.
Medications
Some medications can cause constipation, Ignoring the Urge to Have a
including Bowel Movement
• pain medications (especially narcotics) People who ignore the urge to have a bowel
movement may eventually stop feeling the
• antacids that contain aluminum need to have one, which can lead to consti-
and calcium pation. Some people delay having a bowel
• blood pressure medications (calcium movement because they do not want to use
channel blockers) toilets outside the home. Others ignore the
• antiparkinson drugs urge because of emotional stress or because
they are too busy. Children may postpone
• antispasmodics
having a bowel movement because of stress-
• antidepressants ful toilet training or because they do not
• iron supplements want to interrupt their play.
• diuretics
• anticonvulsants

Changes in Life or Routine

During pregnancy, women may be consti-
pated because of hormonal changes or
because the uterus compresses the intestine.
Aging may also affect bowel regularity,
because a slower metabolism results in less
intestinal activity and muscle tone. In addi-
tion, people often become constipated when
traveling, because their normal diet and
daily routine are disrupted.

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Specific Diseases Problems with Intestinal

Diseases that cause constipation include Function
neurological disorders, metabolic and The two types of constipation are idiopathic
endocrine disorders, and systemic conditions constipation and functional constipation.
that affect organ systems. These disorders Irritable bowel syndrome (IBS) with pre-
can slow the movement of stool through the dominant symptoms of constipation is cate-
colon, rectum, or anus. gorized separately.
Conditions that can cause constipation are Idiopathic—of unknown origin—constipa-
found below. tion does not respond to standard treatment.
• Neurological disorders Functional constipation means that the
– multiple sclerosis bowel is healthy but not working properly.
– Parkinson’s disease Functional constipation is often the result of
poor dietary habits and lifestyle. It occurs in
– chronic idiopathic intestinal pseudo- both children and adults and is most com-
obstruction mon in women. Colonic inertia, delayed
– stroke transit, and pelvic floor dysfunction are
– spinal cord injuries three types of functional constipation.
Colonic inertia and delayed transit are
• Metabolic and endocrine conditions
caused by a decrease in muscle activity in
– diabetes the colon. These syndromes may affect the
– uremia entire colon or may be confined to the
– hypercalcemia lower, or sigmoid, colon.
– poor glycemic control Pelvic floor dysfunction is caused by a weak-
– hypothyroidism ness of the muscles in the pelvis surround-
ing the anus and rectum. However, because
• Systemic disorders this group of muscles is voluntarily con-
– amyloidosis trolled to some extent, biofeedback training
– lupus is somewhat successful in retraining the
– scleroderma muscles to function normally and improving
the ability to have a bowel movement.
Problems with the Colon Functional constipation that stems from
and Rectum problems in the structure of the anus and
Intestinal obstruction, scar tissue—also rectum is known as anorectal dysfunction,
called adhesions—diverticulosis, tumors, or anismus. These abnormalities result in
colorectal stricture, Hirschsprung’s disease, an inability to relax the rectal and anal mus-
or cancer can compress, squeeze, or narrow cles that allow stool to exit.
the intestine and rectum and cause consti- People with IBS having predominantly con-
pation. stipation also have pain and bloating as part
of their symptoms.

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How is the cause of Physical Examination

constipation identified? A physical exam may include a rectal exam
with a gloved, lubricated finger to evaluate
The tests the doctor performs depend on
the tone of the muscle that closes off the
the duration and severity of the constipa-
anus—also called anal sphincter—and to
tion, the person’s age, and whether blood
detect tenderness, obstruction, or blood. In
in stools, recent changes in bowel habits,
some cases, blood and thyroid tests may be
or weight loss have occurred. Most people
necessary to look for thyroid disease and
with constipation do not need extensive
serum calcium or to rule out inflammatory,
testing and can be treated with changes in
metabolic, and other disorders.
diet and exercise. For example, in young
people with mild symptoms, a medical his- Extensive testing usually is reserved for
tory and physical exam may be all that is people with severe symptoms, for those
needed for diagnosis and treatment. with sudden changes in the number and
consistency of bowel movements or blood
Medical History in the stool, and older adults. Additional
The doctor may ask a patient to describe tests that may be used to evaluate constipa-
his or her constipation, including duration of tion include
symptoms, frequency of bowel movements,
consistency of stools, presence of blood in • a colorectal transit study
the stool, and toilet habits—how often and • anorectal function tests
where one has bowel movements. A record • a defecography
of eating habits, medication, and level of
physical activity will also help the doctor Because of an increased risk of colorectal
determine the cause of constipation. cancer in older adults, the doctor may use
tests to rule out a diagnosis of cancer,
The clinical definition of constipation is including a
having any two of the following symptoms
for at least 12 weeks—not always consecu- • barium enema x ray
tive—in the previous 12 months: • sigmoidoscopy or colonoscopy
• straining during bowel movements Colorectal transit study. This test shows
• lumpy or hard stool how well food moves through the colon.
The patient swallows capsules containing
• sensation of incomplete evacuation small markers that are visible on an x ray.
• sensation of anorectal The movement of the markers through the
blockage/obstruction colon is monitored by abdominal x rays taken
• fewer than three bowel movements several times 3 to 7 days after the capsule is
per week swallowed. The patient eats a high-fiber
diet during the course of this test.

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Anorectal function tests. These tests diag- a special liquid to flush out the bowel. A
nose constipation caused by abnormal func- clean bowel is important, because even a
tioning of the anus or rectum—also called small amount of stool in the colon can hide
anorectal function. details and result in an incomplete exam.
• Anorectal manometry evaluates anal Because the colon does not show up well
sphincter muscle function. For this on x rays, the doctor fills it with barium, a
test, a catheter or air-filled balloon is chalky liquid that makes the area visible.
inserted into the anus and slowly pulled Once the mixture coats the inside of the
back through the sphincter muscle to colon and rectum, x rays are taken that show
measure muscle tone and contractions. their shape and condition. The patient may
• Balloon expulsion tests consist of fill- feel some abdominal cramping when the
ing a balloon with varying amounts of barium fills the colon but usually feels little
water after it has been rectally inserted. discomfort after the procedure. Stools
Then the patient is asked to expel may be white in color for a few days after
the balloon. The inability to expel a the exam.
balloon filled with less than 150 mL Sigmoidoscopy or colonoscopy. An exami-
of water may indicate a decrease in nation of the rectum and lower, or sigmoid,
bowel function. colon is called a sigmoidoscopy. An exami-
Defecography is an x ray of the anorectal nation of the rectum and entire colon is
area that evaluates completeness of stool called a colonoscopy.
elimination, identifies anorectal abnormali-
The person usually has a liquid dinner
ties, and evaluates rectal muscle contractions
the night before a colonoscopy or sigmoi-
and relaxation. During the exam, the doc-
doscopy and takes an enema early the next
tor fills the rectum with a soft paste that is
morning. An enema an hour before the
the same consistency as stool. The patient
test may also be necessary.
sits on a toilet positioned inside an x-ray
machine, then relaxes and squeezes the To perform a sigmoidoscopy, the doctor uses
anus to expel the paste. The doctor studies a long, flexible tube with a light on the end,
the x rays for anorectal problems that called a sigmoidoscope, to view the rectum
occurred as the paste was expelled. and lower colon. The patient is lightly
sedated before the exam. First, the doctor
Barium enema x ray. This exam involves
examines the rectum with a gloved, lubri-
viewing the rectum, colon, and lower part
cated finger. Then, the sigmoidoscope is
of the small intestine to locate problems.
inserted through the anus into the rectum
This part of the digestive tract is known as
and lower colon. The procedure may cause
the bowel. This test may show intestinal
abdominal pressure and a mild sensation of
obstruction and Hirschsprung’s disease,
wanting to move the bowels. The doctor
which is a lack of nerves within the colon.
may fill the colon with air to get a better
The night before the test, bowel cleansing, view. The air can cause mild cramping.
also called bowel prep, is necessary to clear
the lower digestive tract. The patient drinks

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To perform a colonoscopy, the doctor uses Laxatives

a flexible tube with a light on the end, called
Most people who are mildly constipated do
a colonoscope, to view the entire colon.
not need laxatives. However, for those who
This tube is longer than a sigmoidoscope.
have made diet and lifestyle changes and are
During the exam, the patient lies on his or
still constipated, a doctor may recommend
her side, and the doctor inserts the tube
laxatives or enemas for a limited time. These
through the anus and rectum into the colon.
treatments can help retrain a chronically
If an abnormality is seen, the doctor can
sluggish bowel. For children, short-term
use the colonoscope to remove a small
treatment with laxatives, along with retrain-
piece of tissue for examination (biopsy).
ing to establish regular bowel habits, helps
The patient may feel gassy and bloated
prevent constipation.
after the procedure.
A doctor should determine when a patient
How is constipation treated? needs a laxative and which form is best.
Laxatives taken by mouth are available in
Although treatment depends on the cause, liquid, tablet, gum powder, and granule
severity, and duration of the constipation, in forms. They work in various ways:
most cases dietary and lifestyle changes will
help relieve symptoms and help prevent • Bulk-forming laxatives generally are
them from recurring. considered the safest, but they can
interfere with absorption of some med-
Diet icines. These laxatives, also known as
A diet with enough fiber (20 to 35 grams fiber supplements, are taken with
each day) helps the body form soft, bulky water. They absorb water in the intes-
stool. A doctor or dietitian can help plan an tine and make the stool softer. Brand
appropriate diet. High-fiber foods include names include Metamucil, Fiberall,
beans, whole grains and bran cereals, fresh Citrucel, Konsyl, and Serutan. These
fruits, and vegetables such as asparagus, agents must be taken with water or they
brussels sprouts, cabbage, and carrots. For can cause obstruction. Many people
people prone to constipation, limiting foods also report no relief after taking bulking
that have little or no fiber, such as ice agents and suffer from a worsening in
cream, cheese, meat, and processed foods, bloating and abdominal pain.
is also important. • Stimulants cause rhythmic muscle
contractions in the intestines. Brand
Lifestyle Changes names include Correctol, Dulcolax,
Other changes that may help treat and pre- Purge, and Senokot. Studies suggest
vent constipation include drinking enough that phenolphthalein, an ingredient in
water and other liquids, such as fruit and some stimulant laxatives, might increase
vegetable juices and clear soups, so as not a person’s risk for cancer. The Food
to become dehydrated, engaging in daily and Drug Administration has proposed
exercise, and reserving enough time to a ban on all over-the-counter products
have a bowel movement. In addition, the containing phenolphthalein. Most lax-
urge to have a bowel movement should not ative makers have replaced, or plan to
be ignored. replace, phenolphthalein with a safer
ingredient.

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• Osmotics cause fluids to flow in a spe- • Saline laxatives act like a sponge to
cial way through the colon, resulting in draw water into the colon for easier
bowel distention. This class of drugs is passage of stool. Brand names include
useful for people with idiopathic Milk of Magnesia and Haley’s M-O.
constipation. Brand names include Saline laxatives are used to treat acute
Cephulac, Sorbitol, and Miralax. Peo- constipation if there is no indication of
ple with diabetes should be monitored bowel obstruction. Electrolyte imbal-
for electrolyte imbalances. ances have been reported with extended
• Stool softeners moisten the stool and use, especially in small children and
prevent dehydration. These laxatives people with renal deficiency.
are often recommended after childbirth • Chloride channel activators increase
or surgery. Brand names include Colace intestinal fluid and motility to help
and Surfak. These products are sug- stool pass, thereby reducing the symp-
gested for people who should avoid toms of constipation. One such agent
straining in order to pass a bowel is Amitiza, which has been shown to be
movement. The prolonged use of this safely used for up to 6 to 12 months.
class of drugs may result in an electrolyte Thereafter a doctor should assess the
imbalance. need for continued use.
• Lubricants grease the stool, enabling People who are dependent on laxatives
it to move through the intestine more need to slowly stop using them. A doctor
easily. Mineral oil is the most common can assist in this process. For most people,
example. Brand names include Fleet stopping laxatives restores the colon’s natural
and Zymenol. Lubricants typically ability to contract.
stimulate a bowel movement within
8 hours.

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Other Treatments Can constipation be serious?

Treatment for constipation may be directed Sometimes constipation can lead to compli-
at a specific cause. For example, the doctor cations. These complications include hem-
may recommend discontinuing medication orrhoids, caused by straining to have a
or performing surgery to correct an anorectal bowel movement, or anal fissures—tears in
problem such as rectal prolapse, a condition the skin around the anus—caused when
in which the lower portion of the colon turns hard stool stretches the sphincter muscle.
inside out. As a result, rectal bleeding may occur,
appearing as bright red streaks on the sur-
People with chronic constipation caused by
face of the stool. Treatment for hemor-
anorectal dysfunction can use biofeedback
rhoids may include warm tub baths, ice
to retrain the muscles that control bowel
packs, and application of a special cream to
movements. Biofeedback involves using a
the affected area. Treatment for anal fis-
sensor to monitor muscle activity, which is
sures may include stretching the sphincter
displayed on a computer screen, allowing for
muscle or surgically removing the tissue or
an accurate assessment of body functions.
skin in the affected area.
A health care professional uses this informa-
tion to help the patient learn how to retrain Sometimes straining causes a small amount
these muscles. of intestinal lining to push out from the anal
opening. This condition, known as rectal
Surgical removal of the colon may be an
prolapse, may lead to secretion of mucus
option for people with severe symptoms
from the anus. Usually eliminating the
caused by colonic inertia. However, the
cause of the prolapse, such as straining or
benefits of this surgery must be weighed
coughing, is the only treatment necessary.
against possible complications, which
Severe or chronic prolapse requires surgery
include abdominal pain and diarrhea.
to strengthen and tighten the anal sphincter
muscle or to repair the prolapsed lining.
Constipation may also cause hard stool to
pack the intestine and rectum so tightly that
the normal pushing action of the colon is
not enough to expel the stool. This condition,
called fecal impaction, occurs most often in
children and older adults. An impaction can
be softened with mineral oil taken by mouth
and by an enema. After softening the
impaction, the doctor may break up and
remove part of the hardened stool by insert-
ing one or two fingers into the anus.

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Hope Through Research

The Division of Digestive Diseases and Points to Remember
Nutrition at the National Institute of Dia- • Constipation affects almost every-
betes and Digestive and Kidney Diseases one at one time or another.
supports basic and clinical research into • Many people think they are consti-
gastrointestinal conditions, including pated when, in fact, their bowel
constipation. Researchers are studying the movements are regular.
anatomical and physiological characteristics
of rectoanal motility and the use of new • The most common causes of
medications and behavioral techniques, constipation are poor diet and lack
such as biofeedback, to treat constipation. of exercise.
• Other causes of constipation
include medications, irritable bowel
syndrome, abuse of laxatives, and
specific diseases.
• A medical history and physical
exam may be the only diagnostic
tests needed before the doctor
suggests treatment.
• In most cases, following these
simple tips will help relieve symp-
toms and prevent recurrence of
constipation:
– Eat a well-balanced, high-fiber
diet that includes beans, bran,
whole grains, fresh fruits,
and vegetables.
– Drink plenty of liquids.
– Exercise regularly.
– Set aside time after breakfast or
dinner for undisturbed visits to
the toilet.
– Do not ignore the urge to have
a bowel movement.
– Understand that normal bowel
habits vary.
– Whenever a significant or pro-
longed change in bowel habits
occurs, check with a doctor.
• Most people with mild constipation
do not need laxatives. However, a
doctor may recommend laxatives
for a limited time for people with
chronic constipation.

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For More Information You may also find additional information on this topic
using the following databases:
International Foundation for Functional
The NIDDK Reference Collection is a collection
Gastrointestinal Disorders of thousands of materials produced for patients and
P.O. Box 170864 health care professionals, including fact sheets,
Milwaukee, WI 53217 brochures, and audiovisual materials. Visit
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Fax: 414–964–7176 MedlinePlus brings together a wealth of information
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Email: iffgd@iffgd.org Institutes of Health, and other government agencies
Internet: www.iffgd.org and health-related organizations. MedlinePlus offers
easy access to medical journal articles, a medical dic-
American Gastroenterological Association tionary and medical encyclopedia, health information
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4930 Del Ray Avenue links to hundreds of clinical trials, and the latest
Bethesda, MD 20814 health news. Visit www.medlineplus.gov.
Phone: 301–654–2055
Fax: 301–654–5920
Email: member@gastro.org
Internet: www.gastro.org The U.S. Government does not endorse or favor any
specific commercial product or company. Trade,
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document are used only because they are considered
necessary in the context of the information provided.
If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.

This publication may contain information about

medications used to treat a health condition. When
this publication was prepared, the NIDDK included
the most current information available. Occasion-
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For updates or for questions about any medications,
please contact the U.S. Food and Drug Administra-
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your doctor for more information.

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U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 07–2754

July 2007