Constipation
Medical Author:
Jay W. Marks,
M.D.Medical Revising Author:
Dennis Lee, M.D.
Medical Editor:
Leslie J. Schoenfield, M.D., Ph.D.
What is constipation?
Constipation means different things to different people. For many people, it
simply means infrequent stools. For others, however, constipation means hard
stools, difficulty passing stools (straining), or a sense of incomplete emptying
after a bowel movement. The cause of each of these "types" of constipation
probably is different, and the approach to each should be tailored to the
specific type of constipation. Constipation can also alternate with diarrhea.
This pattern is more commonly considered as part of the irritable bowel syndrome
(IBS). At the extreme end of the constipation spectrum is fecal impaction, a
condition in which stool hardens in the rectum and prevents the passage of any
stool.
The number of bowel movements generally decreases with age. Ninety-five percent of adults
have bowel movements between three and 21 times per week, and this would be
considered normal. The most common pattern is one bowel movement a day, but this
pattern is seen in less than 50% of people. Moreover, most people are irregular
and do not have bowel movements every day or the same number of bowel movements
each day.
Medically speaking, constipation usually is defined as fewer than three bowel movements per week.
Severe constipation is defined as less than one bowel movement per week.
There is no medical reason to have a bowel movement every day. Going without
a bowel movement for two or three days does not cause physical discomfort, only
mental distress for some people. Contrary to popular belief, there is
no evidence that "toxins" accumulate when bowel movements are infrequent or
that constipation leads to cancer.
It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute
constipation requires urgent assessment because a serious medical illness
may be the underlying cause (e.g., tumors of the colon). Constipation also
requires an immediate assessment if it is accompanied by worrisome symptoms
such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary weight loss. In contrast, the evaluation of chronic
constipation may not require immediate attention, particularly if simple
measures bring relief.
Next: What causes constipation? »
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