• The disease
• Diagnosis
• Treatment options

Definition

Constipation is generally defined as fewer than three bowel movements per week or having overly hard or small stools that are difficult to pass. This can cause straining, pain, a sensation of not being able to completely empty the stools, abdominal pain, and bloating.

There are two main mechanisms involved in constipation: the waste moves too slowly through the intestine and difficulties eliminating the stools from the rectum and anus.

Symptoms and impact on health

The symptoms of constipation include:

• passing fewer than three stools per week,
• hard and too few stools, associated with a sensation of incomplete elimination.
• difficulties defecating, or pain,
• discomfort in the stomach (abdomen), cramps and bloating,

Causes and risk factors

There are several causes of constipation:

• a change in daily routine: a change in diet (especially when traveling abroad);
• poorly balanced diet lacking in fiber;
• constipation that has its origins in toddler toilet training that was either too early or too strict, or problems with access to bathrooms (no privacy, stressful occupation, etc.)
  leading to the development of the wrong reflexes and a pattern of retention;
• medication side effects (particularly cough suppressants, some pain medication like codeine, and some antidepressants, amongst others);
• lack of physical exercise, especially in the elderly and people with reduced mobility;
• intestinal diseases (colorectal cancer, etc.) are another – rare – cause of constipation, as well as chronic diseases (such as diabetes, hypothyroidism, Parkinson’s disease, and multiple sclerosis, etc.);
• Usually constipation is functional and has no specific cause.

Prevalence

Functional constipation effects between 1% and 20% of adults in the western world. The majority are women (two-thirds of cases). In studies of older people, up to 50% of the elderly living in institutions describe symptoms of constipation. These are usually due to a lack of physical activity, an increase in medication, and some illnesses related to old age.

Constipation in children can go unrecognized and often presents as recurring abdominal pain.