0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Constipation FREE

Deborah Tolmach Sugerman, MSW
JAMA. 2013;310(13):1416. doi:10.1001/jama.2013.278592.
Text Size: A A A
Published online

Constipation is a symptom, not a disease.

Constipation is very common, and for some people, especially older adults, it can be an ongoing concern. People often think that constipation means not having a bowel movement every day. But it is normal to have bowel movements at intervals ranging from 3 times a day to once every 3 days.

SIGNS AND SYMPTOMS OF CONSTIPATION

See your doctor if you have 2 or more of the following symptoms for 3 months in a row:

  • Fewer than 3 bowel movements a week

  • Straining

  • Lumpy or hard stools

  • Feeling that you need to have a bowel movement but can’t

  • Feeling that you cannot fully empty your bowels

CAUSES OF CONSTIPATION

The main causes of constipation are diet and lack of exercise. Other causes include

  • Travel

  • Pregnancy

  • Resisting the urge to use the toilet

  • Overusing laxatives

  • Medications for conditions including pain (especially opiates), depression, low iron or calcium, allergies, or high blood pressure

  • Irritable bowel syndrome with constipation (differs from usual constipation because you will likely have stomach pain and bloating)

  • Other medical conditions such as stroke, diabetes, intestinal blockage, or low thyroid hormones

  • Problems with the colon, such as colonic inertia, in which the stool moves slowly, or problems with pelvic floor muscles

TREATMENT

Usually, constipation responds well to changes in lifestyle. The easiest and best way to treat it is to increase the amount of liquid and fiber in your diet. Drinking water and juice is helpful, but drinking caffeine and alcohol, which can lead to dehydration, may make constipation worse.

One of the best diet changes you can make is to eat more foods with fiber, including whole grains, beans (legumes), and vegetables and fruit (especially dried fruit) and to eat fewer low-fiber foods, such as processed foods, fats, dairy products, meat, and sweets.

People who are on bed rest or elderly people who cannot move around tend to become constipated.

It is important to keep as active as possible and increase your exercise if you can.

If diet and exercise do not help, there are a number of medications you can try. Most are available without a prescription, and a pharmacist can help you select one.

  • Stool softeners are often suggested for people who should avoid straining, such as after surgery.

  • Fiber supplements hold water in the intestine and make your stool softer. They are very safe but not always effective.

  • Stimulants make the colon contract. However, they can be habit forming.

  • Hyperosmotics and saline laxatives such as magnesium citrate, magnesium hydroxide, and polyethylene glycol draw water into the colon and usually work quickly.

  • Lubricants such as mineral or olive oil help your stool move more easily.

  • Newer drugs such as lubiprostone and linaclotide work somewhat differently and require a prescription.

Other than fiber supplements, use caution when taking laxatives because your body can become dependent on them to have a bowel movement.

WHEN TO SEEK TREATMENT

Parents of newborns with constipation should always seek medical advice. In general, constipation is not serious in children who previously had normal bowel movements and usually is not serious in young adults or adults of any age who recently had a colon evaluation.

If you have a change in bowel habits, see your doctor to determine the cause and whether you need a test such as a colonoscopy. Constipation may develop because of a new medication, a change in diet, hormone problems, or colon or rectal tumors. Also contact your doctor if you have constipation along with stomach pain when having a bowel movement, blood in your stool, weight loss that is not intentional, vomiting, or rectal bleeding.

Box Section Ref ID

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are published in English and Spanish.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: National Institute of Diabetes and Digestive and Kidney Diseases, American Gastroenterological Association

Figures

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Spanish Patient Page: Estreñimiento

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections