The term constipation can mean infrequent or hard stools, or it can refer to difficulty passing stools. In other words, constipation may involve pain during the passage of a bowel movement, the inability to pass a bowel movement after straining or pushing for longer than 10 minutes, or no bowel movements for more than 3 days.

Since normal bowel patterns vary considerably from person to person, constipation is a relative term. Not everyone, for example, has a bowel movement every day. Similarly, stool consistency can vary widely and still be normal. Some healthy people generally have soft or near-runny stools, while others have firm stools, but no difficulty in passing them.

• Infrequent, difficult passage of stools (fewer than three bowel movements a week)
• Sudden decrease in frequency of bowel movements
• Stools harder than normal
• Bowel still feels full after bowel movement
• Bloated sensation

Constipation is most often caused by a low-fiber diet, lack of physical activity, inadequate intake of fluid each day, or delay in going to the bathroom when you have the urge to defecate. Stress and travel can also contribute to constipation or other changes in bowel habits.

Other times, diseases of the bowel (such as irritable bowel syndrome), pregnancy, certain medical conditions (like an underactive thyroid or cystic fibrosis), mental health problems (such as depression), neurological diseases, or medications may be the reason for your constipation. More serious causes, like colon cancer, are much less common.

Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.

Your doctor will perform a physical examination, which may include a rectal exam and a pelvic exam if you are a woman. As part of the history, the doctor will ask a series of questions such as:

• How long have you had constipation?
• How many days between two bowel movements?
• Is your constipation worse when you are stressed?
• What is the color, shape, and consistency of the stools?
• Do you have any bleeding with bowel movements?
• Do you have any abdominal pain?
• What surgeries or injuries have you had?
• What medications do you take?
• Do you drink coffee or drink alcohol? Do you smoke?
• What other symptoms are also present?

The following tests may help diagnose the cause of constipation:

• Blood tests such as a CBC, PT, or PTT
• Stool studies
• X-rays of the abdomen
• Upper GI series (to look at the esophagus, stomach, and upper part of the small intestines)
• Barium enema (to look at the colon)
• Proctosigmoidoscopy (an examination of the lower bowel) or, depending on the symptoms a colonoscopy (an examimation of the entire colon from the inside)

• Avoiding constipation altogether is easier than treating it, but involves the same lifestyle measures:
• Eat lots of fiber.
• Drink plenty of fluids each day (at least 8 glasses of water per day).
• Exercise regularly.
• Go to the bathroom when you have the urge. Don't wait.

Chronic constipation can usually be prevented or treated with a combination of dietary changes, extra fluid intake, exercise, and, when necessary, short-term use of a laxative. Your health care provider may talk with you about proper bowel habits (consistent, unhurried elimination practices). He or she may have you use a laxative or stool softener over the short term or suggest a bulk-forming agent, such as psyllium, bran, or methylcellulose. You can purchase these bulk-forming agents over the counter. In addition, certain herbs may help promote bowel activity. Use laxative herbs with caution because, like medications, they may become less effective with habitual use.

Children and adults should make sure they get enough fiber in their diet. Vegetables, fresh fruits (especially dried fruits) and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, you must drink plenty of fluids (especially water) to help pass the stool.

Regular exercise is also very important in establishing regular bowel movements. Even if you are confined to a wheelchair or bed, change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend a program of exercises appropriate for your physical abilities.

Additional tips include:

• Take time to eat, breathe slowly, and chew food thoroughly.
• Eat smaller, more frequent meals and avoid overeating at one sitting.
• Drink warm lemon water just before meals to stimulate digestion.
• Try eating stewed or soaked prunes each day.

Stool softeners (such as those containing docusate sodium) may help. Additionally, bulk laxatives such as Psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as mineral oil or milk of magnesia, may be used to establish regular bowel movements. Enemas or laxatives should be reserved for severe cases only. In addition, laxatives should not be used over a long period of time because you can become dependent on them. Talk to your health care provider about what type of laxative is best for you.

DO NOT give laxatives or enemas to children without specific instruction from a doctor. People who have any degree of bowel obstruction, abdominal inflammation, or kidney or heart failure should NOT take over the counter laxatives without talking to their physician.

Fiber

Fiber relieves constipation by adding bulk to stool and speeding its transit through the digestive tract. Psyllium is an example of a soluble fiber used standardly as a laxative in Asia, Europe, and North America.

The use of herbs is a time-honored approach to strengthening the body and treating symptoms. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Aloe (Aloe vera/Aloe barbadensis/Aloe ferox)

Aloe juice (also known as aloe latex or aloe sap) is a yellow, bitter liquid derived from the outer layer of the aloe leaf. It contains substances that, when taken by mouth, have very strong laxative effects. Although aloe latex (which differs from aloe gel) is a powerful laxative, it is not used frequently because it can cause painful cramping. Other gentler, herbal laxatives from the same plant family as aloe (such as cascara and senna) are generally recommended first.

Others

Additional herbs that have been used traditionally for constipation or to treat general digestive disorders are listed below. Since there has been little research regarding these herbs for constipation or other digestive disorders, it is particularly important to check about safety with a healthcare professional trained in herbal medicine as well as with your doctor before using any of them.

• Burdock root (Arctium lappa/Arctium minus/Arctium tomentosum)
• Dandelion (Taraxacum officinale)
• Dong quai (Angelica sinensis)
• Flaxseed (Linum usitatissimum)
• Ginger (Zingiber officinale)

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of constipation based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Calcarea carbonica -- for constipation without the urge to have a bowel movement; for children who often feel better when constipated rather than when bowel habits are normal; this remedy is most appropriate for individuals who tend to be overweight, lack stamina, experience heartburn, and produce sour-smelling belches; the individual may also suffer from pica (a craving for something not normally considered nutritional, such as dirt, clay, or chalk) and milk sensitivity.
• Nux vomica -- for constipation accompanied by a constant urge to move the bowels, but with little success; or for constipation associated with overeating, alcohol, or drug use; this remedy is most appropriate for individuals who tend to be sensitive to noise, odors, and light
• Silica -- for constipation with the sensation that stool remains in the rectum after bowel movements; children for whom this remedy is appropriate may be wary of going to the bathroom; this remedy is most appropriate for individuals who tend to dislike cold temperatures but prefer cold foods and drinks
• Bryonia -- for constipation with large, hard, dry stools; food feels like a lump in the individual's stomach and he or she may suffer from headaches with pain in both temples that may worsen with motion; this remedy is most appropriate for individuals who tend to be disagreeable, prefer cool rooms with open air, and whose thirst is quenched with cold drinks
• Lycopodium -- for small, hard stools with flatulance and bloating following a meal; this remedy is appropriate for individuals, particularly children, who fear being alone and have worsened symptoms in the late afternoon and early evening

The studies investigating acupuncture treatment for constipation have been small and have produced both positive and negative results, meaning that sometimes the research suggests that acupuncture is helpful and sometimes it seems to be neutral - no benefit beyond conventional treatment but no harm either. The bottom line is that acupuncture is fairly individual. It may help your chronic constipation and it may not. Talk to your doctor about whether it is safe for you to try.

Acupuncturists treat people with constipation based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of gastrointestinal conditions like constipation, a qi deficiency is usually detected in the colon and lung meridians.

Although no well-designed trials have evaluated chiropractic treatment for constipation, some chiropractors suggest that manipulation (particularly in the lower spine) helps relieve constipation in certain individuals.

Therapeutic massage can help reduce stress and help relieve constipation related to nervous tension and the resultant intestinal spasm.

Constipation is common in pregnancy and is usually relieved by changing your diet and drinking more water. If you are pregnant, DO NOT take herbs that are stimulating to the digestive tract since they can induce contractions. In fact, you should not use any laxative herbs during pregnancy without a provider's supervision.

The passage of large, wide stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.

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