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Constipation refers to bowel movements that are infrequent

or hard to pass.[
/knstpen rfz t bal muvmnts t nfrikwnt
hd t ps/

[2] The stool is often hard and dry.[

/tu stul z fn hd nd dra/

[3] Other symptoms may include abdominal pain, bloating,

and feeling as if one has not completely passed the bowel
/ri smptmz me nklud bdmnl pen blt nd
fil z f wn hz nt kmplitl pst bal muvmnt/

[4] Complications from constipation may include

hemorrhoids, anal fissure or fecal impaction.
/f kmplkenz frm knstpen me nklud hemrdz
enl f (fecal) (impaction)/

The normal frequency of bowel movements in adults is

between three per day and three per week.[
/ nml frikwns v bal muvmnts n dlts z b
twin ri p de nd ri p wik/

[3] Babies often have three to four bowel movements per

day while young children typically have two to three per day
/ri bebz fn hv ri t f bal muvmnts p de wal j
ldrn tpklli hv tu t ri p de/
Constipation has many causes.
/knstpen hz men kzz/
Common causes include slow movement of stool within the
colon, irritable bowel syndrome, and pelvic floor disorders.
/kmn kzz nklud sl muvmnt v stul wn kln
rtbl bal sndrm nd pelvk fl dsdz/

Underlying associated diseases include hypothyroidism,

diabetes, Parkinson's disease, colon cancer, diverticulitis,
and inflammatory bowel disease.[
/ndla setd dzizz nklud (hypothyroidism) da
bitiz (Parkinson's) dziz kln kns (diverticulitis) nd n
flmtr bal dziz/

[3][6] Medications associated with constipation include

opioids, certain antacids, calcium channel blockers, and
/(36) medkenz setd w knstpen nklud
(opioids) stn ntsdz klsm nl blks nd

[3] Of those taking opioids about 90% develop constipation.

/ri v z tek (opioids) bat (90) dvelp knstpen/

[7] Constipation is more concerning when there is weight

loss or anemia, blood is present in the stool, there is a
history of inflammatory bowel disease or colon cancer in a
person's family, or it is of new onset in someone who is
/sevn knstpen z m knsn wen e z wet ls
(anemia) bld z preznt n stul e z hstr v n
flmtr bal dziz kln kns n psnz fml t
z v nju nset n smwn hu z ld/
[8] Treatment of constipation depends on the underlying
cause and the duration that it has been present.
/et tritmnt v knstpen dpendz n i ndla kz
nd djren t t hz bin preznt/

Measures that may help include drinking enough fluids,

eating more fiber, and exercise.
/mez t me help nklud drk nf fludz it m
fab nd ekssaz/

If this is not effective, laxatives of the bulk forming agent,

osmotic agent, stool softener, or lubricant type may be
/f s z nt fektv lkstvz v blk fm ent z
mtk ent stul sfn lubrknt tap me bi rek

Stimulant laxatives are generally reserved for when other

types are not effective.
/stmjlnt lkstvz enrl rzvd f wen taps
nt fektv/

Other treatments may include biofeedback or in rare cases

/ tritmnts me nklud (biofeedback) n re kesz

[3] In the general population rates of constipation are 230

/ri n enrl ppjlen rets v knstpen (230)
[9] Among elderly people living in a care home the rate of
constipation is 5075 percent.[
/nan m eldl pipl lv n ke hm ret v knst
pen z (5075) psent/

[7] People spend, in the United States, more than US$250

million on medications for constipation a year.
/sevn pipl spend n jnatd stets m n (US250) mljn
n medkenz f knstpen j/

Constipation is a symptom, not a disease.

/knstpen z smptm nt dziz/

Most commonly, constipation is thought of as infrequent

bowel movements, usually less than 3 stools per week.[
/mst kmnl knstpen z t v z nfrikwnt bal
muvmnts jul les n ri stulz p wik/

[11][12] However, people may have other complaints as

well including:[4][13] Straining with bowel movements
Excessive time needed to pass a bowel movement Hard
stools Pain with bowel movements secondary to straining
Abdominal pain Abdominal bloating.
/(1112) haev pipl me hv kmplents z wel
(including413) stren w bal muvmnts ksesv tam
nidd t ps bal muvmnt hd stulz pen w bal
muvmnts sekndr t stren bdmnl pen bdmnl

the sensation of incomplete bowel evacuation.

/ sensen v nkmplit bal vkjen/
The Rome Criteria are a set of symptoms that help
standardize the diagnosis of constipation in various age
/i (Rome) kratr set v smptmz t help
stnddaz dagnss v knstpen n vers e

These criteria help physicians to better define constipation

in a standardized manner.
/iz kratr help fznz t bet dfan knstpen n
stnddazd mn/

The criteria are generated as part of the Rome process.

/ kratr enretd z pt v i (Rome) prses/

The criteria are discussed in further detail under the

Diagnostic and Children sections below.
/ kratr dskst n f ditel nd dagnstk
nd ldrn seknz bl/

Causes The causes of constipation can be divided into

congenital, primary, and secondary.[
/kzz kzz v knstpen kn bi dvadd ntu kn
entl pramr nd sekndr/

[2] The most common cause is primary and not life-

/tu mst kmn kz z pramr nd nt (lifethreatening)/

[14] It can also be divided by the age group affected such

as children and adults.
/(14) t kn ls bi dvadd ba i e grup fektd s z
ldrn nd dlts/

In the elderly, common causes include: insufficient dietary

fiber intake, inadequate fluid intake, decreased physical
activity, side effects of medications, hypothyroidism, and
obstruction by colorectal cancer.[
/n i eldl kmn kzz nklud nsfnt datr fab
ntek ndkwt flud ntek dikrist fzkl ktvt sad
fekts v medkenz (hypothyroidism) nd bstrkn ba
(colorectal) kns/

[15] Primary or functional constipation is defined by

ongoing symptoms for greater than six months not due to
an underlying cause such as medication side effects or an
underlying medical condition.[
/(15) pramr fknl knstpen z dfand ba (ongoing)
smptmz f gret n sks mns nt dju t n ndla
kz s z medken sad fekts n ndla medkl

[2][16] It is not associated with abdominal pain, thus

distinguishing it from irritable bowel syndrome.[
/(216) t z nt setd w bdmnl pen s dstgw
t frm rtbl bal sndrm/

[2] It is the most common cause of constipation, and is

often multifactorial.[
/tu t z mst kmn kz v knstpen nd z fn

[14][17] In adults, such primary causes include: dietary

choices such as insufficient dietary fiber or fluid intake, or
behavioral causes such as decreased physical activity.
/(1417) n dlts s pramr kzz nklud datr sz
s z nsfnt datr fab flud ntek (behavioral)
kzz s z dikrist fzkl ktvt/

Secondary causes include side effects of medications such

as opiates, endocrine and metabolic disorders such as
hypothyroidism, and obstruction such as from colorectal
/sekndr kzz nklud sad fekts v medkenz s z
pts endkran nd metblk dsdz s z
(hypothyroidism) nd bstrkn s z frm (colorectal)

[18] Diet Constipation can be caused or exacerbated by a

low-fiber diet, low liquid intake, or dieting.[
/(18) dat knstpen kn bi kzd ekssbetd ba
(lowfiber) dat l lkwd ntek dat/

[13][19] Dietary fiber helps to decrease colonic transport

time, increases stool bulk but simultaneously softens stool.
/(1319) datr fab helps t dikris (colonic) trnspt tam
nkrisz stul blk bt smltenjsli sfnz stul/

Therefore, diets low in fiber can lead to primary

/ef dats l n fab kn led t pramr knstpen/

[17] Medications Many medications have constipation as a

side effect.
/(17) medkenz men medkenz hv knstpen z
sad fekt/
Some include (but are not limited to) opioids, diuretics,
antidepressants, antihistamines, antispasmodics,
anticonvulsants, tricyclic antidepressants, antiarrythmics,
beta-adrenoceptor antagonists, anti-diarrheals, 5-HT3
receptor antagonists such as ondansetron, and aluminum
/sm nklud bt nt lmtd t (opioids) dajretks
(antidepressants) (antihistamines) (antispasmodics)
(anticonvulsants) (tricyclic) (antidepressants) (antiarrythmics)
(betaadrenoceptor) ntgnsts (antidiarrheals) (5HT3)
(receptor) ntgnsts s z (ondansetron) nd ljmnm

[13][20] Certain calcium channel blockers such as

nifedipine and verapamil can cause severe constipation due
to dysfunction of motility in the rectosigmoid colon.[
/(1320) stn klsm nl blks s z (nifedipine) nd
(verapamil) kn kz sv knstpen dju t (dysfunction)
v (motility) n i (rectosigmoid) kln/

[21] Supplements such as calcium and iron supplements

can also have constipation as a notable side effect.
/(21) splmnts s z klsm nd an splmnts kn
ls hv knstpen z ntbl sad fekt/
Endocrine disorders Metabolic and endocrine problems
which may lead to constipation include: hypercalcemia,
hypothyroidism, hyperparathyroidism, porphyria, chronic
kidney disease, pan-hypopituitarism, diabetes mellitus,
cystic fibrosis, and celiac disease.[
/endkran dsdz metblk nd endkran prblmz
w me led t knstpen nklud (hypercalcemia)
(hypothyroidism) (hyperparathyroidism) (porphyria) krnk
kdn dziz (panhypopituitarism) dabitiz (mellitus) sstk
(fibrosis) nd (celiac) dziz/
[13][14] Constipation is also common in individuals with
muscular and myotonic dystrophy.[
/(1314) knstpen z ls kmn n ndvdjlz w
mskjl nd (myotonic) dstrf/

[13] Structural and functional Constipation has a number of

structural (mechanical, morphological, anatomical) causes,
namely through creating space-occupying lesions within the
colon that stop the passage of stool, such as colorectal
cancer, strictures, rectocoles, and post-surgical changes.
/(13) strkrl nd fknl knstpen hz nmb v
strkrl mknkl mflkl ntmkl kzz
neml ru kriet (spaceoccupying) linz wn kln
t stp ps v stul s z (colorectal) kns strkz
(rectocoles) nd (postsurgical) enz/

Extra-intestinal masses such as other malignancies can also

lead to constipation from external compression.[
/(Extraintestinal) msz s z mlgnnsz kn ls
led t knstpen frm ekstnl kmpren/

[22] Neurologic Constipation also has neurological causes,

including anismus, descending perineum syndrome, and
Hirschsprung's disease.[
/(22) (Neurologic) knstpen ls hz (neurological) kzz
nklud (anismus) dsend pernim sndrm nd
(Hirschsprung's) dziz/

[9] In infants, Hirschsprung's disease is the most common

medical disorder associated with constipation.
/nan n nfnts (Hirschsprung's) dziz z mst kmn
medkl dsd setd w knstpen/
Anismus occurs in a small minority of persons with chronic
constipation or obstructed defecation.[
/(Anismus) kz n sml manrt v psnz w krnk
knstpen bstrktd defken/

[23] Spinal cord lesions and neurological disorders such as

Parkinson's disease and pelvic floor dysfunction[14] can
also lead to constipation.
/(23) spanl kd linz nd (neurological) dsdz s z
(Parkinson's) dziz nd pelvk fl (dysfunction14) kn ls
led t knstpen/

Psychological Voluntary withholding of the stool is a

common cause of constipation.[
/saklkl vlntr whld v stul z kmn
kz v knstpen/

[13] The choice to withhold can be due to factors such as

fear of pain, fear of public restrooms, or laziness.[
/(13) s t whld kn bi dju t fktz s z f v
pen f v pblk restrmz lezns/

[13] When a child holds in the stool a combination of

encouragement, fluids, fiber, and laxatives may be useful to
overcome the problem.[
/(13) wen ald hldz n stul kmbnen v n
krmnt fludz fab nd lkstvz me bi jusfl t v
km prblm/

[24] Early intervention with withholding is important as this

can lead to anal fissures.[
/(24) l ntvenn w whld z mptnt z s kn
led t enl fz/

[25] Congenital A number of diseases present at birth can

result in constipation.
/(25) knentl nmb v dzizz preznt t b kn rzlt
n knstpen/

They are as a group uncommon with Hirschsprungs disease

(HD) being the most common.[
/e z grup nkmn w (Hirschsprung's) dziz (HD)
bi mst kmn/

[26] HD is more common in males than females, affecting 1

out of 5000 babies.
/(26) (HD) z m kmn n mlz n fimelz fekt wn
at v (5000) bebz/

In people with HD, specific types of cells called neural crest

cells fail to migrate to parts of the colon.
/n pipl w (HD) spsfk taps v selz kld njrl krest
(cells') fel t magret t pts v kln/

This causes the affected portion of the colon to be unable to

contract and relax to help push out a bowel movement.
/s kzz i fektd pn v kln t bi nebl t
kntrkt nd rlks t help p at bal muvmnt/

The affected portion of the colon remains contracted,

making it difficult for stool to pass through.[
/i fektd pn v kln rmenz kntrktd mek t
dfklt f stul t ps ru/
[27] Concern for HD should be raised in a child who has not
passed stool during the first 48 hours of life.
/(27) knsn f (HD) d bi rezd n ald hu hz nt pst
stul djr fst (48) az v laf/

Milder forms of HD, in which only a small portion of the

colon is affected, can present later in childhood as
constipation, abdominal pain, and bloating.[
/mald fmz v (HD) n w nl sml pn v kln
z fektd kn preznt let n aldhd z knstpen b
dmnl pen nd blt/

[27] Similar disorders to HD include anal achalasia and

/(27) sml dsdz t (HD) nklud enl (achalasia) nd

In hypoganglionosis, there is a low number of neural crest

cells, so the colon remains contracted.
/n (hypoganglionosis) e z l nmb v njrl krest selz
s kln rmenz kntrktd/

In anal achalasia, the internal anal sphincter remains

contracted, making it difficult for stool to pass.
/n enl (achalasia) i ntnl enl sfkt rmenz kn
trktd mek t dfklt f stul t ps/

However, there is a normal number of neural crest cells

/haev e z nml nmb v njrl krest selz preznt/
[28] There are also congenital structural anomalies that can
lead to constipation, including anterior displacement of the
anus, imperforate anus, strictures, and small left colon
/(28) e ls knentl strkrl nmlz t kn led
t knstpen nklud ntr dsplesmnt v i ens
(imperforate) ens strkz nd sml left kln sndrm/

[28] Anterior displacement of the anus can be diagnosed on

physical exam.[
/(28) ntr dsplesmnt v i ens kn bi dagnzd
n fzkl gzm/

[29] The disease causes constipation because the

inappropriate positioning of the anus which make it difficult
to pass a bowel movement.
/(29) dziz kzz knstpen bkz i nprprt p
zn v i ens w mek t dfklt t ps bal

Imperforate anus is an anus that ends in a blind pouch and

does not connect to the rest of the person's intestines.
/(Imperforate) ens z n ens t endz n bland pa nd
dz nt knekt t rest v psnz ntestnz/

Small left colon syndrome is a rare disease in which the left

side of the babies colon has a small diameter, which makes
it difficult for stool to pass.
/sml left kln sndrm z re dziz n w left sad v
bebz kln hz sml damt w meks t dfklt f
stul t ps/
A risk factor for small left colon syndrome is having a
mother with diabetes.[
/ rsk fkt f sml left kln sndrm z hv m
w dabitiz/

[28] Some symptoms that may indicate an underlying

disease include:[5] Bowel movements that contain blood.
/(28) sm smptmz t me ndket n ndla dziz
(include5) bal muvmnts t knten bld/

Severe abdominal bloating.

/sv bdmnl blt/

Peri-anal fistula Absent anal wink reflex Sacral dimple

Failure to thrive Diagnostic approach Significant
constipation in an 8 year old as seen on plain X ray The
diagnosis is typically made based on a person's description
of the symptoms.
/(Perianal) fstjl bsnt enl wk rifleks sekrl dmpl
felj t rav dagnstk pr sgnfknt knstpen n
n et j ld z sin n plen (X) re dagnss z
tpklli med best n psnz dskrpn v smptmz/

Bowel movements that are difficult to pass, very firm, or

made up of small hard pellets (like those excreted by
rabbits) qualify as constipation, even if they occur every
/bal muvmnts t dfklt t ps ver fm med p
v sml hd pelts lak z ekskritd ba rbts kwlfa z
knstpen ivn f e k evr de/
Constipation is traditionally defined as three or fewer bowel
movements per week.[
/knstpen z trdnl dfand z ri fju bal
muvmnts p wik/

[11] Other symptoms related to constipation can include

bloating, distension, abdominal pain, headaches, a feeling
of fatigue and nervous exhaustion, or a sense of incomplete
/(11) smptmz rletd t knstpen kn nklud
blt dstenn bdmnl pen hedeks fil v ftig
nd nvs gzsn sens v nkmplit empt/

[30] Although constipation may be a diagnosis, it is

typically viewed as a symptom that requires evaluation to
discern a cause.
/(30) l knstpen me bi dagnss t z tpklli
vjud z smptm t rkwaz vljen t dsn kz/

Description Distinguish between acute (days to weeks) or

chronic (months to years) onset of constipation because
this information changes the differential diagnosis.
/dskrpn dstgw btwin kjut dez t wiks krnk
mns t jz nset v knstpen bkz s nfmen
enz dfrenl dagnss/

This in the context of accompanied symptoms help

physicians discover the cause of constipation.
/s n kntekst v kmpnd smptmz help fznz ds
kv kz v knstpen/

People often describe their constipation as bowel

movements that are difficult to pass, firm stool with lumpy
or hard consistency, and excessive straining during bowel
/pipl fn dskrab e knstpen z bal muvmnts
t dfklt t ps fm stul w lmp hd knsstns
nd ksesv stren djr bal muvmnts/

Bloating, abdominal distension, and abdominal pain often

accompany constipation.[
/blt bdmnl dstenn nd bdmnl pen fn
kmpn knstpen/

[31] Chronic constipation (symptoms present at least three

days per month for more than three months) associated
with abdominal discomfort is often diagnosed as irritable
bowel syndrome (IBS) when no obvious cause is found.[
/(31) krnk knstpen smptmz preznt t list ri dez
p mn f m n ri mns setd w bdmnl ds
kmft z fn dagnzd z rtbl bal sndrm az wen
n bvs kz z fand/

[32] Poor dietary habits, previous abdominal surgeries, and

certain medical conditions can contribute to constipation.
/(32) p datr hbts privjs bdmnl srz nd
stn medkl kndnz kn kntrbjut t knstpen/

Diseases associated with constipation include

hypothyroidism, certain types of cancer, and irritable bowel
/dzizz setd w knstpen nklud (hypothyroidism)
stn taps v kns nd rtbl bal sndrm/

Low fiber intake, inadequate amounts of fluids, poor

ambulation or immobility, or medications can contribute to
/l fab ntek ndkwt mants v fludz p
(ambulation) mblt medkenz kn kntrbjut t

[13][19] Once the presence of constipation is identified

based on a culmination of the symptoms described above,
then the cause of the constipation should be figured out.
/(1319) wns prezns v knstpen z adentfad best n
klmnen v smptmz dskrabd bv en kz v
knstpen d bi fgd at/

Separating non-life-threatening from serious causes may be

partly based on symptoms.
/seprt (nonlifethreatening) frm srs kzz me bi ptl
best n smptmz/

For example, colon cancer may be suspected if a person has

a family history of colon cancer, fever, weight loss, and
rectal bleeding.[
/fr gzmpl kln kns me bi sspektd f psn hz
fml hstr v kln kns fiv wet ls nd rektl

[11] Other alarming signs and symptoms include family or

personal history of inflammatory bowel disease, age of
onset over 50, change in stool caliber, nausea, vomiting,
and neurological symptoms like weakness, numbness and
difficulty urinating.[
/(11) lm sanz nd smptmz nklud fml psnl
hstr v nflmtr bal dziz e v nset v (50)
en n stul klb nsj vmt nd (neurological)
smptmz lak wikns nmns nd dfklt jrnet/
[31] Examination A physical examination should involve at
least an abdominal exam and rectal exam.
/(31) gzmnen fzkl gzmnen d nvlv t list
n bdmnl gzm nd rektl gzm/

Abdominal exam may reveal an abdominal mass if there is

significant stool burden and may reveal abdominal
/bdmnl gzm me rvil n bdmnl ms f e z sg
nfknt stul bdn nd me rvil bdmnl dskmft/

Rectal examination gives an impression of the anal

sphincter tone and whether the lower rectum contains any
feces or not.
/rektl gzmnen gvz n mpren v i enl sfkt
tn nd we l rektm kntenz en (feces) nt/

Rectal examination also gives information on the

consistency of the stool, the presence of hemorrhoids,
blood and whether any perineal irregularities are present
including skin tags, fissures, anal warts.[
/rektl gzmnen ls gvz nfmen n kn
sstns v stul prezns v hemrdz bld nd we
en (perineal) regjlrtz preznt nklud skn tgz fz
enl wts/

[19][13][11] Physical examination is done manually by a

physician and is used to guide which diagnostic tests to
/(191311) fzkl gzmnen z dn mnjlli ba fzn
nd z just t gad w dagnstk tests t d/
Diagnostic tests Functional constipation is common and
does not warrant diagnostic testing.
/dagnstk tests fknl knstpen z kmn nd dz
nt wrnt dagnstk test/

Imaging and laboratory tests are typically recommended for

those with alarm signs or symptoms.[
/m nd lbrtr tests tpklli rekmendd f z
w lm sanz smptmz/

[11] The laboratory tests performed depends on the

suspected underlying cause of the constipation.
/(11) lbrtr tests pfmd dpendz n sspektd
ndla kz v knstpen/

Tests may include CBC (complete blood count), thyroid

function tests, serum calcium, serum potassium, etc.[
/tests me nklud (CBC) kmplit bld (count) ard
fnkn tests srm klsm srm ptsjm (etc)/

[13][11] X-rays of the abdomen, generally only performed

if bowel obstruction is suspected, may reveal extensive
impacted fecal matter in the colon, and confirm or rule out
other causes of similar symptoms.[
/(1311) eksrez v i bdmen enrl nl pfmd f
bal bstrkn z sspektd me rvil kstensv mpktd
(fecal) mt n kln nd knfm rul at kzz v
sml smptmz/

[13][19] Colonoscopy may be performed if an abnormality

in the colon like a tumor is suspected.[
/(1319) (Colonoscopy) me bi pfmd f n bnmlt n
kln lak (tumor) z sspektd/

[11] Other tests rarely ordered include anorectal

manometry, anal sphincter electromyography, and
/(11) tests rel dd nklud (anorectal) (manometry)
enl sfkt (electromyography) nd (defecography)/

[13] Colonic propagating pressure wave sequences (PSs)

are responsible for discrete movements of the bowel
contents and are vital for normal defecation.
/(13) (Colonic) prpget pre wev sikwnsz (PSs) rs
pnsbl f dskrit muvmnts v bal kntents nd
vatl f nml defken/

Deficiencies in PS frequency, amplitude, and extent of

propagation are all implicated in severe defecatory
dysfunction (SDD).
/dfnsz n (PS) frikwns mpltjud nd kstent v prp
gen l mplketd n sv (defecatory) (dysfunction) zd/

Mechanisms that can normalize these aberrant motor

patterns may help rectify the problem.
/meknzmz t kn nmlaz iz bernt mt ptnz
me help rektfa prblm/

Recently the novel therapy of sacral nerve stimulation

(SNS) has been utilized for the treatment of severe
/risntl nvl erp v sekrl nv stmjlen zz hz
bin jutlazd f tritmnt v sv knstpen/
[33] Criteria The Rome III Criteria for functional
constipation must include two or more of the following and
present for the past three months, with symptoms starting
for at least 6 months prior to diagnosis.[
/(33) kratr i (Rome) (III) kratr f fknl knst
pen mst nklud tu m v fl nd preznt f
pst ri mns w smptmz stt fr t list sks mns
pra t dagnss/

[11] Straining during defecation for at least 25% of bowel

movements Lumpy or hard stools in at least 25% of
defecations Sensation of incomplete evacuation for at least
25% of defecations Sensation of anorectal
obstruction/blockage for at least 25% of defecations Manual
maneuvers to facilitate at least 25% of defecations Fewer
than 3 defecations per week Loose stools are rarely present
without the use of laxatives There are insufficient criteria
for irritable bowel syndrome Prevention Constipation is
usually easier to prevent than to treat.
/(11) stren djr defken fr t list (25) v bal
muvmnts lmp hd stulz n t list (25) v defkenz
sensen v nkmplit vkjen fr t list (25) v def
kenz sensen v (anorectal) (obstructionblockage) fr t
list (25) v defkenz mnjl (maneuvers) t fsltet t
list (25) v defkenz fju n ri defkenz p wik lus
stulz rel preznt wat jus v lkstvz e ns
fnt kratr fr rtbl bal sndrm prvenn knst
pen z jul (easier) t prvent n t trit/

Following the relief of constipation, maintenance with

adequate exercise, fluid intake, and high-fiber diet is
/fl rlif v knstpen mentnns w dkwt
ekssaz flud ntek nd (highfiber) dat z rekmendd/
[13] Children benefit from scheduled toilet breaks, once
early in the morning and 30 minutes after meals.[
/(13) ldrn benft frm edjuld tlt breks wns l n
mn nd (30) mnts ft milz/

[13][34] Treatment See also: Bowel management A limited

number of causes that require urgent medical intervention
or result in severe consequences.[
/(1334) tritmnt si ls bal mnmnt lmtd
nmb v kzz t rkwa nt medkl ntvenn r
zlt n sv knskwnsz/

[4] The treatment of constipation should focus on the

underlying cause if known.
/f tritmnt v knstpen d fks n i ndla
kz f nn/

The National Institute of Health and Care Excellence (NICE)

break constipation in adults into two categories - chronic
constipation of unknown cause and constipation due to
/ nnl nsttjut v hel nd ke ekslns nas brek
knstpen n dlts ntu tu ktgrz () krnk knst
pen v nnn kz nd knstpen dju t pts/

[35] In chronic constipation of unknown cause, the main

treatment involves the increased intake of water and fiber
(either dietary or as supplements).[
/(35) n krnk knstpen v nnn kz men tritmnt
nvlvz i nkrist ntek v wt nd fab a datr
z splmnts/
[14] The routine use of laxatives is discouraged, as having
bowel movements may come to be dependent upon their
/(14) rutin jus v lkstvz z dskrd z hv bal
muvmnts me km t bi dpendnt pn e jus/

Enemas can be used to provide a form of mechanical

/enmz kn bi just t prvad fm v mknkl stmj

However, enemas are generally useful only for stool in the

rectum, not in the intestinal tract.
/haev enmz enrl jusfl nl f stul n rektm
nt n i ntestnl trkt/

Fiber supplements Soluble fiber supplements such as

psyllium are generally considered first-line treatment for
chronic constipation, compared to insoluble fibers such as
wheat bran.[
/fab splmnts sljbl fab splmnts s z (psyllium)
enrl knsdd (firstline) tritmnt f krnk knstpen
kmped t nsljbl fabz s z wit brn/

[25] Side effects of fiber supplements include bloating,

flatulence, diarrhea, and possible malabsorption of iron,
calcium, and some medications.
/(25) sad fekts v fab splmnts nklud blt fltjlns
(diarrhea) nd psbl (malabsorption) v an klsm nd
sm medkenz/
However, patients with opiate-induced constipation will
likely not benefit from fiber supplements.[
/haev pents w (opiateinduced) knstpen wl lakl
nt benft frm fab splmnts/

[25] Laxatives If laxatives are used, milk of magnesia or

polyethylene glycol are recommended as first-line agents
due to their low cost and safety.[
/(25) lkstvz f lkstvz just mlk v mgni
(polyethylene) (glycol) rekmendd z (firstline) ents
dju t e l kst nd seft/

[4] Stimulants should only be used if this is not effective.[

/f stmjlnts d nl bi just f s z nt fektv/

[14] In cases of chronic constipation, polyethylene glycol

appears superior to lactulose.[
/(14) n kesz v krnk knstpen (polyethylene) (glycol)
pz sjupr t (lactulose)/

[36] Prokinetics may be used to improve gastrointestinal

/(36) (Prokinetics) me bi just t mpruv (gastrointestinal)

A number of new agents have shown positive outcomes in

chronic constipation; these include prucalopride[37] and
/ nmb v nju ents hv n pztv atkmz n krnk
knstpen iz nklud (prucalopride37) nd (lubiprostone)/
[38] Physical intervention Constipation that resists the
above measures may require physical intervention such as
manual disimpaction (the physical removal of impacted
stool using the hands; see fecal impaction).
/(38) fzkl ntvenn knstpen t rzsts i bv
mez me rkwa fzkl ntvenn s z mnjl
(disimpaction) fzkl rmuvl v mpktd stul jus
hndz si (fecal) (impaction)/

Regular exercise can help improve chronic constipation.[

/regjl ekssaz kn help mpruv krnk knstpen/

[39] Children Lactulose and milk of magnesia have been

compared with polyethylene glycol (PEG) in children.
/(39) ldrn (Lactulose) nd mlk v mgni hv bin km
ped w (polyethylene) (glycol) peg n ldrn/

All had similar side effects, but PEG was more effective at
treating constipation.[
/l hd sml sad fekts bt peg wz m fektv t trit

[40][41] Osmotic laxatives are recommended over

stimulant laxatives.[
/(4041) zmtk lkstvz rekmendd v stmjlnt

[42] Surgical intervention In refractory cases, procedures

can be performed to help relieve constipation.
/(42) skl ntvenn n rfrktr kesz prsiz kn
bi pfmd t help rliv knstpen/
Sacral nerve stimulation has been demonstrated to be
effective in a minority of cases.
/sekrl nv stmjlen hz bin demnstretd t bi fektv
n manrt v kesz/

Colectomy with ileorectal anastomosis is another

intervention performed only in patients known to have a
slow colonic transit time and in whom a defecation disorder
has either been treated or is not present.[
/(Colectomy) w (ileorectal) nstmss z n nt
venn pfmd nl n pents nn t hv sl (colonic)
trnst tam nd n hum defken dsd hz a bin
tritd z nt preznt/

[4] Because this is a major operation, side effects can

include considerable abdominal pain, small bowel
obstruction, and post-surgical infections.
/f bkz s z me pren sad fekts kn nklud
knsdrbl bdmnl pen sml bal bstrkn nd
(postsurgical) nfeknz/

Furthermore, it has a very variable rate of success and is

very case dependent.[
/fm t hz ver verbl ret v skses nd z ver kes

[25] Prognosis Complications that can arise from

constipation include hemorrhoids, anal fissures, rectal
prolapse, and fecal impaction.[
/(25) prgnss kmplkenz t kn raz frm knst
pen nklud hemrdz enl fz rektl prlps nd
(fecal) (impaction)/
[13][19][34][43] Straining to pass stool may lead to
/(13193443) stren t ps stul me led t hemrdz/

In later stages of constipation, the abdomen may become

distended, hard and diffusely tender.
/n let stez v knstpen i bdmen me bkm ds
tendd hd nd dfjusli tend/

Severe cases ("fecal impaction" or malignant constipation)

may exhibit symptoms of bowel obstruction (nausea,
vomiting, tender abdomen) and encopresis, where soft stool
from the small intestine bypasses the mass of impacted
fecal matter in the colon.
/sv kesz (fecal) (impaction) mlgnnt knstpen me
gzbt smptmz v bal bstrkn nsj vmt tend
bdmen nd (encopresis) we sft stul frm sml n
testn bapsz ms v mpktd (fecal) mt n

Epidemiology Constipation is the most common chronic

gastrointestinal disorder in adults.
/epdiml knstpen z mst kmn krnk
(gastrointestinal) dsd n dlts/

Depending on the definition employed, it occurs in 2% to

20% of the population.[
/dpend n defnn mpled t kz n tu t (20) v

[14][44] It is more common in women, the elderly and

/(1444) t z m kmn n wmn i eldl nd ldrn/
[44] Specifically constipation with no known cause affects
females more often affected than males.[
/(44) (specifically) knstpen w n nn kz fekts
fimelz m fn fektd n mlz/

[45] The reasons it occurs more frequently in the elderly is

felt to be due to an increasing number of health problems
as humans age and decreased physical activity.[
/(45) riznz t kz m frikwntli n i eldl z felt t bi
dju t n nkris nmb v hel prblmz z hjumnz e
nd dikrist fzkl ktvt/

[16] 12% of the population worldwide reports having

/(16) (12) v ppjlen wldwad rpts hv knst

[46] Chronic constipation accounts for 3% of all visits

annually to pediatric outpatient clinics.[
/(46) krnk knstpen kants f ri v l vzts njl
t (pediatric) atpent klnks/

[13] Constipation-related health care costs total $6.9 billion

in the US annually.[
/(13) (Constipationrelated) hel ke ksts ttl (69) bljn n i
s njl/

[14] More than four million Americans have frequent

constipation, accounting for 2.5 million physician visits a
/(14) m n f mljn merknz hv frikwnt knstpen
kant f (25) mljn fzn vzts j/

[43] Around $725 million is spent on laxative products each

year in America.[
/(43) rand (725) mljn z spent n lkstv prdkts i j
n (America)/

[43] Children Approximately 3% of children have

constipation, with girls and boys being equally affected.[
/(43) ldrn prksmtl ri v ldrn hv knstpen w
glz nd bz bi ikwl fektd/

[28] With constipation accounting for approximately 5% of

general pediatrician visits and 25% of pediatric
gastroenterologist visits, the symptom carries a significant
financial impact upon our healthcare system.[
/(28) w knstpen kant fr prksmtl fav v
enrl (pediatrician) vzts nd (25) v (pediatric)
(gastroenterologist) vzts smptm krz sgnfknt fa
nnl mpkt pn a (healthcare) sstm/

[5] While it is difficult to assess an exact age at which

constipation most commonly arises, children frequently
suffer from constipation in conjunction with life-changes.
/fav wal t z dfklt t ses n gzkt e t w knst
pen mst kmnl razz ldrn frikwntli sf frm
knstpen n knkn w (lifechanges)/

Examples include: toilet training, starting or transferring to

a new school, and changes in diet.[
/gzmplz nklud tlt tren stt trnsf t nju
skul nd enz n dat/
[5] Especially in infants, changes in formula or transitioning
from breast milk to formula can cause constipation.
/fav spel n nfnts enz n fmjl trnsn
frm brest mlk t fmjl kn kz knstpen/

Fortunately, the majority of constipation cases are not tied

to a medical disease, and treatment can be focused on
simply relieving the symptoms.[
/fntli mrt v knstpen kesz nt tad t
medkl dziz nd tritmnt kn bi fkst n smpl rliv

[28] Children have different bowel movement patterns than

/(28) ldrn hv dfrnt bal muvmnt ptnz n

In addition, there is a wide spectrum of normalcy when

considering childrens bowel habits.[
/n dn e z wad spektrm v nmls wen knsdr
ldrnz bal hbts/

[5] On average, infants have 3-4 bowel movements/day,

and toddlers have 2-3 bowel movements per day.
/fav n vr nfnts hv (34) bal (movementsday) nd
tdlz hv (23) bal muvmnts p de/

At around age 4, children develop an adult-like pattern of

bowel movements (1-2 stools/day).
/t rand e f ldrn dvelp n (adultlike) ptn v
bal muvmnts (12) (stoolsday)/
The Rome III Criteria for constipation in children helps to
define constipation for various age groups.
/i (Rome) (III) kratr f knstpen n ldrn helps t d
fan knstpen f vers e grups/

Rome III criteria Less than 4 years old: The child must have
2 or more of the following complaints.
/(Rome) (III) kratr les n f jz ld ald mst hv tu
m v fl kmplents/

These complaints must be present for at least 1 month.[

/iz kmplents mst bi preznt fr t list wn mn/

[28] 2 or fewer bowel movements per week Passing large

bowel movements On physical exam, a doctor may find
large amounts of feces within the childs rectum.
/(28) tu fju bal muvmnts p wik ps l bal
muvmnts n fzkl gzm dkt me fand l mants
v (feces) wn aldz rektm/

A child who is already toilet trained has at least 1 accident

per week involving a bowel movement.
/ ald hu z lred tlt trend hz t list wn ksdnt p
wik nvlv bal muvmnt/

Child demonstrates withholding behavior in which he or she

actively tries not to pass a bowel movement.
/ald demnstrets whld (behavior) n w hi i
ktvli traz nt t ps bal muvmnt/
Hard stools Pain with defecation.
/hd stulz pen w defken/

More than 4 years old: The child must have 2 or more of

the following complaints.
/m n f jz ld ald mst hv tu m v fl

These complaints must be present for at least 2 months 2

or fewer bowel movements per week Passing large bowel
movements On physical exam, a doctor may find large
amounts of feces within the childs rectum.
/iz kmplents mst bi preznt fr t list tu mns tu fju
bal muvmnts p wik ps l bal muvmnts n
fzkl gzm dkt me fand l mants v (feces) w
n aldz rektm/

A child who is already toilet trained has at least 1 accident

per week involving a bowel movement.
/ ald hu z lred tlt trend hz t list wn ksdnt p
wik nvlv bal muvmnt/

Child demonstrates withholding behavior in which he or she

actively tries not to pass a bowel movement.
/ald demnstrets whld (behavior) n w hi i
ktvli traz nt t ps bal muvmnt/

Hard stools Pain with defecation.

/hd stulz pen w defken/

Postpartum women The six-week period after pregnancy is

called the postpartum stage.[
/(Postpartum) wmn i (sixweek) prd ft pregnns z
kld i (postpartum) ste/

[47] During this time, women are at increased risk of being

/(47) djr s tam wmn t nkrist rsk v bi

Multiple studies estimate the prevalence of constipation to

be around 25% during the first 3 months.[
/mltpl stdz estmt prevlns v knstpen t bi
rand (25) djr fst ri mns/

[48] Constipation can cause discomfort for women, as they

are still recovering from the delivery process especially if
they have had a perineal tear or underwent an episiotomy.[
/(48) knstpen kn kz dskmft f wmn z e stl
rkv frm dlvr prses spel f e hv hd
(perineal) te ndwent n (episiotomy)/

[49] Risk factors that increase the risk of constipation in

this population include:[49] Damage to the levator ani
muscles (pelvic floor muscles) during childbirth Forceps-
assisted delivery Lengthy second stage of labor Delivering a
large child Hemorrhoids Hemorrhoids are common in
pregnancy and also may get exacerbated when constipated.
/(49) rsk fktz t nkris rsk v knstpen n s
ppjlen (include49) dm t i (levator) (ani) mslz
pelvk fl mslz djr aldb (Forcepsassisted) dlvr
le seknd ste v leb dlv l ald hemrdz
hemrdz kmn n pregnns nd ls me get eks
sbetd wen knstpetd/
Anything that can cause pain with stooling (hemorrhoids,
perineal tear, episiotomy) can lead to constipation because
patients may withhold from having a bowel movement so as
to avoid pain.[
/en t kn kz pen w stul hemrdz (perineal) te
(episiotomy) kn led t knstpen bkz pents me w
hld frm hv bal muvmnt s z t vd pen/

[49] The pelvic floor muscles play an important role in

helping pass a bowel movement.
/(49) pelvk fl mslz ple n mptnt rl n help ps
bal muvmnt/

Injury to those muscles by some of the above risk factors

(examples- delivering a large child, lengthy second stage of
labor, forceps delivery) can result in constipation.[
/nr t z mslz ba sm v i bv rsk fktz g
zmplz dlv l ald le seknd ste v leb
fseps dlvr kn rzlt n knstpen/

[49] Women sometimes get enemas during labor that can

also alter bowel movements in the days after having given
/(49) wmn smtamz get enmz djr leb t kn
ls lt bal muvmnts n dez ft hv gvn

[47] However, there is insufficient evidence to make

conclusions about the effectiveness and safety of laxatives
in this group of people.[
/(47) haev e z nsfnt evdns t mek knklunz
bat i (effectiveness) nd seft v lkstvz n s grup v