Difficult and infrequent passage of small, hard stools

  • Most common in children and elderly people
  • More common in females
  • A low-fibre diet is a risk factor
  • Genetics as a risk factor depends on the cause

If your stools are small and hard or if you have to strain to pass them, you are probably constipated. How frequently you pass stools is less important because healthy people have bowel movements at widely differing intervals. Usual intervals range from three times a day to three times a week. Most people tend to have a regular routine, and bowels usually function best if they are allowed to follow a consistent pattern.

Bouts of constipation are common and usually harmless, but occasionally they may indicate an underlying disorder. You should consult your doctor if you have recently developed constipation that is severe or lasts more than 2 weeks, particularly if it first occurs after the age of 45 or if blood is present in the faeces. Persistent constipation may lead to faecal impaction, in which hard faeces remain in the rectum. Liquid faeces may leak around the partial obstruction, resulting in diarrhoea.

What are the causes?

A diet that is low in fibre and fluids is the most common cause of constipation. Drinking too much alcohol or drinks containing caffeine, which may lead to dehydration, can also make faeces hard and difficult to pass. Other factors that decrease the frequency of bowel movements are taking too little exercise and long periods of immobility. Several disorders, such as the metabolic disorder hypothyroidism and depression, may also lead to constipation. In addition, the condition is associated with disorders of the large intestine, such as diverticular disease.

People recovering from abdominal surgery and people with anal disorders, such as haemorrhoids or an anal fissure, may find it painful to defecate and then develop constipation. Certain drugs, including some antidepressants and antacids containing aluminium and calcium carbonate, may cause constipation.

Poor toilet training in infants (see Constipation in children) and increasing immobility in elderly people make constipation much more common in these age groups. For unknown reasons, it is more common in women.

What might be done?

If constipation is associated with your lifestyle, there are several measures you can take to relieve it and prevent recurrence (see Preventing constipation). If constipation persists despite taking these self-help measures, you should consult your doctor, who will perform various tests to look for an underlying cause. He or she will probably first examine your abdomen and check your rectum by inserting a gloved finger. You may be asked to give a faecal sample, which will be examined for the presence of blood.

If a cause is not found, you may have your large intestine examined with a viewing instrument (see Colonoscopy) or have contrast X-rays of your intestines to reveal abnormalities. If your doctor finds an underlying cause, its treatment should relieve constipation. Your doctor will prescribe an alternative drug if a particular drug is the cause of constipation.

You may have an enema, in which liquid is passed through a tube into the rectum to stimulate bowel movements. This treatment should be followed by a change in diet to include more fibre.

Constipation linked to a painful anal disorder may be relieved with a soothing ointment or suppositories.

Self-help: Preventing Constipation

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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