Constipation

Definition:

Infrequent or hard stools; or difficulty passing stools.

Considerations:

Constipation is a relative term. There is wide variability is what is considered normal patterns of bowel elimination. While some healthy people may have consistently soft or near runny stools others may have consistently hard firm stools but no difficulty in passing them.

When the stool is hard, infrequent, and requires significant effort to pass, the person has constipation. Constipation may cause discomfort with passage of stools, and passage of large caliber stools may tear the mucosal membrane of the anus, especially in children, causing bleeding and the possibility of an anal fissure.

Constipation can be caused by changes in diet, decrease in physical activity, lack of toilet facilities, behavior and psychological problems, dehydration, diseases of the bowel, neurological diseases, congenital diseases, medications, and many other causes.

Common causes:

• meconium plug (as seen in infants and children with cystic fibrosis)
• cow's milk ingestion (infants and children)
• congenital megacolon (Hirschsprung's disease)
• functional ileus
• meningomyelocele
• mental retardation
• cerebral palsy
• neurological disorders
• depression
• painful defecation (anal fissure, skin irritation, hemorrhoids)
• dietary changes
• medications especially narcotics
• dehydration
• low-fiber diet
• infrequent physical exercise
• immobility (elderly or bedridden patients)
• endocrine disorders such as hypothyroidism
• endometriosis
• pelvic tumors

Note: There may be other causes of constipation. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of constipation can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as time course, aggravating factors, relieving factors, and associated complaints.