DemographicsConstipation is a very common complaint. About
2% of Americans complain of frequent or constant con-
stipation. In 2005, constipation accounted for about 2.5
million visits to the doctor. In the United States more
black Americans report being constipated than white
Americans. In Africa, the reverse is true, suggesting that
diet plays a more important role than race in determining
who develops constipation. This is also supported by the
fact that very few Asians who eat anAsian dietreport
being constipated, while those who adopt a Western diet
report constipation much more frequently. Complaints
about constipation are morelikely to come from women
than from men and from people over age 65. Pregnant
women are at higher risk to become constipated, as are
people who have had surgery and who are taking nar-
cotic painkillers.Causes and symptomsConstipation is not a disorder but a symptom of a
health problem, like a fever or a cough. There are two
general categories of constipation, idiopathic consti-
pation, and functional constipation. Idiopathic means
‘‘of unknown origin.‘‘ Idiopathic constipation is con-
stipation that arises from an unknown cause. It may be
related to hormonal abnormalities, nerve, or muscle
damage, or something physicians do not yet under-
stand. Functional constipation occurs when the bowel
is healthy, but constipation develops because of diet,
lifestyle habits, psychological disorders, or abnormal-
ities in the rectum or anus.
Symptoms of constipation may include:
bowel movements that occur less frequently than
normal
straining to eliminate stools
small, hard, dry, painful, stools
a feeling of pressure in the rectum
a feeling of abdominal fullness or bloating
leakage of small amounts of liquid stool. This occurs
when there is a blockage or impaction and the colon
is abnormally stretched.
Constipation has many causes. The most common
cause in the United States is poor diet. A diet that
increases the chances of developing constipation is one
that is high in meat, dairy products, and refined sugar
and low in dietaryfiber. Other causes include:
little physical exercise. This is a particular problem in
the elderly.
medications, especially narcotic drugs used to treat
pain, but also antidepressants, antacids containingaluminum, iron supplements, tranquilizers, antispas-
modics and anticonvulsants
pregnancy
change in routine, for example traveling
irritable bowel syndrome
not drinking enough fluids; dehydration
laxative abuse (People become dependant on laxa-
tives and need higher and higher doses to avoid
constipation.)
poor bowel habits, such as ignoring the urge to have
a bowel movement or refusal to use public toilets
tumor or other mechanical blockage
eating disorders such as anorexia nervosa or bulimia
nervosa where there is low calorie intake and (for
bulimia) vomiting
stroke or other conditions causing nerve damage
such as multiple sclerosis, Parkinson’s disease, and
spinal cord injuries
disorders that affect the muscles that cause material
to move through the colon
hormonal disorders such as diabetes, hypercalcemia
(too much calcium), and hypothyroidism (too little
thyroid hormone)
abnormalities of the rectum or anus
iron supplementsDiagnosis
Diagnosis begins with a medical history so that
the physician can determine the normal frequency ofKEY TERMS
Anus—The opening from the rectum to the outside
of the body through which stools pass. The open-
ing and closing of the anus is controlled by a
strong ring of musclesunder somewhat voluntary
control.
Dietary fiber—Also known as roughage or bulk.
Insoluble fiber moves through the digestive system
almost undigested and gives bulk to stools. Solu-
ble fiber dissolves in water and helps keep stools
soft.
Idiopathic—Occurring from unknown causes.
Laxative—A substance that stimulates movement
of food through the bowels. Laxatives are used to
treat constipation.
Rectum—The last few inches of the large intestine.Constipation