bowel movements and the length of time the individual
has been constipated. The clinical definition of con-
stipation requires that it be present for at least 12
weeks out of the past 12 months. The 12 weeks do
not have to be consecutive.
A physical examination including a rectal exam
and blood tests. Other tests, such as a thyroid hor-
mone test, may be necessary to rule out other disor-
ders. When symptoms are severe or do not improve
with treatment, the physician may order specialized
tests to determine how long material stays in the colon,
evaluate the condition of the muscles of the rectum
and anus, and look for evidence ofcanceror other
disease. These tests may include a sigmoidoscopy,
barium enema x ray, colorectal transit study, and
anorectal function tests.
TreatmentThe first choice in treating constipation is a change
of diet. People with constipation are advised to eat
more foods high in dietary fiber, decrease dairy, egg,
and meat products to a healthy balance, and increase
the amount of water and non-caffeinated beverages
they drink. They are also encouraged to increase their
level of physical activity and respond promptly to the
urge to have a bowel movement.
When changes in diet and exercise do not work,
laxatives can be used to stimulate movement of the
bowels. Many types of laxatives can be purchased with-
out a prescription. Americans spend about $725 million
annually on laxatives. However, laxative dependency
can become a problem with all laxatives. People who
have been using laxatives regularly and wish to stop
should reduce their use gradually. Each type of laxative
has benefits and drawbacks. Individuals should discuss
which one is best for them with their healthcare provider
or pharmacist. Laxativesusually take 6–12 hours to
stimulate a bowel movement.
Bulk-forming or fiber supplement laxatives are
generally the safest type of laxative. Some common
brand names of fiber-supplement laxatives are Meta-
mucil, Citrocel, Fiberall, Konsyl, and Serutan. These
must be taken with water. They provide extra fiber that
absorbs water and helps keep the stool soft. The extra
bulk also helps move materials through the colon.
Stool softeners help prevent the stool from drying
out. They are recommended for people who should
not strain to have a bowel movement, for example,
people recovering from abdominal surgeries or child-
birth. Brand names include Colace and Surfak.
Stimulant laxatives such as Ducolax, Senokot,
Correctol, and Purge increase the rhythmic contrac-
tions of the colon and move the material along faster.
Lubricants add grease to the stool so that it moves
more easily through the colon. Mineral oil is the most
common lubricant.
Saline laxatives such as Milk of Magnesia draw
water from the body into the colon to help soften and
move the stool.
In the case of serious constipation, prescription
drugs such as tegaserod (Zelnorm) may be used under
the supervision of a doctor. Other medical treatment
involves treating the underlying cause of the constipa-
tion such as changing a medication, removing tumors,
or correcting a hormonal imbalance.Nutrition/dietetic concerns
The major cause of constipation is poor diet.
Studies find that the average American eats only 5–
14 grams of fiber daily. The United States Institute of
Medicine (IOM) of the National Academy of Sciences
has issued the following guidelines for daily consump-
tion of fiber.
men age 50 and younger: 38 grams
women age 50 and younger: 25 grams
men age 51 and older: 30 grams
women age 51 and older: 21 grams
There are two types of dietary fiber, and both play
a role in controlling constipation. Insoluble fiber
passes through the intestines undigested, adds bulk
to stool, and increases the speed with which it moves
through the colon. Good sources of insoluble fiber
include many whole grains such as wholemeal bread,
brown rice, and high bran cereals. Soluble fiber dis-
solves in water and forms a gel that keeps the stool
soft. It also has health benefits such as lowering cho-
lesterol (see entry forhigh fiber diet). Good sources of
soluble fiber include oats, apples, beans, peas, citrus
fruits, barley, and carrots.
The American Dietetic Association and several
other health organizations encourage people to increase
the amount of fiber in their diet for many health rea-
sons, not just to control or prevent constipation. The
following list gives the fiber content of some common
foods.
split peas, cooked, 1 cup: 16.3 g
lentils, cooked, 1 cup: 14.6 g
kidney beans, cooked, 1 cup: 13.1 g
brown rice, cooked, 1 cup: 3.5 g
100% bran cereal, 1/2 cup: 8.4 gConstipation