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Constipation, Age 12 and Older
Constipation occurs when stools are difficult to pass. Some people are overly concerned with the frequency of their bowel movements, because they have been taught that a healthy person has a bowel movement every day. This is not true. Most people pass stools anywhere from 3 times a day to 3 times a week. If your stools are soft and pass easily, you are not constipated.
Constipation is present if you have 2 or fewer bowel movements each week or you do not take laxatives and have 2 or more of the following problems at least 25% of the time:
- Feeling that you do not completely empty your bowels
- Hard stools, or stools that look like pellets
- A feeling of being blocked up
- You can't pass stools unless you put a finger in your rectum or use manual pressure to pass a stool.
Constipation may occur with cramping and pain in the rectum caused by the strain of trying to pass hard, dry stools. You may have some bloating and nausea. You may also have small amounts of bright red blood on the stool or on the toilet tissue, caused by bleeding hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. This should stop when the constipation is controlled.
Constipation can mean the slow movement of stool through the intestines or problems releasing a stool.
Slow transit constipation
Lack of fiber is a common cause of constipation. Other causes include:
- Irritable bowel syndrome.
- Travel or other change in daily routine.
- Lack of exercise.
- Immobility caused by illness or aging.
- Medicine use.
- Overuse of laxatives.
Outlet delay constipation
Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Excessive straining, needing manual pressure on the vaginal wall, or feelings of incomplete emptying may be a symptom of this type of constipation. Outlet delay constipation is caused by:
- Physical disorders that cause loss of function, such as colon cancer, uterine prolapse or rectal prolapse, scarring (adhesions), or injury caused by physical or sexual abuse.
- Nervous system diseases, such as Parkinson's disease, multiple sclerosis, or stroke.
- Spinal cord injury.
- Pain from hemorrhoids or anal fissures.
- Delaying bowel movements because of convenience issues or because having a bowel movement causes pain.
Constipation is more common in people older than 65. People in this age group are more likely to have poor dietary habits and increased medicine use. Older adults also often have decreased muscular activity of the intestinal tract, which increases the time it takes for stool to move through the intestines. Physical problems, such as arthritis, may make sitting on the toilet uncomfortable or painful.
Women report problems with constipation more often than men.
If a stool becomes lodged in the rectum (impacted), mucus and fluid may leak out around the stool, sometimes leading to leakage of fecal material (fecal incontinence). You may experience this as constipation alternating with episodes of diarrhea.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.
A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.
A large amount of blood in the stool may mean a more serious problem is present. For example, if there is a lot of blood in the stool, not just on the surface, you may need to call your doctor right away. If there are just a few drops on the stool or in the diaper, you may need to let your doctor know today to discuss your symptoms. Black stools may mean you have blood in the digestive tract that may need treatment right away, or may go away on its own.
Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.
If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Many prescription and nonprescription medicines can cause constipation. A few examples are:
- Some blood pressure medicines.
- Cold medicines (antihistamines).
- Calcium and iron supplements.
- Opioid pain medicines.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Constipation can be treated at home.
- Try gentle exercise. Take a short walk each day. Gradually increase your walking time until you are walking for at least 20 minutes.
- Make sure you drink enough fluids. Most adults should try to drink between 8 and 10 glasses of water or noncaffeinated beverages each day. Avoid alcoholic beverages and caffeine, which can increase dehydration. If you have heart failure or kidney failure, talk to your doctor about what amount of fluid is right for you.
- Include fruits, vegetables, and fiber in your diet each day. Have a bran muffin or bran cereal for breakfast, and try eating a piece of fruit for a mid-afternoon snack.
- Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement. But do not sit on the toilet too long.
- Support your feet with a small step stool [about 6 in. (15 cm)] when you sit on the toilet. This will help flex your hips and place your pelvis in a more normal "squatting" position for having a bowel movement.
- If you are still constipated:
- Add some processed or synthetic fiber—such as Benefiber, Citrucel, Metamucil, or Perdiem—to your diet each day.
- Try a stool softener, such as Colace, if your stools are very hard.
- Try a rectal glycerin suppository. Follow the directions on the label. Do not use more often than recommended on the label.
- You may at times need to try a laxative. If your teen has constipation problems, talk to your teen's doctor before trying laxatives.
- Osmotic laxatives (such as Fleet Phospho-Soda, Milk of Magnesia, or Miralax) and nonabsorbable sugars (such as lactulose or sorbitol) hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.
- Stimulant laxatives (such as Ex-Lax or bisacodyl) speed up the movement of stool through the intestine. Use these preparations sparingly. Overuse of stimulant laxatives decreases the tone and sensation in the large intestine, causing physical dependence on laxatives. Regular use may interfere with your body's ability to absorb vitamin D and calcium, which can weaken your bones. Do not use laxatives for longer than 2 weeks without consulting your doctor.
- If you are still constipated, check your symptoms to determine if and when you need to see your doctor.
- Talk to your doctor before using an enema. Your doctor may need to check your symptoms or may suggest a different way to treat your constipation.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Constipation occurs or continues after 1 week of home treatment.
- Rectal pain develops or increases.
- Blood in the stool develops or increases.
- Uncontrolled leakage of stool occurs.
- Your symptoms become more severe or more frequent.
If you have any of these symptoms, you need to be evaluated by a doctor.
You can prevent constipation.
- Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
- Add high-fiber foods to your diet. Try to get 20 to 35 grams of fiber a day. Packaged foods and fiber supplements include the amount of fiber content in the nutrition information. You should increase the amount of fiber in your diet slowly so that your stomach can adjust to the change. Adding too much fiber too quickly may cause stomach upset and gas.
- Eat at least 1½ to 2 cups of fruit a day. Choose whole fruit instead of fruit juice.
- Eat at least 2 to 3 cups of vegetables a day.
- Increase the amount of high-fiber foods, such as bran flakes, bran muffins, oatmeal, brown rice, beans, and lentils. Eat brown rice, bulgur, or millet instead of white rice.
- Use whole wheat bread instead of white bread. Choose whole-grain breads and cereals; buy bread that lists whole wheat, stone-ground wheat, or cracked wheat in the ingredients.
- Snack on unbuttered, unsalted popcorn.
- Add 2 Tbsp of wheat bran to cereal or soup. If you do this, start slowly with 1 tsp a day. Gradually increase the amount to 2 Tbsp a day.
- Mix 2 Tbsp of psyllium (found in Metamucil and other bulk-forming agents) with a fluid, and drink it.
- Avoid alcohol beverages. They can increase dehydration.
- Exercise more. A walking program would be a good start. For more information, see the topic Fitness.
- Set aside relaxing times for having bowel movements. Urges usually occur sometime after meals. Establishing a daily routine for bowel movements, such as after breakfast, may help.
- Go when you feel the urge. Your bowels send signals when a stool needs to pass. If you ignore the signal, the urge will go away, and the stool will eventually become dry and difficult to pass.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- Is constipation an ongoing (chronic) problem for you, or is this a new or different problem? If it is chronic, when did it begin?
- When did this episode of constipation begin?
- When was your last normal bowel movement?
- Have you recently changed your diet or fluid intake, decreased your activity level, or started a new medicine?
- Have you recently changed your daily routine, such as a change in your job, school, or travel?
- What have you tried to correct your constipation? Did it work?
- Do you have any rectal bleeding?
- Do you have rectal pain before, during, or after a bowel movement? If so, how long does the pain usually last?
- Do you have any health risks?
Current as of: October 19, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
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