Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. It may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation that prevents passage of both stools and gas. Causes of constipation may be dietary, hormonal, anatomical, a side effect of medications (e.g. some painkillers), or an illness or disorder. Treatments consist of changes in dietary and exercise habits, the use of laxatives, and other medical interventions depending on the underlying cause. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... what was here was sick and improperly spelled. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... For the death metal band, see Defecation (band). ... Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ... For other uses, see Hormone (disambiguation). ... This article does not cite any references or sources. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... A laxative is a preparation used for the purpose of encouraging defecation, or the elimination of feces. ...

Signs and symptoms

Types 1 and 2 on the Bristol Stool Chart indicate constipation

In common constipation, the stool is hard,difficult and painful to pass. Usually, there is an infrequent urge to void. Straining to pass stool may cause hemorrhoids and anal fissures, which are themselves painful. In later stages of constipation, the abdomen may become distended and diffusely tender and crampy, occasionally with enhanced bowel sounds. Image File history File links Size of this preview: 460 × 599 pixel Image in higher resolution (507 × 660 pixel, file size: 107 KB, MIME type: image/png) Steven Perlow, self made diarrhea extraordinaire. ... Image File history File links Size of this preview: 460 × 599 pixel Image in higher resolution (507 × 660 pixel, file size: 107 KB, MIME type: image/png) Steven Perlow, self made diarrhea extraordinaire. ... The Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the faeces form into seven groups. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... An anal fissure is an unnatural crack or tear in the anus skin. ... This article is about muscular pain. ... Borborygmus (plural borborygmi) is the rumbling sound produced by the movement of gas through the intestines of animals. ...

The definition of constipation includes the following:^[1]

• infrequent bowel movements (typically 3 times or fewer per week)
• difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or
• the sensation of incomplete bowel evacuation.

Severe cases ("fecal impaction") may feature symptoms of bowel obstruction (vomiting, very tender abdomen) and "paradoxical diarrhea", where soft stool from the small intestine bypasses the impacted matter in the colon. Heaving redirects here. ... It has been suggested that this article or section be merged with Large intestine. ...

Diagnosis

The diagnosis is essentially made from the patient's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.^[2]

Inquiring about dietary habits may reveal a low intake of dietary fiber or inadequate amounts of fluids. Constipation as a result of poor ambulation or immobility should be considered in the elderly. Constipation may arise as a side effect of medications (especially antidepressants and opiates).^{[citation needed]} Rarely, other symptoms suggestive of hypothyroidism may be elicited.^{[citation needed]} Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... This article or section does not cite its references or sources. ...

During physical examination, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present. In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ... This rectal bulb syringe may be used to administer small enemas. ...

X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms. In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz...

Chronic constipation (symptoms present for more than 3 months at least 3 days per month) associated with abdominal discomfort is often diagnosed as irritable bowel syndrome (IBS) when no obvious cause is found. Physicians caring for patients with chronic constipation are advised to rule out obvious causes through normal testing.^[3]

Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation. ^[4]

Causes

The main causes of constipation include:

• Hardening of the feces
  • Improper mastication (chewing) of food
  • Insufficient intake of dietary fiber
  • Dehydration from any cause or inadequate fluid intake
  • Medication, e.g. diuretics and those containing iron, calcium, aluminum
• Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along
  • Hypothyroidism (slow-acting thyroid gland)
  • Hypokalemia
  • Injured anal sphincter (patulous anus)
  • Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants
  • Severe illness due to other causes
  • Acute porphyria (a rare inherited condition)
  • Lead poisoning
• Dyschezia (usually the result of suppressing defecation)
• Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass
  • Stenosis (Strictures)
  • Diverticula
  • Tumors, either of the bowel or surrounding tissues
  • Retained foreign body or a bezoar
• Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
  • Functional constipation
  • Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain^[5]
• Smoking cessation (nicotine has a laxative effect)^[6]
• Abdominal surgery, other types of surgery, childbirth
• Anismus

Mastication or chewing is the process by which food is mashed and crushed by teeth. ... Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... This illustration shows where some types of diuretics act, and what they do. ... General Name, symbol, number iron, Fe, 26 Chemical series transition metals Group, period, block 8, 4, d Appearance lustrous metallic with a grayish tinge Standard atomic weight 55. ... For other uses, see Calcium (disambiguation). ... Aluminum is a soft and lightweight metal with a dull silvery appearance, due to a thin layer of oxidation that forms quickly when it is exposed to air. ... Peristalsis is the process of involuntary wave-like successive muscular contractions by which food is moved through the digestive tract. ... This article or section does not cite its references or sources. ... The thyroid gland and its relations In anatomy, the thyroid (IPA θaɪɹoɪd) is an endocrine gland. ... Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. ... Male Anatomy The anus, in anatomy, is the external opening of the rectum. ... This article is about the bodily orifice. ... Imodium redirects here. ... An opioid is a chemical substance that has a morphine-like action in the body. ... For the band, see Codeine (band). ... This article is about the drug. ... Chemical structure of the tricyclic antidepressant amitriptyline. ... Porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme biosynthetic pathway (also called porphyrin pathway). ... Lead poisoning is a medical condition, also known as saturnism, plumbism, or painters colic caused by increased blood lead levels. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Diverticula are outpouchings of the intestinal wall. ... For malignant tumors specifically, see cancer. ... The word Foreign means originating elsewhere or in the physiological context outside the body. ... A bezoar or enterolith is a sort of calculus or concretion, a stone found in the intestines of mostly ruminant animals, but occurring among others including humans. ... A psychosomatic illness is one with physical manifestations and supposed psychological cause, often diagnosed when any known or identifiable physical cause was excluded by medical examination. ... Functional constipation is a form of constipation with a psychological or psychosomatic background. ... A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ... This article is about the chemical compound. ... Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ...

Treatment

In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and pulses such as baked beans and chick peas and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract. Impact from a water drop causes an upward rebound jet surrounded by circular capillary waves. ... Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. ... For other uses, see Vegetable (disambiguation). ... For other uses, see Fruit (disambiguation). ... This article or section does not cite its references or sources. ... For other uses, see Bread (disambiguation). ... Binomial name Linum usitatissimum L. Linnaeus, 17?? Common flax (also known as linseed) is a member of the Linaceae family, which includes about 150 plant species widely distributed around the world. ...

Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. hyponatremia may occur in some cases especially in diabetics. Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. ...

In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter. This rectal bulb syringe may be used to administer small enemas. ...

Laxatives

Main article: laxative

Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli. Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. ... Melanosis coli identified on colonoscopy as a brownish moire pattern on the wall of the colon. ...

Physical intervention

Constipation that resists all the above measures requires physical intervention. Manual disimpaction (the physical removal of impacted stool) is done for those patients who have lost control of their bowels secondary to spinal injuries. Manual disimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual disimpaction can occasionally be done under sedation or a general anesthetic—this avoids pain and loosens the anal sphincter. Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... A general anaesthetic drug is an anaesthetic (or anesthetic AE) drug that brings about a reversible loss of consciousness. ...

Many of the products are widely available over-the-counter. Enemas and clysters are a remedy occasionally used for hospitalized patients in whom the constipation has proven to be severe, dangerous in other ways, or resistant to laxatives. Sorbitol, glycerin and arachis oil suppositories can be used. Severe cases may require phosphate solutions introduced as enemas. Over-the-counter (OTC) drugs are medicines that may be sold without a prescription, in contrast to prescription drugs. ... This 2qt (about 1. ... A normal clyster syringe (in front) and the nozzle for a syringe designed for self-administration (in the back). ... Sorbitol, also known as glucitol, is a sugar alcohol the body metabolises slowly. ... Glycerin, also well known as glycerine and glycerol, and less commonly as 1,2,3-propanetriol, 1,2,3-trihydroxypropane, glyceritol, and glycyl alcohol is a colorless, odorless, hygroscopic, and sweet-tasting viscous liquid. ... Peanut oil is often used in cooking, because it has a mild flavour and burns only at a relatively high temperature. ... Suppository casting mould A suppository is a drug delivery system that is inserted either into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository) where it dissolves. ... A phosphate, in inorganic chemistry, is a salt of phosphoric acid. ...

Prevention

Constipation is usually easier to prevent than to treat. The relief of constipation with osmotic agents, i.e. lactulose, polyethylene glycol (PEG), or magnesium salts, should immediately be followed with prevention using increased fiber (fruits, vegetables, and grains) and a nightly decreasing dose of osmotic laxative. With continuing narcotic use, for instance, nightly doses of osmotic agents can be given indefinitely (without harm) to cause a daily bowel movement. Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers. ...

Recent controlled studies have questioned the role of physical exercise in the prevention and management of chronic constipation, while exercise is often recommended by published materials on the subject.^{[citation needed]}

In various conditions (such as the use of codeine or morphine), combinations of hydrating (e.g. lactulose or glycols), bulk-forming (e.g. psyllium) and stimulant agents may be necessary to prevent constipation. For the band, see Codeine (band). ... This article is about the drug. ... Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. ... Ethylene glycol (monoethylene glycol (MEG), IUPAC name:ethane-1,2-diol) is an alcohol with two -OH groups (a diol), a chemical compound widely used as an automotive antifreeze. ... Psyllium or Ispaghula is the common name used for several members of the plant genus Plantago whose seeds are used commercially for the production of mucilage. ...

Epidemiology

Depending on the definition employed, constipation occurs in 2% of the population; it is more common in women, the elderly and children ^[7]

In animals

Hibernating animals can experience tappens that are usually expelled in the spring. For example, bears eat many foods that create a "rectal plug" before hibernation. This article refers to the process of hibernation in biology. ... A tappen is an obstruction, or indigestible mass, found in the intestines of bears and other animals during hibernation. ...

Canines may also experience constipation, which they usually attempt to rectify by ingesting grass and other plant materials. Genera Alopex Atelocynus Canis Cerdocyon Chrysocyon Cuon Cynotherium † Dusicyon † Dasycyon † Fennecus (Part of Vulpes) Lycalopex (Part of Pseudalopex) Lycaon Nyctereutes Otocyon Pseudalopex Speothos Urocyon Vulpes The Canidae (′kanə′dē, IPA: ) family is a part of the order Carnivora within the mammals (Class Mammalia). ...

See also

• Diarrhea
• Feces

In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ...

References

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 180th day of the year (181st in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• 09-129b. at Merck Manual of Diagnosis and Therapy Home Edition
• MedlinePlus Overview constipation
• Constipation Guideline - the World Gastroenterology Organisation (WGO)