Constipation is an acute or chronic condition in which bowel movements occurless often than usual or consist of hard, dry stools that are painful or difficult to pass. Bowel habits vary, but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days isconsidered constipated.

Constipation is one of the most common medical complaints in the United States. Constipation can occur at any age, and is more common among individuals who resist the urge to move their bowels at their body's signal. This often happens when children start school or enter daycare and feel shy about asking permission to use the bathroom.

Constipation is more common in women than in men and is especially apt to occur during pregnancy. Age alone does not increase the frequency of constipation, but elderly people (especially women) are more likely to suffer from constipation.

Although this condition is rarely serious, it can lead to bowel obstruction,chronic constipation, hemorrhoids (a mass of dilated veins in swollen tissuearound the anus), hernia (a protrusion of an organ through a tear in the muscle wall), spastic colitis (irritable bowel syndrome---(a condition characterized by alternating periods of diarrhea and constipation), and laxative dependency.

Chronic constipation may be a symptom of colorectal cancer, depression, diabetes, diverticulosis (small pouches in the muscles of the large intestine), lead poisoning, or Parkinson's disease.

Constipation usually results from not getting enough exercise, not drinking enough water, or from a diet that does not include an adequate amount of fiber-rich foods like beans, bran cereals, fruits, raw vegetables, rice, and whole-grain breads.

Other causes of constipation include anal fissure (a tear or crack in the lining of the anus); chronic kidney failure; colon or rectal cancer; depression;hypercalcemia (abnormally high levels of calcium in the blood); hypothyroidism (underactive thyroid gland); illness requiring complete bed rest; irritable bowel syndrome; and stress.

Constipation can also be a side effect of a variety of medications, includingantacids, blood pressure medications, diuretics (drugs that promote the formation and secretion of urine), and iron or calcium supplements.

An adult who is constipated may feel bloated, have a headache, swollen abdomen, or pass rock-like feces; or strain, bleed, or feel pain during bowel movements. A constipated baby may strain, cry, draw its legs toward the abdomen, or arch the back when having a bowel movement.

Everyone becomes constipated once in a while, but a doctor should be notifiedif significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber andfluid intake.

The patient's observations and medical history help a primary care physiciandiagnose constipation. The doctor uses his fingers to see if there is a hardened mass in the abdomen, and may perform a rectal examination. Other diagnostic procedures include a barium enema, which reveals blockage inside the intestine; laboratory analysis of blood and stool samples for internal bleeding orother symptoms of systemic disease; and a sigmoidoscopy (examination of thesigmoid area of the colon with a flexible tube equipped with a magnifying lens).

Physical and psychological assessments and a detailed history of bowel habitsare especially important when an elderly person complains of constipation.

If changes in diet and activity fail to relieve occasional constipation, an over-the-counter laxative may be used for a few days. Preparations that softenstools or add bulk (bran, psyllium) work more slowly but are safer than Epsom salts and other harsh laxatives or herbal laxatives containing senna (Cassia senna) or buckthorn (Rhamnus purshianna), which can harm thenerves and lining of the colon.

A woman who is pregnant should never use a laxative. Neither should anyone who is experiencing abdominal pain, nausea, or vomiting.

A warm-water or mineral oil enema can relieve constipation, and a non-digestible sugar (lactulose) or special electrolyte solution is recommended for adults and older children with stubborn symptoms.

If a patient has an impacted bowel, the doctor inserts a gloved finger into the rectum and gently dislodges the hardened feces.

Changes in diet and exercise usually eliminate the problem.

Most Americans consume between 11 and 18 grams (about a half an ounce of fiber a day. Consumption of 30 grams of fiber and between six and eight glasses of water each day can generally prevent constipation.

Sitting on the toilet for 10 minutes at the same time every day, preferably after a meal, can induce regular bowel movements. This may not become effective for a few months, and it is important to defecate whenever necessary.

Fiber supplements containing psyllium (Plantago psyllium) usually become effective within about 48 hours and can be used every day without causingdependency. Powdered flaxseed (Linium usitatissimum) works the same way. Insoluble fiber, like wheat or oat bran, is as effective as psyllium but may give the patient gas at first.

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