Constipation

Constipation refers to infrequent or difficult bowel movements. It commonly means fewer than three bowel movements per week, with stools that are hard, dry, and painful to pass; or a sense of incomplete evacuation. Symptoms can include bloating, abdominal discomfort, and a feeling of fullness. Constipation can be short-term (acute) or chronic, lasting several months.

Causes include dietary factors such as low fiber intake and insufficient fluids, reduced physical activity, and medications such as opioids, anticholinergics, iron supplements, and certain calcium channel blockers. Medical conditions like thyroid disease, diabetes, Parkinson’s disease, and colorectal disorders can contribute. Pregnancy, aging, and lifestyle factors also play a role. Primary constipation refers to functional causes or defecatory disorders; secondary constipation is due to another medical condition or medication.

Diagnosis is based on history and physical examination. Alarm features such as weight loss, bleeding, anemia, or onset of constipation in people over age 50 warrant additional testing (blood tests, colonoscopy, thyroid function, celiac screening) or referral. Anorectal exam and, rarely, specialized tests may be used to identify pelvic floor dysfunction.

Management focuses on both lifestyle changes and, if needed, medicines. Increasing dietary fiber gradually to about 20–35 g per day, fluid intake, and physical activity can help. Establishing a regular toilet routine and proper positioning may aid evacuation. Laxatives are used when needed: bulk-forming agents, osmotic laxatives, stimulant laxatives, and stool softeners. For opioid-induced constipation, targeted therapies may be used. Most cases improve with conservative measures; persistent symptoms deserve medical review to rule out secondary causes or complications.