Definition
Constipation is an acute or chronic condition in which bowel movements
occur less often than usual or consist of hard, dry stools that are
painful or difficult to pass. Although constipation is a relative term,
with normal patterns of bowel movements varying widely from person to
person, generally 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 is considered
constipated. Infants who are still exclusively breastfed may go seven days
without a stool.
Description
The colon (the large intestine) absorbs water while forming waste products
(the stool) from digested food. Muscle contractions in the colon
(peristalsis) push the stool toward the rectum. By the time the stool
reaches the rectum, it is solid because most of the water has been
absorbed. However, hard, dry stools and constipation occur when too much
water is absorbed by the colon from the stool, which can result from the
muscle of the colon contracting too slowly. Constipation is also referred
to as irregularity of bowels or lack of regular bowel movements.
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. They may feel
shy about asking permission to use the bathroom, they may be involved in
more enjoyable activities and may not want to stop, or they may be rushed
when using the bathroom and not have time to complete the bowel movement.
Once constipation has developed and bowel movements become painful or more
difficult, the child will attempt to go even less often, and the
constipation will worsen.
Although this condition is rarely serious, it can lead to the following:
Less commonly, 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 (in adults) and should be investigated by
a doctor.
Demographics
Constipation is a common complaint in children, occurring in up to 10
percent of youngsters. It accounts for approximately 3 percent of
pediatric outpatient visits and 25 percent of visits to a pediatric
gastroenterologist.
Causes and symptoms
Constipation usually results from not getting enough
exercise
, not drinking enough fluids (especially water), delays in going to the
bathroom when there is the urge to defecate, or from a diet that does not
include an adequate amount of fiber-rich foods such as beans, bran
cereals, fruits, raw vegetables, rice, and whole-grain breads. Eating too
many dairy products such as milk, cheese, yogurt, and ice cream may also
result in harder stools. Constipation in children often occurs when they
hold back bowel movements for various reasons, such as when they are not
ready for
toilet training
or are afraid of toilet training.
Other less common 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; and
irritable bowel syndrome. Stress and travel can also contribute to
constipation, as well as other changes in bowel habits.
Constipation can also be a side effect of the use of the following
medications, many of which are not commonly used by children:
A child 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 the legs
toward the abdomen, or arch the back when having a bowel movement.
Newborns and young infants may also strain, turn red in the face, grunt
and draw legs up when passing normal, soft stool. If the stool is not hard
(rabbit pellet in consistency), then these infants are not considered
constipated.
Most people become constipated once in a while, but a doctor should be
contacted if significant changes in bowel patterns last for more than a
week or if symptoms continue more than three weeks after increasing
activity and fiber and fluid intake.
In addition, a doctor should be called if an infant younger than two
months is constipated, or if an infant (except those that are exclusively
breastfed) goes three days without a stool. If
vomiting
or irritability is also present, then the doctor should be called
immediately. A doctor should also be consulted if a child is holding back
bowel movements (in order to resist toilet training) or whenever
constipation occurs after starting a new prescription, vitamin, or mineral
supplement or is accompanied by blood in the stools, changes in bowel
patterns,
fever
, and rectal or abdominal pain.
Diagnosis
The child's symptoms and medical history help a primary care
physician to diagnose 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 or other symptoms of systemic disease;
and a sigmoidoscopy (examination of the sigmoid area of the colon with a
flexible tube equipped with a magnifying lens).
Treatment
Constipation is usually a temporary problem in children and no cause for
concern. A child with constipation should be instructed to drink an
adequate amount of water each day (six to eight glasses), exercise on a
regular basis, and eat a diet high in soluble and insoluble fibers.
Soluble fibers include pectin, flax, and gums; insoluble fibers include
psyllium and brans from grains like wheat and oats. Fresh fruits and
vegetables contain both soluble and insoluble fibers. Dietary fiber intake
should be increased gradually, along with an increase in water
consumption, in order to produce soft, bulky stools.
Constipation in infants may be treated by the following:
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
soften stools 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 the nerves and lining of the colon. A child who is
experiencing abdominal pain,
nausea
, or vomiting should not use a laxative. Laxatives should not be used for
a long period, because the child can become dependent on them.
A warm-water or mineral oil enema can relieve constipation in children
with severe or stubborn cases of constipation. However, laxatives or
enemas should not be given to children without instruction from a doctor.
If a child has an impacted bowel, the doctor can insert a gloved finger
into the rectum and gently dislodge the hardened feces.
Castor oil, applied topically to the abdomen and covered by a heat source
(a heating pad or hot water
Constipation is an acute or chronic condition in which bowel
movements occur less often than usual or consist of hard, dry stools
that are painful or difficult to pass.
(Illustration by Electronic Illustrators Group.)
bottle) can help relieve constipation when used nightly for 20 to 30
minutes.
This needleless form of acupuncture is said to relax the abdomen, ease
discomfort, and stimulate regular bowel movements when diet and exercise
fail to do so. After lying down, the child closes his or her eyes and
takes a deep breath. For two minutes, the child or parent applies gentle
fingertip pressure to a point about 2.5 in (14 cm) below the navel.
Acupressure can also be applied to the outer edges of one elbow crease and
maintained for 30 seconds before pressing the crease of the other elbow.
This should be done three times a day to relieve constipation.
Six drops of rosemary (
Rosmarinus officinalis
) and six drops of thyme (
Thymus
spp.) diluted by one ounce of almond oil, olive oil, or another carrier
oil can relieve constipation when used to massage the abdomen.
A variety of herbal therapies can be useful in the treatment of
constipation. Several herbs, including chamomile (
Matricaria recutita
), dandelion (
Taraxacum mongolicum
), and burdock (
Arctium lappa
), act as bitters, stimulating the movement of the digestive and excretory
systems.
Homeopathy also can offer assistance with constipation. There are acute
remedies for constipation that can be found in one of the many home remedy
books on homeopathic medicine. A constitutional prescription also can help
rebalance someone who is struggling with chronic constipation.
Massaging the leg from knee to hip in the morning, at night, and before
trying to move the bowels is said to relieve constipation. There is also a
specific Swedish massage technique that can help relieve constipation.
The knee-chest position, said to relieve gas and stimulate abdominal
organs, involves the following:
The cobra position, which can be repeated as many as four time a day,
involves the following:
Prognosis
Changes in diet and exercise can often eliminate constipation. However,
childhood constipation can sometimes be difficult to treat when a child,
after having a painful experience, makes a decision to resist and delay
going to the bathroom. These cases often require prolonged support,
explanation, and medical treatment.
Prevention
Avoiding constipation by making lifestyle changes is easier than treating
it. Most American adults only consume between 11 to 18 grams of fiber a
day, but to prevent constipation, consumption of 30 to 35 grams of fiber
(an amount equal to five servings of fruits and vegetables, and a large
bowl of high-fiber cereal) and between six and eight glasses of water each
day can generally prevent constipation. A suggested goal for dietary fiber
intake during childhood and
adolescence
is consumption in grams equivalent to the age of the child plus 5 grams
per day.
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 causing dependency. Powdered flaxseed (
Linium usitatissimum
) works the same way. Insoluble fiber, like wheat or oat bran, is as
effective as psyllium but may give the child gas at first.
Parental concerns
KEY TERMS
Constipation
—Difficult bowel movements caused by the infrequent production of
hard stools.
Dietary fiber
—Mostly indigestible material in food that stimulates the
intestine to peristalsis.
Peristalsis
—Slow, rhythmic contractions of the muscles in a tubular organ,
such as the intestines, that move the contents along.
Resources
Bernard, H.
The Homoeopathic Treatment of Constipation.
New Delhi, India: B. Jain Publishers Pvt. Limited, 2003.
Peiken, Steven R.
Gastrointestinal Health: The Proven Nutritional Program to Prevent,
Cure, or Alleviate Irritable Bowel Syndrome (IBS), Ulcers, Gas,
Constipation, Heartburn, and Many Other Digestive Disorders.
London: Harper Trade, 2005.
Whorton, James C.
Inner Hygiene: Constipation and the Pursuit of Health in Modern Society.
Collingdale, PA: DIANE Publishing Co., 2003.
"Constipation."
MedlinePlus.
Available online at
http://www.nlm.nih.gov/medlineplus/constipation.html (accessed
December 9, 2004).
