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Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others.

At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.

Those reporting constipation most often are women, children, and adults age 65 and over. Pregnant women also complain of constipation, and it is a common problem following child birth or surgery.

Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the health care provider. However, most people treat themselves without seeking medical help.

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through it, the colon absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.

The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly.

Here are some of the causes of constipation:

1. Diet
2. Not enough liquids
3. Lack of exercise
4. Changes in life or routing
5. Problems with colon and rectum
6. Ignoring the urge to have a bowel movement
7. Medications
8. Specific diseases
9. Problems with intestinal function (Chronic idiopathic)

Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent constipation.

DIET
A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. A healthcare provider or dietitian can help plan an appropriate diet. High-fiber foods include beans; whole grains and bran cereals; fresh fruits; and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber such as ice cream, cheese, meat, and processed foods is also important.

LIFESTYLE CHANGES
Other changes that can help treat and prevent constipation include drinking enough water and other liquids such as fruit and vegetable juices and clear soup, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.

LAXATIVES
Most people who are mildly constipated do not need laxatives. However, for those who have made lifestyle changes and are still constipated, health care providers may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, also helps prevent constipation.

A health care provider should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum, powder, and granule forms. They work in various ways:

1. Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer.
2. Stimulants cause rhythmic muscle contractions in the intestines. Most laxative makers have replaced or plan to replace phenolphthalein with a safer ingredient.
3. Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after child birth or surgery.
4. Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common lubricant.
5. Saline laxatives act like a sponge to draw water into the colon for easier passage of stool.

People who are dependent on laxatives need to slowly stop using the medications. A health care provider can assist in this process. In most people, this restores the colon's natural ability to contract.

Treatment may be directed at a specific cause. For example, the health care provider may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse.

People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control release of bowel movements. Biofeedback involves using a sensor to monitor muscle activity that at the same time can be displayed on a computer screen allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to use these muscles.

Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.