Constipation is most often defined as having a bowel movement less than 3 times per week. It usually is associated with hard stools or difficulty passing stools. You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing for more than 10 minutes.
Infants who are exclusively breastfed may go 7 days without a bowel movement.
Irregularity of bowels; Lack of regular bowel movements
Normal patterns of bowel elimination vary widely from person to person and you may not have a bowel movement every day. While some healthy people have consistently soft or near-runny stools, others have consistently firm stools, but no difficulty passing them.
When the stool is infrequent, or requires significant effort to pass, you have constipation. The passage of large, wide, or hard stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.
Constipation is most often caused by:
Stress and travel can also contribute to constipation or other changes in bowel habits.
Other causes of constipation may include:
Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.
Children and adults should get enough fiber in their diet. Vegetables, fresh fruits, dried fruits, and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, drink plenty of fluids to help pass the stool.
For infants with constipation:
Regular exercise may also help establish regular bowel movements. If you are confined to a wheelchair or bed, change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend exercises appropriate for your physical capabilities.
Stool softeners (such as those containing docusate sodium) may help. Additionally, bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as milk of magnesia liquid, may establish regular bowel movements. Enemas or stimulant laxatives should be reserved for severe cases only. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief.
Do NOT give laxatives or enemas to children without first asking your doctor.
Call your doctor immediately if you have sudden constipation with abdominal cramps and an inability to pass gas or stool. Do NOT take any laxatives.
Also call your doctor if you have:
Call your child's pediatrician immediately if:
Also call your child's pediatrician if:
Your doctor will perform a physical examination, which may include a rectal exam, and ask questions such as:
The following tests may help diagnose the cause of constipation:
Avoiding constipation altogether is easier than treating it, but involves the same lifestyle measures:
Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 138.
Wyllie R. Motility disorders and Hirschsprung disease. In: Kliegman RM, Jenson HP, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 329.