Constipation, Age 12 and Older

Topic Overview

Constipation occurs when stools are difficult to pass. Some people are overly concerned with the frequency of their bowel movements, because they have been taught that a healthy person has a bowel movement every day. This is not true. Most people pass stools anywhere from 3 times a day to 3 times a week. If your stools are soft and pass easily, you are not constipated.

Constipation is present if you have 2 or fewer bowel movements each week or you do not take laxatives and have 2 or more of the following problems at least 25% of the time:

Straining
Feeling that you do not completely empty your bowels
Hard stools, or stools that look like pellets
A feeling of being blocked up
You can't pass stools unless you put a finger in your rectum or use manual pressure to pass a stool.

Constipation may occur with cramping and pain in the rectum caused by the strain of trying to pass hard, dry stools. You may have some bloating and nausea. You may also have small amounts of bright red blood on the stool or on the toilet tissue, caused by bleeding hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. This should stop when the constipation is controlled.

Constipation can mean the slow movement of stool through the intestines or problems releasing a stool.

Slow transit constipation

Lack of fibre is a common cause of constipation. Other causes include:

Irritable bowel syndrome.
Travel or other change in daily routine.
Lack of exercise.
Immobility caused by illness or aging.
Medicine use.
Overuse of laxatives.
Pregnancy.

Constipation is sometimes a sign of another health problem, such as diabetes, hypothyroidism, or hypercalcemia.

Outlet delay constipation

Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Excessive straining, needing manual pressure on the vaginal wall, or feelings of incomplete emptying may be a symptom of this type of constipation. Outlet delay constipation is caused by:

Physical disorders that cause loss of function, such as colon cancer, uterine prolapse or rectal prolapse, scarring (adhesions), or injury caused by physical or sexual abuse.
Nervous system diseases, such as Parkinson's disease, multiple sclerosis, or stroke.
Spinal cord injury.
Pain from hemorrhoids or anal fissures.
Delaying bowel movements because of convenience issues or because having a bowel movement causes pain.

Constipation may occur more frequently as you get older. Older adults also often have decreased muscular activity of the intestinal tract, which increases the time it takes for stool to move through the intestines. Physical problems, such as arthritis, may make sitting on the toilet uncomfortable or painful.

Women report problems with constipation more often than men.

If a stool becomes lodged in the rectum (impacted), mucus and fluid may leak out around the stool, sometimes leading to leakage of fecal material (fecal incontinence). You may experience this as constipation alternating with episodes of diarrhea.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Are you constipated?

Constipation means your stools are hard and you have trouble passing them. If your stools are soft and pass easily, you are not constipated.

Yes

Constipation

How old are you?

Less than 12 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Do you have moderate or severe belly pain?

This is not the cramping type of pain you have with diarrhea.

Yes

Abdominal pain

Are your stools black or bloody?

Yes

Black or bloody stools

Have you had:

At least 1 stool that is mostly black or bloody?

At least 1 stool mostly black or bloody

At least 1 stool that is partly black or bloody?

At least 1 stool partly black or bloody

Streaks of blood in your stool?

Streaks of blood in stool

Have you had any stool leak from your rectum?

Yes

Leaking stool

How much leakage has there been?

Sometimes with severe constipation you may leak a little bit of loose stool. This usually isn't serious, but you also shouldn't ignore it. Sudden leakage of a lot of stool is more serious.

A lot of stool

Leakage of large amount of stool

A small amount of stool

Leakage of small amount of stool

Has there been a recent injury to the rectum or vagina?

Physical or sexual abuse and other injuries to these areas can cause problems like rectal pain and bleeding, urination problems, constipation, and vaginal bleeding.

Yes

Recent injury to rectum or vagina

Do you have pain in the rectal area?

Yes

Rectal pain

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Does the rectal pain last for more than 30 minutes after you have a bowel movement?

Yes

Rectal pain continues for more than 30 minutes after bowel movement

Is pain preventing you from having a bowel movement?

Yes

Rectal pain is preventing bowel movement

Do you think that a medicine could be causing the constipation?

Think about whether the constipation started after you began taking a new medicine or a higher dose of a medicine.

Yes

Medicine may be causing constipation

Is constipation a new problem for you?

Yes

Constipation is a new problem

Do you have other symptoms, such as a fever, shaking chills, or vomiting?

Yes

Other symptoms, such as fever, shaking chills, or vomiting

Have you tried home treatment for constipation for more than 1 week?

Home treatment includes things like drinking plenty of water; eating more fruits, vegetables, and whole grains; and getting some exercise every day.

Yes

Tried home treatment for constipation for more than 1 week

Can you have a bowel movement without the help of a laxative?

Yes

Able to have bowel movement without using laxatives

Unable to have bowel movement without using laxatives

Have you been using laxatives for more than 2 weeks?

Yes

Has been using laxatives for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.

A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.

A large amount of blood in the stool may mean a more serious problem is present. For example, if there is a lot of blood in the stool, not just on the surface, you may need to call your doctor right away. If there are just a few drops on the stool or in the diaper, you may need to let your doctor know today to discuss your symptoms. Black stools may mean you have blood in the digestive tract that may need treatment right away, or may go away on its own.

Certain medicines and foods can affect the colour of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food colouring can turn the stool black.

If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Many prescription and non-prescription medicines can cause constipation. A few examples are:

Antacids.
Antidepressants.
Some blood pressure medicines.
Cold medicines (antihistamines).
Calcium and iron supplements.
Opioid pain medicines.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Abdominal Pain, Age 12 and Older

Constipation, Age 11 and Younger

Home Treatment

Constipation can be treated at home.

If you are still constipated, check your symptoms to determine if and when you need to see your doctor.

First:
- Try gentle exercise. Take a short walk each day. Gradually increase your walking time until you are walking for at least 20 minutes.
- Make sure you drink enough fluids. Most adults should try to drink between 8 and 10 glasses of water or non-caffeinated beverages each day. Avoid alcoholic beverages, which can increase dehydration. If you have heart failure or kidney failure, talk to your doctor about what amount of fluid is right for you.
- Include fruits, vegetables, and fibre in your diet each day. Have a bran muffin or bran cereal for breakfast, and try eating a piece of fruit for a mid-afternoon snack.
- Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement. Do not sit on the toilet too long.
Support your feet with a small step stool [about 15 cm (6 in.)] when you sit on the toilet. This will help flex your hips and place your pelvis in a more normal "squatting" position for having a bowel movement.
If you are still constipated:
- Add some processed or synthetic fibre—such as Metamucil or Prodiem—to your diet each day.
- Try a stool softener, such as Colace, if your stools are very hard.
- Try a rectal glycerin suppository. Follow the directions on the label. Do not use more often than recommended on the label.
You may occasionally need to try a laxative. If your teen has constipation problems, talk to your teen's doctor before trying laxatives.
- Osmotic laxatives (such as Fleet Phospho-Soda, Milk of Magnesia, or RestoraLAX) and non-absorbable sugars (such as lactulose or sorbitol) hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.
- Stimulant laxatives (such as Ex-Lax) increase the movement of stool through the intestine. Use these preparations sparingly. Overuse of stimulant laxatives decreases the tone and sensation in the large intestine, causing dependence on using laxatives. Regular use may interfere with your body's ability to absorb vitamin D and calcium, which can weaken your bones. Do not use laxatives for longer than 2 weeks without consulting your doctor.
Talk to your doctor before using an enema. Your doctor may need to check your symptoms or may suggest a different way to treat your constipation.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Constipation occurs or continues after 1 week of home treatment.
Rectal pain develops or increases.
Blood in the stool develops or increases.
Uncontrolled leakage of stool occurs.
Your symptoms become more severe or more frequent.

If you have any of these symptoms, you need to be evaluated by a doctor.

Prevention

You can prevent constipation.

Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
Add high-fibre foods to your diet. Try to get 20 to 35 grams of fibre a day. Packaged foods and fibre supplements include the amount of fibre content in the nutrition information. You should increase the amount of fibre in your diet slowly so that your stomach can adjust to the change. Adding too much fibre too quickly may cause stomach upset and gas.
- Eat at least 1½ to 2 cups of fruit a day. Choose whole fruit instead of fruit juice.
- Eat at least 2 to 3 cups of vegetables a day.
Increase the amount of high-fibre foods, such as bran flakes, bran muffins, oatmeal, brown rice, beans, and lentils. Eat brown rice, bulgur, or millet instead of white rice.
- Use whole wheat bread instead of white bread. Choose whole-grain breads and cereals; buy bread that lists whole wheat, stone-ground wheat, or cracked wheat in the ingredients.
- Snack on unbuttered, unsalted popcorn.
- Add 30 mL (2 Tbsp) of wheat bran to cereal or soup. If you do this, start slowly with 7.5 mL (0.5 Tbsp) a day. Gradually increase the amount to 30 mL (2 Tbsp) a day.
- Mix 30 mL (2 Tbsp) of psyllium (found in Metamucil and other bulk-forming agents) with a fluid, and drink it.
Avoid alcohol beverages. They can increase dehydration.
Exercise more. A walking program would be a good start. For more information, see the topic Fitness.
Set aside relaxing times for having bowel movements. Urges usually occur sometime after meals. Establishing a daily routine for bowel movements, such as after breakfast, may help.
Go when you feel the urge. Your bowels send signals when a stool needs to pass. If you ignore the signal, the urge will go away, and the stool will eventually become dry and difficult to pass.

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

Is constipation an ongoing (chronic) problem for you, or is this a new or different problem? If it is chronic, when did it begin?
When did this episode of constipation begin?
When was your last normal bowel movement?
Have you recently changed your diet or fluid intake, decreased your activity level, or started a new medicine?
Have you recently changed your daily routine, such as a change in your job, school, or travel?
What have you tried to correct your constipation? Did it work?
Do you have any rectal bleeding?
Do you have rectal pain before, during, or after a bowel movement? If so, how long does the pain usually last?
Do you have any health risks?