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Constipation, Age 12 and Older
Constipation means having a hard time passing stools and passing fewer stools. Some people are overly concerned with how often they have bowel movements. That's because they've been taught that a healthy person has a bowel movement every day. But this isn't 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 aren't constipated.
You have constipation if you have 3 or fewer bowel movements each week. And you may have some of the following problems:
- Feeling that you don't completely empty your bowels
- Hard stools, or stools that look like pellets
- A feeling of being blocked up
- Not being able to 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. This is caused by bleeding hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. It should stop when the constipation is controlled.
Constipation can also mean the slow movement of stool through the intestines or problems releasing a stool.
Slow transit constipation
Lack of fiber 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.
Outlet delay constipation
Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Straining too much, 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. These include colon cancer, uterine prolapse or rectal prolapse, scarring (adhesions), and 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 is more common in people older than 65. People in this age group are more likely to have poor dietary habits and take more medicines. Older adults also often have less muscular activity of the intestinal tract. This 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.
If a stool can't pass through the rectum (impacted), mucus and fluid may leak out around the stool. This can sometimes lead to leakage of fecal material (fecal incontinence). So you may go back and forth between having constipation and diarrhea.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, 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.
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, herbal remedies, or supplements 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.
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 color 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 coloring 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 nonprescription medicines can cause constipation. A few examples are:
- 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.
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.
Here are some things you can do to help relieve constipation.
- First try healthy habits.
- Try gentle exercise. Take a short walk each day. Bit by bit, increase your walking time until you are walking for at least 20 minutes.
- Make sure you drink enough fluids. Avoid alcohol and caffeine. They 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 fiber 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 having a bowel movement, but don't sit for more than 10 minutes at a time. And don't strain too much.
- Support your feet with a small step stool 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're still constipated, try fiber, stool softeners, or suppositories.
- Add some processed or synthetic fiber—such as Benefiber or Metamucil—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.
- If other treatments don't help, try a laxative.
If your teen has constipation problems, talk to your teen's doctor before trying laxatives.
- Osmotic laxatives (such as Milk of Magnesia or Miralax) and nonabsorbable 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 or bisacodyl) speed up the movement of stool through the intestine. Use these sparingly. Overuse of these 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. Don't use laxatives for longer than 2 weeks without talking to your doctor.
- Talk to your doctor before you use an enema.
Your doctor may need to check your symptoms or may suggest a different way to treat your constipation.
Treating chronic constipation
There are many ways to treat chronic constipation, depending on what's causing it. Many people need to combine treatments. You may have already tried increasing activity or changing your diet.
Your doctor may also suggest some of these treatments.
Fiber helps keep water in your stool, making it softer and easier to pass.
- Drinking more water.
Your body needs water to be able to pass stool.
Some foods have a natural laxative effect, like prunes. There are also laxative medicines. One type (osmotic) holds water in the intestine to make it easier to pass stool. The other type (stimulant) increases movement in the intestine.
- Stool softeners.
These keep stool soft.
- Prescription medicines.
Some medicines may help with your bowels. But others can make constipation worse. Talk with your doctor about everything you take. You may be able to switch to a different medicine that will not cause constipation.
This can help retrain your pelvic floor muscles to know when to relax and when to push.
There are four types of products for preventing or treating constipation.
- Bulking agents.
Food such as bran or products such as Citrucel, Metamucil, Fibercon, or Perdiem ease constipation by absorbing more fluid in the intestines. This makes the stool bigger, which gives you the urge to pass the stool. Regular use of bulking agents is safe and often lets you have more stools.
- Stool softeners.
Products such as Colace lubricate and soften the stool in the intestine, making it easier to pass. Stool softeners do not often cause problems but they don't work as well if you don't drink enough water during the day.
- Osmotic laxatives.
Products such as Fleet Phospho-Soda, Milk of Magnesia, or Miralax and nonabsorbable sugars such as lactulose or sorbitol hold fluids in the intestine and 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.
Products such as Correctol, Dulcolax, Ex-Lax, bisacodyl, or Senokot speed up how fast a stool moves through the intestines by irritating the lining of the intestines. Regular use of stimulant laxatives is not recommended. Stimulant laxatives change the tone and feeling in the large intestine and you can become dependent on using laxatives all the time to have a bowel movement.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- Constipation or changes in the stool that continue after a few days to 1 week of home treatment.
- New or worse rectal pain.
- New or worse blood in the stool.
- Uncontrolled leakage of stool.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: September 8, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine