Constipation in adults

Constipation is a common problem in adults. It is characterized by less frequent bowel movements and stools that are difficult to pass. Stools are harder and may not seem to pass completely.

Certain criteria are used to detect constipation. Stools must rarely be loose or liquid without the use of laxatives. The possibility of irritable bowel syndrome must also be ruled out. In addition, in 25% of bowel movements, at least 2 of the following symptoms must be present for 3 months:

• Straining on bowel movements
• Hard or lumpy stools
• Feeling of incomplete evacuation
• Sensation of a blockage in the rectum
• Use of manual extraction (e.g. using a finger to evacuate a stool)
• Fewer than 3 spontaneous bowel movements per week.

It is important to note that the normal frequency of bowel movements is not the same for everyone and that it is not necessary to have a bowel movement every day. Some people may have a bowel movement 3 times a week while others may go 1 to 3 times a day.

Causes and triggers

Several factors can contribute to constipation, such as:

• Diet (especially a low-fibre diet)
• Certain medications
• Certain diseases
• Excessive use of certain laxatives
• Age: constipation is more common in older adults

Regular or excessive use of certain laxatives can make bowel movements dependent on these medications. Therefore, they should not be used over a long period of time without the advice of your health care provider.

Rarely, constipation may be the first manifestation of a disease (e.g., diabetes, obstructive bowel disease) or neurological condition.

In many cases, identifying the cause of constipation is impossible.

Treatment

You can take the following steps to relieve and/or prevent constipation:

• Go to the bathroom as soon as you feel the urge to have a bowel movement.
• Establish a routine for regular bowel movements (the bowels are most active after breakfast).
• Place a stool in front of the toilet to rest your feet on so that you are in the ideal position for moving your bowels.
• Exercise regularly
• Add more fibre to your diet (fruits, vegetables, legumes, and whole grains all contain fibre).
  • In Canada, the recommended daily intake of fibre is 25 g for women and 38 g for men.
  • Increase your fibre intake gradually to reduce any unpleasant effects, such as flatulence, intestinal sounds, cramps, and diarrhea.
• Drink enough water, especially if you increase your fibre intake.

If these measures do not work, consult your health care provider. A health assessment and review of your medication list may be necessary to recommend a treatment or course of action.

When should I see a health care professional?

Speak with your health care provider in the following cases:

• You continue to be constipated even after taking laxatives for 2 weeks.
• You have not had a bowel movement for more than 7 days even after taking laxatives.
• You experience severe pain when you have a bowel movement or severe and persistent stomach pain.
• You have blood or mucus in your stool.
• You have unexplained weight loss.
• You have symptoms of weakness or fever that accompany the constipation.
• You feel a mass in your rectum.
• You have recently had stomach surgery.
• You have a history of colon cancer in your family.