Constipation is an acute or chronic condition in which there is infrequent (3 times per week or less) or difficult (straining more than 25% of the time) evacuation of hard stools which are often painful to pass. Associated symptoms can include bloating, distension, abdominal pain or a sensation of incomplete emptying.
Constipation usually results from a low dietary intake of fibre in foods such as vegetables and fruit, from an inadequate intake of fluids or from not getting enough exercise. Constipation can arise as a side effect of medication in particular opiates and antidepressants and may occur in association with other conditions such as anal fissure (a tear or crack in the lining of the anus); chronic kidney failure; colon or rectal cancer; depression; hypercalcaemia (abnormally high blood calcium levels); hypothyroidism (under active thyroid gland); illnesses requiring complete bed rest and stress.
The diagnosis is made from the reported symptoms and the finding of hard stool which can be felt when examining the abdomen and rectum. Investigation is aimed at confirming the diagnosis and finding any possible contributory factors.
Treatment consists of increasing the intake of dietary fibre and fluids (preferably water) with increased activity if possible. If these measures are unsuccessful then treatment with laxatives (ideally short term) and suppositories or enemas can be considered.