Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2005;71(3):539-540

What is constipation?

When you have trouble having bowel movements, you have constipation. Your stools may be very hard, making them so difficult to pass that you have to strain and push. Or you may feel like you still need to have a bowel movement after you just had one.

How often should I have a bowel movement?

Not everyone has bowel movements once a day. Do not believe ads that say you must have a daily bowel movement to be “regular.” A normal range is generally from three times a day to three times a week. You may be getting constipated if you begin to have bowel movements much less often than you usually do.

Tips on preventing constipation

  • Do not resist the urge to have a bowel movement.

  • Set aside time to have a bowel movement. A good time may be after breakfast or any other meal.

  • Eat more fiber.

  • Drink plenty of fluids—at least eight glasses a day. Fluids can include water, juices, soup, tea, and other drinks.

  • Do not take laxatives too often.

  • Exercise or move around more.

What causes constipation?

As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motions).

A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating enough fiber, taking certain medicines, not going to the bathroom when you have the urge to have a bowel movement, and regularly using laxatives. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation.

How is constipation treated?

The main thing in treating constipation is to be sure you are eating enough fiber and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how much you exercise also will help.

Talk to your doctor if you notice any blood in your stools, if constipation is new and unusual for you, if you are constipated for three weeks or more, or if it is causing you pain.

What should I eat?

Eat plenty of fiber (see the box below). Two to four servings of fruits and three to five servings of vegetables a day is ideal. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal.

If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water, too.

Should I use laxatives?

Laxatives usually should be avoided. They are not meant for long-term use. Bulk-forming laxatives are OK for you, though.

Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. You can take bulk-forming laxatives every day. They include oat bran, psyllium (one brand: Metamucil), polycarbophil (one brand: FiberCon), and methylcellulose (one brand: Citrucel).

Foods rich in fiber

  • Unprocessed wheat bran

  • Unrefined breakfast cereals

  • Whole wheat and rye flours

  • Grainy breads, such as whole wheat, rye, or pumpernickel

  • Fresh fruits

  • Dried fruits, such as prunes, apricots, and figs

  • Vegetables

  • Beans, such as chickpeas, baked beans, and lima beans

How are bulk-forming laxatives used?

You must take bulk-forming laxatives daily for the best effect. Follow the directions on the label. Start with a little bit and drink lots of fluids. Gradually increase how much bulk-forming laxative you take every three to five days (as you get used to it) until you get the effect you want.

You can help bulk-forming laxatives taste better by mixing them with fruit juice.

Do bulk-forming laxatives have side effects?

You may notice some bloating, gas, or cramping at first, especially if you start taking too much or increase the amount you are using too quickly. These symptoms should go away in a few weeks or less.

What if I have been using laxatives for a long time?

You may have to retrain your body to go without laxatives if you have been using them for a long time. This means eating lots of fiber and taking a bulk-forming laxative, drinking plenty of water, exercising, and learning to give yourself time to have a bowel movement.

If you have taken laxatives for a long time, your doctor may suggest that you wean yourself off them slowly to give your system a chance to return to normal. It may take many months for your bowels to get back to normal if you have been using laxatives or enemas regularly. Talk with your doctor about any concerns you might have.

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Copyright © 2005 by the American Academy of Family Physicians.

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