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Constipation is most often defined as having a bowel movement less than three times per week. It usually is associated with hard stools or difficulty passing stools. You may have pain while passing stools or may be unable to have a bowel movement after straining or pushing for more than ten minutes.

Normal bowel movements are different for each person. You may not have a bowel movement every day. Although some healthy people always have soft or near-runny stools, others have firm stools, but have no trouble passing them.

When you rarely have a bowel movement, or it takes a lot of effort to pass stool, you have constipation. Passing large, wide or hard stools may tear the anus, especially in children. This can cause bleeding and may lead to an anal fissure.

Common causes

Constipation is most often caused by:

• Low-fiber diet
• Lack of physical activity
• Not drinking enough water
• Delay in going to the bathroom when you have the urge to move your bowels

Stress and travel can also contribute to constipation or other changes in bowel habits.
Other causes of constipation may include:

• Colon cancer
• Diseases of the bowel, such as irritable bowel syndrome
• Mental health disorders
• Nervous system disorders
• Pregnancy
• Underactive thyroid
• Use of certain medications

Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.

Home care

Children and adults should get enough fiber in their diet. Vegetables, fresh fruits, dried fruits, and whole wheat, bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, drink plenty of fluids to help pass the stool.

Regular exercise may also help establish regular bowel movements. If you are confined to a wheelchair or bed, change position often.

Also do abdominal exercises and leg raises. A physical therapist can recommend exercises that you can do.

Stool softeners (such as those containing docusate sodium) may help. Bulk laxatives such as psyllium may help add fluid and bulk to the stool. Suppositories or gentle laxatives, such as milk of magnesia liquid, may help you have regular bowel movements.

Enemas or stimulant laxatives should only be used in severe cases. These methods should be used only if fiber, fluids, and stool softeners do not provide enough relief. 

When to call your health care provider

Call your doctor immediately if you have sudden constipation with abdominal cramps and you cannot pass gas or stool. Do not take any laxatives.

Also call your doctor if you have:

• Been using laxatives for several weeks or self care is not working
• Blood in your stool
• Constipation alternating with diarrhea
• Rectal pain
• Sharp or severe abdominal pain, especially if you also have bloating
• Thin, pencil-like stools
• Unexplained weight loss

Prevention

Avoiding constipation is easier than treating it, but involves the same lifestyle measures:

• Drink plenty of fluids each day (at least eight glasses of water per day)
• Eat lots of fiber
• Exercise regularly
• Go to the bathroom when you have the urge. Don't wait.