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{{CMG}}
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{| class="infobox" style="float:right;"
'''Associate Editor-In-Chief:''' {{MUT}}
 
{{Editor Help}}
 
==Overview==
{{DiseaseDisorder infobox |
  Name          = Constipation |
  ICD10          = {{ICD10|K|59|0|k|55}} |
  ICD9          = {{ICD9|564.0}} |
  ICDO          = |
  Image          = |
  Caption        = |
  OMIM          = |
  MedlinePlus    = 003125 |
  eMedicineSubj  = med |
  eMedicineTopic = 2833 |
  DiseasesDB    = 3080 |
}}
{{SI}}
'''Constipation''' or '''irregularity''', is a condition of the [[digestive system]] where a person (or animal) experiences hard [[feces]] that are difficult to [[Defecation|egest]].  It may be extremely painful, and in severe cases (''fecal impaction'') lead to symptoms of [[bowel obstruction]]. The term '''obstipation''' is used for severe constipation. Causes of constipation may be [[diet (nutrition)|diet]]ary, [[hormone|hormonal]], anatomical, a side effect of [[medication]]s (e.g. some [[analgesic|painkillers]]), or an illness or disorder. Treatments consist of changes in dietary and [[exercise]] habits, the use of laxatives, and other medical interventions depending on the underlying cause.
 
==Signs and symptoms==
 
<gallery>
Image:Bristol Stool Chart.png|Types 1 and 2 on the [[Bristol Stool Scale|Bristol Stool Chart]] indicate constipation
</gallery>
 
Constipation is one of the most common digestive complaints. It varies greatly between different people, as each person's bowel movements differ. Rate of defecation is not in itself a problem, as infrequent defecation without problems is not abnormal. Constipation is most common in children and older people, and affects women more than men. In children, constipation can lead to [[soiling]] ([[enuresis]] and [[encopresis]]).
<ref>[http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=111&sectionId=1 NHS direct] page on constipation.</ref>
 
In common constipation, the stool is hard and difficult and painful to pass. Usually, there is an infrequent urge to void. Straining to pass stool may cause [[hemorrhoid]]s and [[anal fissure]]s, which are themselves painful. In later stages of constipation, the abdomen may become distended and diffusely tender and [[cramp]]y, occasionally with enhanced [[borborygmus|bowel sounds]].
 
The definition of constipation includes the following:<ref>[http://www.emedicine.com/med/topic2833.htm Emedicine], "constipation".</ref>
* infrequent bowel movements (typically 3 times or less per week)
* difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or
* the sensation of incomplete bowel evacuation.
 
Severe cases ("fecal impaction") may feature symptoms of bowel obstruction ([[vomiting]], very tender abdomen) and "paradoxical diarrhea", where soft stool from the small intestine bypasses the impacted matter in the [[colon (anatomy)|colon]].
 
==Diagnosis==
 
The diagnosis is essentially made from the patient's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.
 
Inquiring about dietary habits may reveal a low intake of dietary fiber or inadequate amounts of fluids. Constipation as a result of poor ambulation or immobility should be considered in the elderly. Constipation may arise as a [[Adverse effect (medicine)|side effect]] of medications (especially [[antidepressants]] and [[opiates]]). Rarely, other symptoms suggestive of [[hypothyroidism]] may be elicited.
 
During [[physical examination]], ''scybala'' (manually palpable lumps of stool) may be detected on palpation of the abdomen. [[Rectal examination]] gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or [[enema]]s may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.
 
[[X-ray]]s of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms.
 
Chronic constipation (symptoms present for more than 3 months at least 3 days per month) associated with abdominal discomfort is often diagnosed as [[irritable bowel syndrome]] (IBS) when no obvious cause is found.  Physicians caring for patients with chronic constipation are advised to rule out obvious causes through normal testing.<ref>{{cite journal |author=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061}}</ref>
 
==Causes==
The main causes of constipation include:
* Hardening of the feces
** Improper [[mastication]] (chewing) of food
** Insufficient intake of [[dietary fiber]]
** [[Dehydration]] from any cause or inadequate fluid intake
** Medication, e.g. [[diuretic]]s and those containing [[iron]], [[calcium]], [[aluminium]]
* Paralysis or slowed transit, where [[Peristalsis|peristaltic action]] is diminished or absent, so that feces are not moved along
** [[Hypothyroidism]] (slow-acting [[thyroid gland]])
** [[Hypokalemia]]
** Injured [[Anus|anal sphincter]] (patulous [[anus]])
** Medications, such as [[loperamide]], [[opioid]]s (e.g. [[codeine]] & [[morphine]]) and certain [[tricyclic antidepressant]]s
** Severe illness due to other causes
** Acute [[porphyria]] (a rare inherited condition)
** [[Lead poisoning]]
* Dyschezia (usually the result of suppressing defecation)
* Constriction, where part of the [[intestine]] or [[rectum]] is narrowed or blocked, not allowing feces to pass
** [[Stenosis]] (Strictures)
** [[Diverticula]]
** [[Tumor]]s, either of the bowel or surrounding tissues
** Retained [[foreign body]] or a [[bezoar]]
* [[Psychosomatic]] constipation, based on anxiety or unfamiliarity with surroundings.
** [[Functional constipation]]
** Constipation-predominant [[irritable bowel syndrome]], characterized by a combination of constipation and abdominal discomfort and/or pain<ref>{{cite journal |author=Caldarella MP, Milano A, Laterza F, ''et al'' |title=Visceral sensitivity and symptoms in patients with constipation- or diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion |journal=Am. J. Gastroenterol. |volume=100 |issue=2 |pages=383–9 |year=2005 |pmid=15667496 |doi=10.1111/j.1572-0241.2005.40100.x}}</ref>
* [[Smoking cessation]] ([[tobacco smoking]] has a [[laxative]] effect)<ref> {{cite web|url=http://www.helpwithsmoking.com/nicotine-withdrawal.php#constipation |title=Nicotine withdrawal symptoms:Constipation |accessdate=2007-06-29 |date=2005 |publisher=helpwithsmoking.com }}</ref>
* Abdominal surgery, other types of surgery, childbirth
 
===Complete Differential Diagnosis of the Causes of Constipation===
(In alphabetical order)
 
{{MultiCol}}
*[[5-HT3 antagonist]]
*[[5-Hydroxytryptophan]]
*[[Acamprosate (patient information)]]
*[[Acebutolol (patient information)]]
*[[Actiq]]
*[[Acute Intermittent Porphyria]]
*[[Adhesion]]
*[[Adjustable gastric band]]
*[[Aldesleukin (patient information)]]
*[[Alendronate (patient information)]]
*[[Alfentanil Hydrochloride Injection (patient information)]]
*[[Alfuzosin (patient information)]]
*[[Aluminium hydroxide]]
*[[Amiodarone Oral (patient information)]]
*[[Amitriptyline (patient information)]]
*[[Amobarbital (patient information)]]
*[[Amyloidosis]]
*[[Amyotrophic Lateral Sclerosis]]
*[[Anagrelide (patient information)]]
*[[Anal atresia]]
*[[Anastrozole (patient information)]]
*[[Aprepitant (patient information)]]
*[[Aripiprazole (patient information)]]
*[[Ascites]]
*[[Atorvastatin]]
*[[Atovaquone (patient information)]]
*[[Auranofin]]
*[[Autonomic neuropathy]]
*[[Barium Sulfate (patient information)]]
*[[Batten disease]]
*[[Belladonna Alkaloid Combinations and Phenobarbital (patient information)]]
*Benign colonic tumors
*[[Benzatropine]]
*[[Benzonatate (patient information)]]
*[[Bepridil (patient information)]]
*[[Berdon syndrome]]
*[[Bezafibrate]]
*[[Bile acid sequestrant]]
*[[Bismuth Subsalicylate, Metronidazole, and Tetracycline Combination (patient information)]]
*[[Blastocystosis]]
*[[Bortezomib (patient information)]]
*[[Botulism]]
*[[Bowel obstruction]]
*[[Buspirone (patient information)]]
*[[Butabarbital (patient information)]]
*[[Calcitriol]]
*[[Calcium carbonate (patient information)]]
*[[Capecitabine (patient information)]]
*[[Carbamazepine (patient information)]]
*[[Carboplatin (patient information)]]
*[[Carteolol (patient information)]]
*[[Celiac disease]]
*[[Cerivastatin (patient information)]]
*[[Cetuximab Injection (patient information)]]
*[[Chagas Disease]]
*[[Chlordiazepoxide (patient information)]]
*[[Chloropyramine]]
*[[Chlorpropamide]]
*[[Cholestyramine]]
*[[Choline Magnesium Trisalicylate (patient information)]]
*[[Chronic amebiasis]]
*[[Cidofovir Injection (patient information)]]
*[[Cimetidine Hydrochloride Injection (patient information)]]
*[[Cimicifuga racemosa]]
*[[Cisapride (patient information)]]
*[[Cladribine (patient information)]]
*[[Clofarabine Injection (patient information)]]
*[[Clomipramine]]
*[[Clonazepam (patient information)]]
*[[Clonidine]]
*[[Clorazepate (patient information)]]
*[[Clozapine]]
*[[Codeine (patient information)]]
*[[Colesevelam (patient information)]]
*[[Colestipol (patient information)]]
*[[Colofac]]
*Colonic stricture
*[[Colorectal cancer]]
*[[Complications of pregnancy]]
*[[Conn's Syndrome]] (primary aldosteronism)
*[[Cornelia de Lange Syndrome]]
*Corrosive enema
*[[Crohn's disease]]
*[[Cystic fibrosis]]
*[[Daptomycin]]
*[[Darbepoetin Alfa Injection (patient information)]]
*[[Darifenacin (patient information)]]
*[[Darunavir (patient information)]]
*[[Dehydration]]
*Descending perineum syndrome
*[[Desipramine (patient information)]]
*[[Dextroamphetamine and Amphetamine (patient information)]]
*[[Dextropropoxyphene]]
*[[Diabetes Mellitus]]
*[[Diacetyldihydromorphine]]
*[[Diazepam (patient information)]]
*[[Dicyclomine (patient information)]]
*[[Diethylcathinone]]
*[[Diflunisal]]
*[[Dihydroetorphine]]
*[[Diltiazem (patient information)]]
*[[Diphenhydramine]]
*[[Disopyramide (patient information)]]
*[[Diuretic]]
*Diverticular stricture
*[[Diverticulosis]]
*[[Dolasetron Mesylate Injection (patient information)]]
*[[Doripenem]]
*[[Dosulepin hydrochloride]]
*[[Doxepin (patient information)]]
*[[Duloxetine]]
*[[Enfuvirtide Injection (patient information)]]
*[[Enteric Neuropathy]]
*Eosinophilic colitis
*[[Epoetin Alfa Injection (patient information)]]
*[[Esomeprazole (patient information)]]
*[[Estazolam (patient information)]]
*[[Estradiol Topical (patient information)]]
*[[Ethcathinone]]
*[[Ethosuximide]]
*[[Ethylmorphine]]
*[[Etodolac (patient information)]]
*[[Etoposide]]
*Extrinsic compression
*[[Famotidine (patient information)]]
*[[Felbamate (patient information)]]
*[[Felodipine (patient information)]]
*[[Fenofibrate (patient information)]]
*[[Fenoprofen (patient information)]]
*[[Fentanyl Citrate Injection (patient information)]]
{{ColBreak}}
*[[Ferrous Sulfate (Iron) (patient information)]]
*[[Fludarabine Phosphate (patient information)]]
*[[Fluphenazine (patient information)]]
*[[Flurazepam (patient information)]]
*[[Fluvoxamine]]
*[[Food allergy]]
*[[Food intolerance]]
*[[Fructose malabsorption]]
*[[Fulvestrant Injection (patient information)]]
*[[Furosemide (patient information)]]
*[[Gabapentin (patient information)]]
*[[Ganciclovir (patient information)]]
*[[Gastroptosis]]
*[[Gatifloxacin (patient information)]]
*[[Gemcitabine Hydrochloride (patient information)]]
*[[Gemfibrozil (patient information)]]
*[[Glucagonoma]]
*[[Glycopyrrolate (patient information)]]
*[[Granisetron (patient information)]]
*[[Guanethidine (patient information)]]
*[[Guanfacine]]
*[[H2 antagonist]]
*[[Haloperidol]]
*[[Hashimoto's thyroiditis]]
*[[Hernia]]
*[[Heroin]]
*[[Hexamethonium]]
*[[Hirschsprung's disease]]
*[[Hookworm]]
*[[Hydralazine (patient information)]]
*[[Hydroxyurea (patient information)]]
*[[Hydroxyzine]]
*[[Hyoscyamine (patient information)]]
*[[Hypercalcemia]]
*[[Hypervitaminosis D]]
*[[Hypokalemia]]
*[[Hypothyroidism]]
*[[Hypotonia]]
*[[Ibandronate (patient information)]]
*[[Ileus]]
*[[Imatinib (patient information)]]
*[[Imipramine (patient information)]]
*[[Imperforate anus]]
*[[Indomethacin (patient information)]]
*[[Inflammatory Bowel Syndrome]]
*[[Insulin lispro injection (patient information)]]
*[[Interferon Beta-1b Injection (patient information)]]
*[[Internal intussusception]]
*Intestinal pseduoobstruction
*Intraabdominal/pelvic tumors
*[[Intussusception]]
*[[Iron deficiency anemia]]
*[[Iron supplements]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isocarboxazid (patient information)]]
*[[Itraconazole (patient information)]]
*[[Kaolin and Pectin (patient information)]]
*[[Ketogenic diet]]
*[[Ketorolac]]
*Lack of fiber
*[[Lamivudine and Zidovudine (patient information)]]
*[[Lamotrigine (patient information)]]
*[[Lanthanum (patient information)]]
*[[Lassa fever]]
*[[Lead poisoning]]
*[[Letrozole (patient information)]]
*[[Leuprolide (patient information)]]
*[[Levalbuterol Oral Inhalation (patient information)]]
*[[Levetiracetam (patient information)]]
*[[Levodopa and Carbidopa (patient information)]]
*[[Levomethadyl (patient information)]]
*[[Levorphanol Oral (patient information)]]
*[[Linezolid]]
*[[Lofepramine]]
*[[Lomotil]]
*[[Loperamide]]
*[[Loprazolam]]
*[[Lorazepam (patient information)]]
*[[Lovastatin (patient information)]]
*Low fluid intake
*Low-residue diet
*[[Loxapine Oral (patient information)]]
*[[Lymphogranuloma venereum]]
*[[Magaldrate]]
*[[Meclofenamate (patient information)]]
*[[Mefenamic Acid (patient information)]]
*[[Meningocele]]
*[[Meperidine (patient information)]]
*[[Meropenem Injection (patient information)]]
*[[Mesalamine (patient information)]]
*[[Mesoridazine Oral (patient information)]]
*[[Metformin (patient information)]]
*[[Methadone]]
*[[Methsuximide Oral (patient information)]]
*[[Methyprylon]]
*[[Metoclopramide]]
*[[Metoprolol (patient information)]]
*[[Milk-alkali syndrome]]
*[[Misoprostol]]
*[[Modafinil (patient information)]]
*[[MOPP (medicine)]]
*[[Morphine]]
*[[Motofen]]
*[[Multiple endocrine neoplasia (MEN 2b)]]
*[[Muscular dystrophies]]
*[[Mycophenolate (patient information)]]
*[[Myxedema]]
*[[Myxedema]]
*[[Nabumetone (patient information)]]
*[[Nateglinide oral (patient information)]]
*[[Nefazodone (patient information)]]
*[[Neuroblastoma]]
*[[Nialamide]]
*[[Nicardipine (patient information)]]
*[[Nifedipine (patient information)]]
*[[Nilutamide (patient information)]]
*[[Nimodipine (patient information)]]
*[[Nizatidine (patient information)]]
*[[Nortriptyline (patient information)]]
*[[Olanzapine (patient information)]]
*[[Omeprazole (patient information)]]
*[[Ondansetron]]
*[[Opisthorchis infection]]
*[[Osteitis fibrosa cystica]]
*[[Ovarian cancer]]
*[[Oxaliplatin injection (patient information)]]
*[[Oxazepam (patient information)]]
*[[Oxcarbazepine (patient information)]]
*[[Oxybutynin (patient information)]]
{{ColBreak}}
*[[Oxycodone]]
*[[Pamidronate injection (patient information)]]
*[[Pancrelipase (patient information)]]
*[[Panhypopituitarism]]
*[[Papaverine]]
*[[Paralytic ileus]]
*[[Paroxetine]]
*[[Peginterferon alfa-2b (patient information)]]
*[[Pemetrexed injection (patient information)]]
*[[Pergolide (patient information)]]
*[[Perphenazine oral (patient information)]]
*[[Pethidine]]
*[[Phenelzine (patient information)]]
*[[Phentermine (patient information)]]
*[[Phenytoin oral (patient information)]]
*[[Pheochromocytoma]]
*[[Pholcodine]]
*[[Pimozide (patient information)]]
*[[Piperacillin sodium and tazobactam sodium]]
*[[Piroxicam (patient information)]]
*[[Polio]]
*[[Polyp (medicine)]]
*[[Posaconazole (patient information)]]
*[[Pramipexole (patient information)]]
*[[Prazepam (patient information)]]
*[[Prazosin and polythiazide (patient information)]]
*[[Prednisolone]]
*[[Pregabalin (patient information)]]
*[[Primary hyperparathyroidism]]
*[[Procarbazine (patient information)]]
*[[Procyclidine (patient information)]]
*[[Progressive supranuclear palsy]]
*[[Propafenone (patient information)]]
*[[Propantheline]]
*[[Propoxyphene (patient information)]]
*[[Propranolol Oral (patient information)]]
*[[Protriptyline (patient information)]]
*[[Pseudocyesis]]
*[[Pseudohypoparathyroidism]]
*[[Quetiapine]]
*[[Rabeprazole (patient information)]]
*[[Ranitidine (patient information)]]
*[[Ranolazine (patient information)]]
*[[Rasagiline (patient information)]]
*[[Reboxetine]]
*[[Rectal carcinoma]]
*[[Rectocele]]
*[[Renal cell carcinoma]]
*[[Repaglinide (patient information)]]
*[[Rett syndrome]]
*[[Ribavirin (patient information)]]
*[[Rilmenidine]]
*[[Risperidone (patient information)]]
*[[Rivastigmine (patient information)]]
*[[Ropinirole (patient information)]]
*[[Rosuvastatin (patient information)]]
*[[Sacrococcygeal teratoma]]
*[[Saquinavir (patient information)]]
*[[Scleroderma]]
*[[Scopolamine]]
*[[Secobarbital (patient information)]]
*[[Selegiline (patient information)]]
*[[Sevelamer (patient information)]]
*[[Sibutramine]]
*[[Sibutramine]]
*[[Simethicone]]
*[[Simvastatin (patient information)]]
*[[Sirolimus (patient information)]]
*[[Sitaxsentan]]
*[[Smoking cessation]]
*[[Solifenacin]]
*[[Sorafenib (patient information)]]
*[[Sotalol (patient information)]]
*[[SSRI discontinuation syndrome]]
*[[Stomach cancer]]
*[[Sucralfate]]
*[[Sufentanil citrate injection (patient information)]]
*[[Sulindac (patient information)]]
*[[Sunitinib]]
*[[Suxamethonium chloride]]
*[[Syphilis]]
*[[Tamoxifen (patient information)]]
*[[Tapentadol]]
*[[Temazepam (patient information)]]
*[[Temozolomide (patient information)]]
*[[Terazosin]]
*[[Teriparatide (rDNA origin) Injection (patient information)]]
*[[Thalidomide]]
*[[Thioridazine (patient information)]]
*[[Thiothixene Oral (patient information)]]
*[[Tianeptine]]
*[[Tiludronate (patient information)]]
*[[Tinidazole (patient information)]]
*[[Tiotropium]]
*[[Tolterodine]]
*[[Topiramate]]
*[[Topotecan Hydrochloride (patient information)]]
*[[Toxic megacolon]]
*[[Tranylcypromine (patient information)]]
*Travel constipation
*[[Triazolam (patient information)]]
*[[Triclofos]]
*[[Trifluoperazine Oral (patient information)]]
*[[Trihexyphenidyl (patient information)]]
*[[Trimethadione (patient information)]]
*[[Trimipramine (patient information)]]
*[[Tropisetron]]
*[[Trospium (patient information)]]
*[[Tuberculosis]]
*[[Typhoid fever]]
*[[Ulcerative colitis]]
*[[Upper gastrointestinal series]]
*[[Valproic Acid (patient information)]]
*[[Venlafaxine]]
*[[Verapamil]]
*[[Vicodin]]
*[[Vigabatrin]]
*[[Viloxazine]]
*[[Vinblastine (patient information)]]
*[[Vincristine]]
*[[Vinorelbine]]
*[[Visceroptosis]]
*[[Volvulus]]
*[[Vorinostat (patient information)]]
*[[Wandering spleen]]
*[[Zaleplon (patient information)]]
*[[Zidovudine Injection (patient information)]]
*[[Zileuton (patient information)]]
*[[Ziprasidone (patient information)]]
*[[Zoledronic Acid Injection (patient information)]]
*[[Zolpidem (patient information)]]
*[[Zonisamide (patient information)]]
*[[Zotepine]]
{{EndMultiCol}}
 
===Complete Differential Diagnosis of the Causes of Constipation===
(By organ system)
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
| [[File:Siren.gif|link= Constipation resident survival guide|41x41px]]|| <br> || <br>
| '''Chemical / poisoning'''
| [[Constipation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|bgcolor="Beige"| [[Lead poisoning]],
|}
{{Constipation}}


|-
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| 
[[5-HT3 antagonist]],
[[5-Hydroxytryptophan]],
[[Acamprosate (patient information)]],
[[Acebutolol (patient information)]],
[[Actiq]],
[[Aldesleukin (patient information)]],
[[Alendronate (patient information)]],
[[Alfentanil Hydrochloride Injection (patient information)]],
[[Alfuzosin (patient information)]],
[[Aluminium hydroxide]],
[[Amiodarone Oral (patient information)]],
[[Amitriptyline (patient information)]],
[[Amobarbital (patient information)]],
[[Anastrozole (patient information)]],
[[Aprepitant (patient information)]],
[[Aripiprazole (patient information)]],
[[Anagrelide (patient information)]],
[[Atorvastatin]],
[[Atovaquone (patient information)]],
[[Auranofin]],
[[Barium Sulfate (patient information)]],
[[Benzatropine]],
[[Benzonatate (patient information)]],
[[Bepridil (patient information)]],
[[Bezafibrate]],
[[Bile acid sequestrant]],
[[Bortezomib (patient information)]],
[[Buspirone (patient information)]],
[[Butabarbital (patient information)]],
[[Calcitriol]],
[[Calcium carbonate (patient information)]],
[[Capecitabine (patient information)]],
[[Carbamazepine (patient information)]],
[[Carboplatin (patient information)]],
[[Carteolol (patient information)]],
[[Cerivastatin (patient information)]],
[[Cetuximab Injection (patient information)]],
[[Chlordiazepoxide (patient information)]],
[[Chloropyramine]],
[[Chlorpropamide]],
[[Cholestyramine]],
[[Choline Magnesium Trisalicylate (patient information)]],
[[Cidofovir Injection (patient information)]],
[[Cimetidine Hydrochloride Injection (patient information)]],
[[Cisapride (patient information)]],
[[Cladribine (patient information)]],
[[Clofarabine Injection (patient information)]],
[[Clomipramine]],
[[Clonazepam (patient information)]],
[[Clonidine]],
[[Clorazepate (patient information)]],
[[Clozapine]],
[[Codeine]],
[[Codeine (patient information)]],
[[Colesevelam (patient information)]],
[[Colestipol (patient information)]],
[[Colofac]],
[[Daptomycin]],
[[Darbepoetin Alfa Injection (patient information)]],
[[Darifenacin (patient information)]],
[[Darunavir (patient information)]],
[[Desipramine (patient information)]],
[[Dextroamphetamine and Amphetamine (patient information)]],
[[Dextropropoxyphene]],
[[Diacetyldihydromorphine]],
[[Diazepam (patient information)]],
[[Dicyclomine (patient information)]],
[[Diethylcathinone]],
[[Diflunisal]],
[[Dihydroetorphine]],
[[Diltiazem (patient information)]],
[[Diphenhydramine]],
[[Disopyramide (patient information)]],
[[Diuretic]],
[[Dolasetron Mesylate Injection (patient information)]],
[[Doripenem]],
[[Dosulepin hydrochloride]],
[[Doxepin (patient information)]],
[[Duloxetine]],
[[Enfuvirtide Injection (patient information)]],
[[Epoetin Alfa Injection (patient information)]],
[[Esomeprazole (patient information)]],
[[Estazolam (patient information)]],
[[Estradiol Topical (patient information)]],
[[Ethcathinone]],
[[Ethosuximide]],
[[Ethylmorphine]],
[[Etodolac (patient information)]],
[[Etoposide]],
[[Famotidine (patient information)]],
[[Felbamate (patient information)]],
[[Felodipine (patient information)]],
[[Fenofibrate (patient information)]],
[[Fenoprofen (patient information)]],
[[Fentanyl Citrate Injection (patient information)]],
[[Ferrous Sulfate (Iron) (patient information)]],
[[Fludarabine Phosphate (patient information)]],
[[Fluphenazine (patient information)]],
[[Flurazepam (patient information)]],
[[Fluvoxamine]],
[[Fulvestrant Injection (patient information)]],
[[Furosemide (patient information)]],
[[Gabapentin (patient information)]],
[[Ganciclovir (patient information)]],
[[Gatifloxacin (patient information)]],
[[Gemcitabine Hydrochloride (patient information)]],
[[Gemfibrozil (patient information)]],
[[Glycopyrrolate (patient information)]],
[[Granisetron (patient information)]],
[[Guanethidine (patient information)]],
[[Guanfacine]],
[[H2 antagonist]],
[[Haloperidol]],
[[Hexamethonium]],
[[Hydralazine (patient information)]],
[[Hydroxyurea (patient information)]],
[[Hydroxyzine]],
[[Hyoscyamine (patient information)]],
[[Ibandronate (patient information)]],
[[Imatinib (patient information)]],
[[Imipramine (patient information)]],
[[Indomethacin (patient information)]],
[[Insulin lispro injection (patient information)]],
[[Interferon Beta-1b Injection (patient information)]],
[[Iron supplements]],
[[Isocarboxazid (patient information)]],
[[Itraconazole (patient information)]],
[[Kaolin and Pectin (patient information)]],
[[Lamivudine and Zidovudine (patient information)]],
[[Lamotrigine (patient information)]],
[[Lanthanum (patient information)]],
[[Letrozole (patient information)]],
[[Leuprolide (patient information)]],
[[Levalbuterol Oral Inhalation (patient information)]],
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[[Levodopa and Carbidopa (patient information)]],
[[Levomethadyl (patient information)]],
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[[Linezolid]],
[[Lofepramine]],
[[Lomotil]],
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[[Loprazolam]],
[[Lorazepam (patient information)]],
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[[Oxcarbazepine (patient information)]],
[[Oxybutynin (patient information)]],
[[Oxycodone]],
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[[Paroxetine]],
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[[Pergolide (patient information)]],
[[Perphenazine oral (patient information)]],
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[[Zolpidem (patient information)]],
[[Zonisamide (patient information)]],
[[Zotepine]],


{{CMG}}; '''Associate Editor-In-Chief:''' {{EG}}


|-
{{SK}}Hard stool, Hard feces, Idiopathic constipation.
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|
[[Conn's Syndrome]] ([[primary aldosteronism]]),
[[Diabetes Mellitus]],
[[Glucagonoma]],
[[Hypothyroidism]],
[[Myxedema]],
[[Panhypopituitarism]],
[[Pheochromocytoma]],
[[Pseudohypoparathyroidism]],


|-
==[[Constipation overview|Overview]]==
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| Change of environment,
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
[[Adhesion]],
[[Anal atresia]], [[malformation]], [[stenosis]],
[[Ascites]],
Benign colonic [[tumor]]s,
[[Bowel obstruction]],
[[Celiac disease]],
[[Crohn's disease]],
Chronic [[amebiasis]]],
Colonic stricture,
[[Colorectal Cancer]],
Corrosive enemas
Descending perineum syndrome,
Diverticular stricture,
[[Diverticulitis]],
Extrinsic compression,
Eosinophilic colitis,
[[Gastroptosis]],
[[Hernia]],
[[Hirschsprung's Disease]],
[[Ileus]],
[[Imperforate anus]],
[[Inflammatory Bowel Syndrome]],
Intraabdominal/pelvic tumors,
[[Intussusception]],
[[Irritable Bowel Syndrome]],
Ischemic colitis,
[[Paralytic ileus]],
[[Perianal abscess]],
[[Proctitis]] (ulcerative),
Rectal, [[anal carcinoma]],
[[Rectal prolapse]],
Rectal ulcer,
[[Rectocele]], enterocele
[[Ulcerative colitis]],
[[Volvulus]],
[[Wandering spleen]],
|-


|-bgcolor="LightSteelBlue"
==[[Constipation historical perspective|Historical Perspective]]==
| '''Genetic'''
|bgcolor="Beige"| 
Hereditary internal anal sphincter [[myopathy]],
[[Batten disease]],
[[Cornelia de Lange Syndrome]],
[[Cystic fibrosis]],


|-
==[[Constipation classification|Classification]]==
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|
[[Acute Intermittent Porphyria]],
[[Amyloidosis]],


|-
==[[Constipation pathophysiology|Pathophysiology]]==
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|
Postoperative disorder,
[[Adjustable gastric band]],
[[Upper gastrointestinal series]],


|-
==[[Constipation causes|Causes]]==
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Blastocystosis]],
[[Botulism]],
[[Chagas Disease]],
[[Chronic amebiasis]],
[[Hookworm]],
[[Lassa fever]],
[[Lymphogranuloma venereum]],
[[Syphilis]],
[[Tuberculosis]],
[[Typhoid fever]],
[[Opisthorchis infection]],
[[Polio]],


|-
==[[Constipation differential diagnosis|Differentiating Constipation from Other Diseases]]==
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Osteitis fibrosa cystica]],


|-
==[[Constipation epidemiology and demographics|Epidemiology and Demographics]]==
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Amyloidosis]],
[[Amyotrophic Lateral Sclerosis]],
[[Autonomic neuropathy]],
[[Chagas Disease]],
[[Diabetes Mellitus]],
[[Hirschsprung's Disease]],
Intestinal pseduoobstruction,
[[Meningocele]],
[[Multiple endocrine neoplasia]] (MEN 2b),
[[Multiple Sclerosis]],
Muscular dystrophies,
[[Neurofibromatosis]],
[[Paraplegia]],
[[Parkinson's Disease]],
[[Scleroderma]],
Spinal lesions,
[[Tabes Dorsalis]],
[[Progressive supranuclear palsy]],


==[[Constipation risk factors|Risk Factors]]==


|-
==[[Constipation screening|Screening]]==
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Food intolerance]],
[[Hypercalcemia]],
[[[Hypokalemia]],
[[Hypervitaminosis D]],
[[Iron deficiency anemia]],
Lack of fiber,
Low fluid intake,
Low-residue diet,
Starvation,
[[Ketogenic diet]],
[[Milk-alkali syndrome]],


|-
==[[Constipation natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|  [[Endometriosis]],
[[Ovarian cancer]],
[[Complications of pregnancy]],


|-
==Diagnosis==
|-bgcolor="LightSteelBlue"
[[Constipation history and symptoms| History and Symptoms]] | [[Constipation physical examination | Physical Examination]] | [[Constipation laboratory findings|Laboratory Findings]] | [[Constipation abdominal x ray|Abdominal X Ray]] |  [[Constipation CT|CT]] | [[Constipation MRI|MRI]] | [[Constipation ultrasound|Ultrasound]] | [[Constipation other imaging findings|Other Imaging Findings]] | [[Constipation other diagnostic studies|Other Diagnostic Studies]]
| '''Oncologic'''
|bgcolor="Beige"|[[Colorectal Cancer]],
[[Benign colonic [[tumor]]s,]],
[[Multiple endocrine neoplasia (MEN 2b),]],
[[Neuroblastoma]],
[[Rectal carcinoma]],
[[Renal cell carcinoma]],
[[Stomach cancer]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Acamprosate (patient information)]],
[[Haloperidol]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|
Obsessive/compulsive disorder,
Psychosis,
[[Pseudocyesis]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Uremia]],
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
[[Scleroderma]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| Spinal cord injury,
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| Urogenital tumors
 
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Berdon syndrome]],
Corrosive enemas,
[[Dehydration]],
Dietary change’s,
Fasting, reduced food intake,
Eating disorder,
Emotional stress ,
Extended bed rest,
[[Food allergy]],
[[Hypotonia]],
Idiopathic constipation,
Repressed urge to defecate,
[[Rett syndrome]],
[[Smoking cessation]],
[[SSRI discontinuation syndrome]],
Travel constipation,
|-
|}
== Physical Examination ==
 
* Complete physical examination including thyroid examination
 
=== Abdomen ===
 
* Examination of abdomen:
*:* Palpate for masses
*:* Surgical scars
*:* [[Hernia]]s
*:* Hepatosoplenomegaly
*:*:* Examination results are usually normal
 
=== Other ===
 
* Complete rectal examination with attention paid to:
*:* Presence of stool
*:* Masses
*:* [[Fistula]]s
*:* [[Hemorrhoid]]s
*:* [[Abscess]]es
*:* [[Fissure]]s
*:* Squeezing and resting of sphincter tone
*:* Palpable relaxation of anal tone and perineal descents
 
== Laboratory Findings ==
 
* [[Complete blood count]] ([[CBC]])
* [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]
* [[Phosphate]]
* [[Glucose]]
* [[Liver function test]]s ([[LFT]]s)
* Fecal occult blood test
* [[Thyroid function test]]s
* [[Calcium]]
 
=== Echocardiography or Ultrasound ===
* [[Ultrasound]] may be used to detect [[tumor]]s, [[fibroid]]s, [[ovarian cyst]]s or [[pregnancy]]
 
=== Other Diagnostic Studies ===
* Colonoscopy for patients:
*:* Greater than 50 years old
*:* Present with constipation with no apparent cause
*:* Presence of blood in the stool
* Sigmoidoscopy for all other patients
* To rule out ova and parasites, a stool examination should be considered


==Treatment==
==Treatment==
[[Constipation medical therapy|Medical Therapy]] | [[Constipation surgery|Surgery]] | [[Constipation primary prevention|Primary Prevention]] | [[Constipation secondary prevention|Secondary Prevention]] | [[Constipation cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Constipation future or investigational therapies|Future or Investigational Therapies]]


In people without medical problems, the main intervention is to increase the intake of fluids (preferably [[water]]) and [[dietary fiber]]. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation.
==Case Studies==
 
[[Constipation case study one|Case #1]]
In alternative and traditional medicine, [[Enema|colonic irrigation]], enemas, exercise, diet and herbs are used to treat constipation.
 
===Laxatives===
{{main|laxative}}
[[Laxative]]s may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of [[melanosis coli]].
 
===Physical intervention===
Constipation that resists all the above measures requires physical intervention. ''Manual disimpaction'' (the physical removal of impacted stool) is done by patients who have lost control of their bowels secondary to spinal injuries. Manual disimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual disimpaction can occasionally be done under [[sedation]] or a [[General anaesthetic|general anesthetic]]—this avoids pain and loosens the anal sphincter.
 
Many of the products are widely available [[over-the-counter drug|over-the-counter]]. [[Enema]]s and [[clyster]]s are a remedy occasionally used for hospitalized patients in whom the constipation has proven to be severe, dangerous in other ways, or resistant to laxatives. [[Sorbitol]], [[Glycerol|glycerin]] and [[Peanut oil|arachis oil]] [[Suppository|suppositories]] can be used. Severe cases may require [[phosphate]] solutions introduced as enemas.
 
==Prevention==


Constipation is usually easier to prevent than to treat. The relief of constipation with osmotic agents, i.e. lactulose, [[polyethylene glycol]] (PEG), or magnesium salts, should immediately be followed with prevention using increased fiber (fruits, vegetables, and grains) and a nightly decreasing dose of osmotic laxative. With continuing narcotic use, for instance, nightly doses of osmotic agents can be given indefinitely (without harm) to cause a daily bowel movement.
Recent controlled studies have questioned the role of physical exercise in the prevention and management of chronic constipation, while exercise is often recommended by published materials on the subject.
In various conditions (such as the use of [[codeine]] or [[morphine]]), combinations of hydrating (e.g. [[lactulose]] or [[Diol|glycols]]), bulk-forming (e.g. [[psyllium]]) and  stimulant agents may be necessary to prevent constipation.
==Epidemiology==
Depending on the definition employed, constipation occurs in 2% of the population; it is more common in women, the elderly and children <ref>{{cite journal |author=Sonnenberg A, Koch TR |title=Epidemiology of constipation in the United States |journal=Dis. Colon Rectum |volume=32 |issue=1 |pages=1–8 |year=1989 |pmid=2910654 |doi=}}</ref>
==In animals==
[[Hibernation|Hibernating]] animals can experience [[tappen]]s that are usually expelled in the spring. For example, bears eat many foods that create a "rectal plug" before hibernation.
==See also==
* [[Diarrhea]]
* [[Feces]]
==References==
<div class="references-small"><references/></div>
==External links==
* {{MerckHome|09|129|b}}
* {{MedlinePlusOverview|constipation}}
{{SIB}}
{{Gastroenterology}}
{{Gastroenterology}}
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[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
 
 
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Latest revision as of 21:07, 29 July 2020
Resident
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Eiman Ghaffarpasand, M.D. [2]

Synonyms and keywords:Hard stool, Hard feces, Idiopathic constipation.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Constipation from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Abdominal X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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