Constipation causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Overview

Constipation in adults is a common health issue which may be due to medications use like antispasmodics, anticholinergics, analgesics or may be associated with systemic disorders like diabetes mellitus, hypothyroidism etc. Idiopathic constipation is considered once when the secondary causes are ruled out and may be associated with normal or slow colonic transit, defecatory dysfunction, or both. Constipation, a common problem throughout childhood, often resolves with age after proper guidance regarding diet, toilet training, and toileting behaviors.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Atropine poisoning
• Hypokalemia
• Lead poisoning
• Opium poisoning
• Severe dehydration
• Spinal cord injury
• Superior mesenteric artery occlusion
• Volvulus

Common Causes

The main causes of constipation include:

• Hardening of the feces
  • Improper mastication (chewing) of food
  • Insufficient intake of dietary fiber
  • Dehydration
  • Medications (aluminium, calcium, diuretic, iron)
• Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along
  • Hypothyroidism
  • Hypokalemia
  • Injured anal sphincter (patulous anus)
  • Medications (loperamide, codeine, morphine and certain tricyclic antidepressants
  • Severe illness due to other causes
  • Acute intermittent porphyria
  • 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
  • Diverticulosis
  • Pelvic masses
  • Retained foreign body or a bezoar
• Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
  • Functional constipation
  • Irritable bowel syndrome
• Smoking cessation
• Abdominal surgery
• Childbirth

Causes by Organ System

Cardiovascular	Iliac artery aneurysm, superior mesenteric artery occlusion
Chemical / poisoning	Atropine poisoning, lead poisoning, opium poisoning
Dermatologic	No underlying causes
Drug Side Effect	5-HT3 antagonist, 5-hydroxytryptophan, acamprosate, acebutolol, aldesleukin, alendronate, alfentanil, alfuzosin, alosetron, aluminium hydroxide, amiodarone, amitriptyline, amlodipine, amobarbital, anagrelide, anastrozole, aprepitant, aripiprazole, atorvastatin, atovaquone, atropine, auranofin, barium sulfate, benzatropine, benzonatate, bepridil, beta blockers bezafibrate, bile acid sequestrant, bortezomib, buspirone, butabarbital, calcitriol, calcium carbonate, capecitabine, carbamazepine, carbidopa, carboplatin, carfilzomib, carteolol, cerivastatin, cetuximab, chlordiazepoxide, chloropyramine, chlorpromazine, chlorpropamide, cholestyramine, cidofovir, cimetidine, cisapride, citalopram, cladribine, clofarabine, clomipramine, clonazepam, clonidine, clorazepate, clozapine, codeine, colesevelam, colestipol, colofac, cyclizine, daptomycin, darbepoetin alfa, darifenacin, darunavir, desipramine, desvenlafaxine, dextroamphetamine, dextropropoxyphene, diacetyldihydromorphine, diazepam, dicyclomine, diethylcathinone, diflunisal, dihydroetorphine, diltiazem, dimenhydrinate, diphenhydramine, disopyramide, diuretic, dolasetron, dolasetron, doripenem, dosulepin hydrochloride, doxepin, droperidol, duloxetine, enfuvirtide, epoetin alfa, esomeprazole, estazolam, estradiol, ethcathinone, ethosuximide, ethylmorphine, etodolac, etoposide, everolimus, famotidine, felbamate, felodipine, fenofibrate, fenoprofen, fentanyl, ferrous sulfate, fludarabine phosphate, fluorouracil, fluoxetine, fluphenazine, flurazepam, fluvoxamine, fulvestrant, furosemide, gabapentin, ganciclovir, gatifloxacin, gemcitabine, gemfibrozil, glycopyrrolate granisetron, guanethidine, guanfacine, H2 antagonist, haloperidol, hexamethonium, histone deacetylase inhibitors, hydralazine, hydrocodone, hydroxyurea, hydroxyzine, hyoscyamine, ibandronate, imatinib, imipramine, indomethacin, insulin lispro, interferon beta-1b, ipratropium, iron supplements, isocarboxazid, isradipine, itraconazole, kaolin, lacidipine, lamivudine, lamotrigine, lanthanum, letrozole, leuprolide, levalbuterol, levetiracetam, levodopa, levomethadyl, levorphanol, linezolid, lofepramine, lomotil, loperamide, loprazolam, lorazepam, lovastatin, loxapine, magaldrate, meclizine, meclofenamate, mefenamic acid, meperidine, meropenem, mesalamine, mesoridazine, metformin, methadone, methsuximide, methyprylon, metoprolol, milnacipran, misoprostol, modafinil, morphine, motofen, nabumetone, nateglinide, nefazodone, nicardipine, nifedipine, nilutamide, nimodipine, nisoldipine, nizatidine, nortriptyline, olanzapine, omeprazole, ondansetron, oxaliplatin, oxazepam, oxcarbazepine, oxybutynin, oxycodone, palonosetron, pamidronate, pancrelipase, paroxetine, peginterferon alfa-2b, pemetrexed, pergolide, perphenazine, pethidine, phenelzine, phentermine, phenytoin, pholcodine, pimozide, piperacillin sodium, piroxicam, posaconazole, pramipexole, prazepam, prazosin, prednisolone, pregabalin, procarbazine, prochlorperazine, procyclidine, promethazine, propafenone, propantheline, propoxyphene, propranolol, protriptyline, quetiapine, rabeprazole, ranitidine, ranolazine, rasagiline, reboxetine, repaglinide, ribavirin, rilmenidine, risperidone, rivastigmine, ropinirole, rosuvastatin, saquinavir, scopolamine, scopolamine, secobarbital, selegiline, sertraline, sevelamer, sibutramine, simethicone, simvastatin, sirolimus, sitaxsentan, sorafenib, sotalol, sucralfate, sufentanil, sulindac, sunitinib, suxamethonium chloride, tamoxifen, tapentadol, tegaserod, temazepam, temozolomide, terazosin, teriparatide, thalidomide, thioridazine, thiothixene, tianeptine, tiludronate, tinidazole, tiotropium, tolterodine, topiramate, topotecan, tranylcypromine, triazolam, triclofos, trifluoperazine, trihexyphenidyl, trimethadione, trimipramine, tropisetron, trospium, valproic acid, venlafaxine, verapamil, vicodin, vigabatrin, viloxazine, vinblastine, vincristine, vindesine, vinorelbine, vorinostat, zaleplon, zidovudine, zileuton, ziprasidone, zoledronic acid, zolpidem, zonisamide, zotepine
Ear Nose Throat	No underlying causes
Endocrine	Conn's syndrome, diabetes mellitus, glucagonoma, Hashimoto's thyroiditis, hyperparathyroidism, hypothyroidism, multiple endocrine neoplasia, myxedema, panhypopituitarism, parathyroid adenoma, pheochromocytoma, primary parathyroid hyperplasia, pseudohypoparathyroidism
Environmental	Cow’s milk intolerance
Gastroenterologic	Anal atresia, anal carcinoma, ascites, bowel adhesion, bowel obstruction, cap polyposis, celiac disease, chronic amebiasis, colectomy, colonic stricture, colorectal cancer, congenital malformation, corrosive enemas, Crohn's disease, diverticular stricture, diverticulitis, enterocele, eosinophilic colitis, extrinsic compression, gastroptosis, hernia, Hirschsprung's disease, ileus, imperforate anus, inflammatory bowel disease, intraabdominal/pelvic tumors, intussusception, irritable bowel syndrome, ischemic colitis, megacolon, megarectum, painful defecation, paralytic ileus, pelvic masses, pelvic tumors, perianal abscess, proctitis, rectal cancer, rectal prolapse, rectal ulcer, rectocele, ulcerative colitis, visceral myopathies, volvulus, wandering spleen
Genetic	Batten disease, cerebral palsy, Cornelia de Lange syndrome, cystic fibrosis, Down syndrome, gastroschisis, hereditary coproporphyria, hereditary internal anal sphincter myopathy, megacolon, megarectum, Prune belly syndrome
Hematologic	Acute intermittent porphyria, amyloidosis, hereditary coproporphyria, iron deficiency anemia
Iatrogenic	Adjustable gastric band, colectomy, painful defecation peritoneal dialysis, postoperative complications, postoperative ileus, toilet training issues, upper gastrointestinal series
Infectious Disease	Blastocystosis, botulism, chagas disease, chronic amebiasis, hookworm, lassa fever, lymphogranuloma venereum, syphilis, tuberculosis, typhoid fever, opisthorchis infection, polio
Musculoskeletal / Ortho	Ankylosing spondylitis, Guillain-Barre syndrome, Lambert-Eaton myasthenic syndrome, muscular dystrophy, osteitis fibrosa cystica, paraplegia, spinal cord injury, spinal cord tumor
Neurologic	Amyotrophic lateral sclerosis, autonomic neuropathy, cerebral palsy, chagas disease, chronic inflammatory demyelinating polyneuropathy, diabetes mellitus, Guillain-Barre syndrome, Hirschsprung's disease, intestinal neuronal dysplasia, Lambert-Eaton myasthenic syndrome, meningocele, multiple sclerosis, muscular dystrophy, neurofibromatosis, occult spinal dysraphism sequence, paraplegia, parkinson's disease, progressive supranuclear palsy, pseduoobstruction, scleroderma, spina bifida, spinal cord injury, spinal cord lesions, static encephalopathy, tabes dorsalis, tethered spinal cord syndrome
Nutritional / Metabolic	Cow’s milk intolerance, food intolerance, hypercalcemia, hypervitaminosis D, hypokalemia, iron deficiency anemia, ketogenic diet, lack of fiber, low residue diet, milk-alkali syndrome, severe dehydration, starvation
Obstetric/Gynecologic	Berdon syndrome, childbirth, complication of pregnancy, extremely low birth weight, ovarian cancer, rectovaginal or bowel endometriosis, uterine fibroid
Oncologic	Colorectal cancer, intraabdominal/pelvic tumors, multiple endocrine neoplasia (MEN 2b), neuroblastoma, ovarian cancer, parathyroid adenoma, rectal carcinoma, renal cell carcinoma, sacrococcygeal teratoma, spinal cord tumor, stomach cancer, uterine fibroid
Opthalmologic	No underlying causes
Overdose / Toxicity	Acamprosate, amiodarone, atropine, carboplatin, fentanyl, phenytoin, hypervitaminosis D, haloperidol
Psychiatric	Anorexia nervosa, autism, bipolar disorder, eating disorder, emotional stress, major depression, obsessive compulsive disorder, pseudocyesis, psychosis
Pulmonary	Cystic fibrosis
Renal / Electrolyte	Hypercalcemia, hypokalemia, renal cell carcinoma, severe dehydration, uremia
Rheum / Immune / Allergy	Amyotrophic lateral sclerosis, ankylosing spondylitis, chronic inflammatory demyelinating polyneuropathy, Cow’s milk intolerance, food intolerance, Guillain-Barre syndrome, Lambert-Eaton myasthenic syndrome, Rett syndrome, scleroderma
Sexual	Tabes dorsalis
Trauma	Spinal cord injury
Urologic	Urogenital neoplasm
Miscellaneous	Dietary pattern change, dieting, extended bed rest, functional constipation, idiopathic, normal aging, smoking cessation, SSRI discontinuation syndrome, travel constipation

Causes in Alphabetical Order

5-HT3 antagonist 5-Hydroxytryptophan Abdominal surgery Acamprosate Acebutolol Acute intermittent porphyria Adjustable gastric band Aldesleukin Alendronate Alfentanil Alfuzosin Alosetron Aluminium hydroxide Amantadine Amiodarone Amitriptyline Amlodipine Amobarbital Amyloidosis Amyotrophic lateral sclerosis Anagrelide Anal atresia Anastrozole Ankylosing spondylitis Anorexia nervosa Aprepitant Aripiprazole Ascites Atorvastatin Atovaquone Atropine Atropine Auranofin Autism Autonomic neuropathy Barium sulfate Batten disease Belladonna Benzatropine Benzonatate Bepridil Berdon syndrome Beta blockers Bezafibrate Bile acid sequestrant Bipolar disorder Bismuth subsalicylate Blastocystosis Bortezomib Botulism Bowel obstruction Bromocriptine Buspirone Butabarbital Cabergoline Calcitriol Calcium carbonate Cap polyposis Capecitabine Carbamazepine Carboplatin Carfilzomib Carteolol Celiac disease Cerebral palsy Cerivastatin Cetuximab Chagas disease Childbirth Chlordiazepoxide Chloropyramine Chlorpheniramine Chlorpromazine Chlorpropamide Cholestyramine Chronic amebiasis Chronic inflammatory demyelinating polyneuropathy Chronic intestinal pseudo-obstruction Cidofovir Cilansetron Cimetidine Cimicifuga racemosa Cinnarizine Cisapride Citalopram Cladribine Clofarabine Clomipramine Clonazepam Clonidine Clorazepate Clozapine Codeine Colectomy Colesevelam Colestipol Colestyramine Colofac Colorectal cancer Conn's syndrome Cornelia de Lange Syndrome Corrosive enema Cow’s milk intolerance Crohn's disease Cyclizine Cystic fibrosis Daptomycin Darbepoetin alfa Darifenacin Darunavir Dehydration Dermatitis herpetiformis Desipramine Desvenlafaxine Dextroamphetamine Dextropropoxyphene Diabetes mellitus Diacetyldihydromorphine Diazepam Dicyclomine Dietary pattern change Diethylcathinone Dieting Diflunisal Dihydroetorphine Diltiazem Dimenhydrinate Diphenhydramine Diphenoxylate Disopyramide Diuretic Diverticular stricture, Diverticulosis Dolasetron Doripenem Dosulepin hydrochloride Doxepin Droperidol Duloxetine Enfuvirtide Eosinophilic colitis Epoetin Alfa Esomeprazole Estazolam Estradiol Ethcathinone Ethosuximide Ethylmorphine Etodolac Etoposide Everolimus Extended bed rest Extremely low birth weight Extrinsic compression Famotidine Felbamate Felodipine Fenofibrate Fenoprofen Fentanyl Ferrous sulfate Fludarabine phosphate

Fluorouracil Fluoxetine Fluphenazine Flurazepam Fluvoxamine Food allergy Food intolerance Fructose malabsorption Fulvestrant Functional constipation Furosemide Gabapentin Ganciclovir Gastroptosis Gatifloxacin Gemcitabine Gemcitabine Gemfibrozil Glucagonoma Glycopyrrolate Granisetron Guanethidine Guanfacine Guillain-Barre syndrome H2 antagonist Haloperidol Hashimoto's thyroiditis Hereditary coproporphyria Hernia Heroin Hexamethonium Hirschsprung's disease Histone deacetylase inhibitors Hookworm Hydralazine Hydrocodone Hydroxyurea Hydroxyzine Hyoscyamine Hypercalcemia Hypervitaminosis D Hyperparathyroidism Hypokalemia Hypothyroidism Hypotonia Ibandronate Idiopathic Ileus Iliac artery aneurysm Imatinib Imipramine Imperforate anus Indomethacin Inflammatory bowel disease Insulin lispro Interferon beta-1b Internal intussusception Intestinal neuronal dysplasia Intestinal pseduoobstruction Intraabdominal/pelvic tumors Intussusception Ipratropium Iron deficiency anemia Iron supplements Irritable bowel syndrome Ischemic colitis Isocarboxazid Isradipine Itraconazole Jacobsen syndrome Kaolin Pectin Ketogenic diet Ketorolac Lacidipine Lack of fiber Lambert-Eaton myasthenic syndrome Lamivudine Lamotrigine Lanthanum Lassa fever Laxative abuse Lead poisoning Lerisetron Letrozole Leuprolide Levalbuterol Levetiracetam Levodopa Levomepromazine Levomethadyl Levorphanol Linezolid Lofepramine Lomotil Loperamide Loprazolam Lorazepam Lovastatin Low residue diet Loxapine Lymphogranuloma venereum Magaldrate Major depression Meclizine Meclofenamate Mefenamic acid Megacolon Megarectum Meningocele Meperidine Meropenem Mesalamine Mesoridazine Metformin Methadone Methsuximide Methyprylon Metoclopramide Metoprolol Milk-alkali syndrome Milnacipran Misoprostol Modafinil Morphine Motofen Multiple endocrine neoplasia (MEN 2b) Multiple sclerosis Muscular dystrophies Mycophenolate Myxedema Nabumetone Nateglinide Nefazodone Neuroblastoma Nialamide Nicardipine Nifedipine Nilutamide Nimodipine Nisoldipine Nizatidine Normal aging Nortriptyline Occult spinal dysraphism sequence Ogilvie's syndrome Olanzapine Omeprazole Ondansetron Opisthorchis infection Opium Osteitis fibrosa cystica Parathyroid adenoma Ovarian cancer Oxaliplatin injection Oxazepam Oxcarbazepine Oxybutynin Oxycodone Painful defecation Palonosetron Pamidronate

Pancrelipase Panhypopituitarism Papaverine Paralytic ileus Parkinson disease Paroxetine Peginterferon alfa-2b Pemetrexed Perazine Pergolide Peritoneal dialysis Perphenazine Pethidine Phenelzine Phentermine Phenytoin Pheochromocytoma Pholcodine Pimozide Piperacillin sodium Pipothiazine Piribedil Piroxicam Pizotifen Polio Polyp Posaconazole Postoperative ileus Pramipexole Prazepam Prazosin Prednisolone Pregabalin Pregnancy Primary hyperparathyroidism Procarbazine Prochlorperazine Proctitis Procyclidine Progressive supranuclear palsy Promethazine Propafenone Propantheline Propoxyphene Propranolol Protriptyline Prune belly syndrome Pseudocyesis Pseudohypoparathyroidism Quetiapine Rabeprazole Ranitidine Ranolazine Rasagiline Reboxetine Rectal carcinoma Rectocele Rectovaginal or bowel endometriosis Renal cell carcinoma Repaglinide Rett syndrome Ribavirin Rilmenidine Risperidone Rivastigmine Ropinirole Rosuvastatin Sacrococcygeal teratoma Saquinavir Scleroderma Scopolamine Secobarbital Selegiline Sertraline Sevelamer Sibutramine Simethicone Simvastatin Sirolimus Sitaxsentan Smoking cessation Solifenacin Sorafenib Sotalol Spina bifida Spinal cord injury Spinal cord lesions SSRI discontinuation syndrome Starvation Static encephalopathy Stomach cancer Sucralfate Sufentanil Sulindac Sunitinib Superior mesenteric artery occlusion Suxamethonium chloride Syphilis Systemic sclerosis Tabes dorsalis Tamoxifen Tapentadol Tazobactam Tegaserod Temazepam Temozolomide Terazosin Teriparatide Tethered spinal cord syndrome Thalidomide Thioridazine Thiothixene Tianeptine Tiludronate Tinidazole Tiotropium Toilet training issues Tolterodine Topiramate Topotecan Toxic megacolon Tranylcypromine Travel constipation Triazolam Triclofos Trifluoperazine Trihexyphenidyl Trimethadione Trimipramine Tropisetron Trospium Tuberculosis Typhoid fever Ulcerative colitis Upper gastrointestinal series Urogenital neoplasm Uterine fibroid Valproic acid Venlafaxine Verapamil Vicodin Vigabatrin Viloxazine Vinblastine Vincristine Vindesine Vinorelbine Vinorelbine Visceral myopathies Visceroptosis Volvulus Vorinostat Wandering spleen Williams-Beuren syndrome Zaleplon Zidovudine Zileuton Ziprasidone Zoledronic Acid Zolpidem Zonisamide Zotepine

References

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