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 is a common problem throughout childhood and 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.

Common 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. diuretics and those containing iron, calcium, aluminium
• Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along
  • Hypothyroidism (slow-acting thyroid gland)
  • Hypokalemia
  • Injured anal sphincter (patulous anus)
  • Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants
  • 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
  • Tumors, 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
• Smoking cessation (tobacco smoking has a laxative effect)
• Abdominal surgery, other types of surgery, childbirth

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	Lead poisoning,
Dermatologic	No underlying causes
Drug Side Effect	5-HT3 antagonist, 5-hydroxytryptophan, acamprosate, acebutolol, actiq, aldesleukin, alendronate, alfentanil, alfuzosin, aluminium hydroxide, amiodarone, amitriptyline, amobarbital, anastrozole, aprepitant, aripiprazole, anagrelide, atorvastatin, atovaquone, auranofin, barium Sulfate, benzatropine, benzonatate, bepridil, bezafibrate, bile acid sequestrant, bortezomib, buspirone, butabarbital, calcitriol, calcium carbonate, capecitabine, carbamazepine, carbidopa, carboplatin, carteolol, cerivastatin, cetuximab, chlordiazepoxide, chloropyramine, chlorpropamide, cholestyramine, cidofovir, cimetidine, cisapride, cladribine, clofarabine, clomipramine, clonazepam, clonidine, clorazepate, clozapine, codeine, codeine, colesevelam, colestipol, colofac, daptomycin, darbepoetin alfa, darifenacin, darunavir, desipramine, dextroamphetamine, dextropropoxyphene, diacetyldihydromorphine, diazepam, dicyclomine, diethylcathinone, diflunisal, dihydroetorphine, diltiazem, diphenhydramine, disopyramide, diuretic, dolasetron, doripenem, dosulepin hydrochloride, doxepin, duloxetine, enfuvirtide, epoetin alfa, esomeprazole, estazolam, estradiol, ethcathinone, ethosuximide, ethylmorphine, etodolac, etoposide, famotidine, felbamate, felodipine, fenofibrate, fenoprofen, fentanyl, ferrous sulfate, fludarabine phosphate, fluphenazine, flurazepam, fluvoxamine, fulvestrant, furosemide, gabapentin, ganciclovir, gatifloxacin, gemcitabine, gemfibrozil, glycopyrrolate, granisetron, guanethidine, guanfacine, H2 antagonist, haloperidol, hexamethonium, hydralazine, hydroxyurea, hydroxyzine, hyoscyamine, ibandronate, imatinib, imipramine, indomethacin, insulin lispro, interferon beta-1b, iron supplements, isocarboxazid, itraconazole, kaolin, lamivudine, lamotrigine, lanthanum, letrozole, leuprolide, levalbuterol, levetiracetam, levodopa, levomethadyl, levorphanol, linezolid, lofepramine, lomotil, loperamide, loprazolam, lorazepam, lovastatin, loxapine, magaldrate, meclofenamate, mefenamic acid, meropenem, mesalamine, mesoridazine, metformin, methadone, methsuximide, methyprylon, metoclopramide, metoprolol, misoprostol, modafinil, morphine, motofen, nabumetone, nateglinide, nefazodone, nicardipine, nifedipine, nilutamide, nimodipine, nizatidine, nortriptyline, olanzapine, omeprazole, ondansetron, oxaliplatin, oxazepam, oxcarbazepine, oxybutynin, oxycodone, pamidronate injection, pancrelipase, paroxetine, peginterferon alfa-2b, pemetrexed, pergolide, perphenazine, pethidine, phenelzine, phentermine, phenytoin, pholcodine, pimozide, piperacillin sodium, piroxicam, posaconazole, pramipexole, prazepam, prazosin, prednisolone, pregabalin, procarbazine, procyclidine, propafenone, propantheline, propoxyphene, propranolol, protriptyline, quetiapine, rabeprazole, ranitidine, ranolazine, rasagiline, reboxetine, repaglinide, ribavirin, rilmenidine, risperidone, rivastigmine, ropinirole, rosuvastatin, saquinavir, scopolamine, secobarbital, selegiline, sevelamer, sibutramine, simethicone, simvastatin, sirolimus, sitaxsentan, sorafenib, sotalol, sucralfate, sufentanil, sulindac, sunitinib, suxamethonium chloride, tamoxifen, tapentadol, 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, vinorelbine, vorinostat, zaleplon, zidovudine, zileuton, ziprasidone, zoledronic acid, zolpidem, zonisamide, zotepine
Ear Nose Throat	No underlying causes
Endocrine	Conn's syndrome, diabetes mellitus, glucagonoma, hypothyroidism, myxedema, panhypopituitarism, pheochromocytoma, pseudohypoparathyroidism,
Environmental	Change of environment
Gastroenterologic	Anal atresia, anal carcinoma, ascites, bowel adhesion, bowel obstruction, celiac disease, chronic amebiasis, 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, intussusception, irritable bowel syndrome, ischemic colitis, paralytic ileus, pelvic tumors, perianal abscess, proctitis, rectal cancer, rectal prolapse, rectal ulcer, rectocele, ulcerative colitis, volvulus, wandering spleen,
Genetic	Hereditary internal anal sphincter myopathy, Batten disease, Cornelia de Lange syndrome, Cystic fibrosis,
Hematologic	Acute intermittent porphyria, amyloidosis,
Iatrogenic	Adjustable gastric band, aostoperative complications, 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	Osteitis fibrosa cystica
Neurologic	amyotrophic Lateral Sclerosis, autonomic neuropathy, chagas disease, diabetes mellitus, Hirschsprung's disease, pseduoobstruction, meningocele, multiple endocrine neoplasia, multiple Sclerosis, muscular dystrophy, neurofibromatosis, paraplegia, parkinson's Disease, scleroderma, spinal cord lesions, tabes Dorsalis, progressive supranuclear palsy
Nutritional / Metabolic	Food intolerance, hypercalcemia, hypervitaminosis D, hypokalemia, iron deficiency anemia, ketogenic diet, lack of fiber, low residue diet, milk-alkali syndrome, starvation
Obstetric/Gynecologic	Complications of pregnancy, endometriosis, ovarian cancer
Oncologic	Colorectal Cancer, multiple endocrine neoplasia (MEN 2b), neuroblastoma, rectal carcinoma, renal cell carcinoma, stomach cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	Acamprosate, haloperidol
Psychiatric	Eating disorder, emotional stress obsessive compulsive disorder, pseudocyesis, psychosis
Pulmonary	No underlying causes
Renal / Electrolyte	Uremia
Rheum / Immune / Allergy	Rett syndrome, scleroderma
Sexual	No underlying causes
Trauma	Spinal cord injury
Urologic	Urogenital neoplasm
Miscellaneous	Berdon syndrome, corrosive enemas, dietary pattern change, extended bed rest, fasting, food allergy, idiopathic reduced food intake, smoking cessation, SSRI discontinuation syndrome

Causes in Alphabetical Order

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) Alosetron Aluminium hydroxide Amantadine Amiodarone Oral (patient information) Amitriptyline (patient information) Amobarbital (patient information) Amyloidosis Amyotrophic Lateral Sclerosis Anagrelide (patient information) Anal atresia Anastrozole (patient information) Anorexia nervosa Aprepitant (patient information) Aripiprazole (patient information) Ascites Atorvastatin Atovaquone (patient information) Atropine 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 Bromocriptine Buspirone (patient information) Butabarbital (patient information) Cabergoline 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) Chlorpheniramine Chlorpromazine Chloropyramine Chlorpropamide Cholestyramine Choline Magnesium Trisalicylate (patient information) Chronic amebiasis Cidofovir Injection (patient information) Cimetidine Hydrochloride Injection (patient information) Cimicifuga racemosa Cilansetron Cinnarizine 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 Colestyramine 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 Diphenoxylate 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)

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 Laxative abuse Lead poisoning Letrozole (patient information) Leuprolide (patient information) Lerisetron Levomepromazine 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 Lysuride 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) Multiple sclerosis Muscular dystrophies Mycophenolate (patient information) 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) Oxycodone Pamidronate injection (patient information) Pancrelipase (patient information) Panhypopituitarism

Papaverine Paralytic ileus Paroxetine Peginterferon alfa-2b (patient information) Pemetrexed injection (patient information) Perazine 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 Pipothiazine Piroxicam (patient information) Piribedil Pizotifen Polio Polyp (medicine) Posaconazole (patient information) Pramipexole (patient information) Prazepam (patient information) Prazosin and polythiazide (patient information) Prednisolone Pregabalin (patient information) Pregnancy Primary hyperparathyroidism Procarbazine (patient information) Prochlorperazine 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) Spinal cord injury, chronic phase SSRI discontinuation syndrome Stomach cancer Sucralfate Sufentanil citrate injection (patient information) Sulindac (patient information) Sunitinib Superior mesenteric artery occlusion Suxamethonium chloride Syphilis Systemic sclerosis 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

References

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