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What is constipation?

The normal frequency range for bowel movements is from three times daily to three times weekly. By definition constipation is when the frequency of bowel movements falls below the lower threshold of three times a week. Bowel movements are a reflection of our diet and because the modern diet of today all too often does not include the daily requirements of 30 grams of fiber and at least 70 ounces of fluids it has become common for the majority of people to experience several episodes of constipation throughout their lives.

What causes constipation?

Common causes of constipation are inadequate fiber and fluid intake as well as minimal or no physical activity. In some cases the practice of actually ignoring the urge to have a bowel movement can have a detrimental effect. Constipation can also be caused by several medical conditions such as a physical obstruction due to cancer, diabetes, thyroid disease, autoimmune disorders such as scleroderma and neurological conditions like Parkinson's disease, multiple sclerosis and spinal cord injuries. The use of multiple medications can also be a cause of constipation.

When should I see a doctor about constipation?

If a bout of constipation lasts for more than three weeks you should be evaluated by a physician. Also, any persistent change in bowel habit, increase or decrease in frequency or size of stool or an increased difficulty in evacuating warrants evaluation. Prompt attention is required at any time there is blood present in the stool.

How can the cause of constipation be determined?

Physical examination (including a rectal exam) and a good review of one's medical history are an important initial part of the investigation. Having a colonoscopy is also often recommended. In some cases laboratory blood tests might be needed. Other studies that could provide valuable information include: marker studies (the patient ingests markers that are visible on X-ray images), defecography (X-ray study evaluating function of the pelvic floor muscles during defecation) manometry and transrectal ultrasound (studies looking at anatomy and function of the pelvic floor).

What treatments are available?

Most of the patients with constipation are successfully treated by modifying their life styles (increasing fiber in the diet, fluid intake, and physical activity) thus eliminating contributing factors. Other patients may require the retraining of a poorly functioning pelvic floor using biofeedback techniques. Surgical intervention is typically a last resort.