Constipation is one of those topics few like to talk about. If you've suffered from this problem, though, you know it can be both painful and frustrating.
Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass.
You are considered constipated if you have two or more of the following for at least 3 months:

• Straining during a bowel movement more than 25% of the time.

• Hard stools more than 25% of the time.

• Incomplete evacuation more than 25% of the time.

• Two or fewer bowel movements in a week.

Almost everyone gets constipated at some time during his or her life. It affects approximately 2% of the population in the U.S. Women and the elderly are more commonly affected. Though not usually serious, constipation can be a concern.

Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include:

• Inadequate water intake.

• Inadequate fiber in the diet.

• A disruption of regular diet or routine; traveling.

• Inadequate activity or exercise or immobility.

• Eating large amounts of dairy products.

• Stress.

• Resisting the urge to have a bowel movement, this is sometimes the result of pain from hemorrhoids.

• Overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles.

• Hypothyroidism.

• Neurological conditions such as Parkinson's disease or multiple sclerosis.

• Antacid medicines containing calcium or aluminum.

• Medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills).

• Depression.

• Eating disorders.

• Irritable bowel syndrome.

• Pregnancy.

• Colon cancer.

In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

Symptoms of constipation can include:
• Infrequent bowel movements and/or difficulty having bowel movements.
• Swollen abdomen or abdominal pain.
• Pain.
• Vomiting.

Most people do not need extensive testing to diagnose constipation. Only a small number of patients with constipation have a more serious medical problem. If you have constipation for more than two weeks, you should see a doctor so he or she can determine the source of your problem and treat it. If constipation is caused by colon cancer, early detection and treatment is very important.
Tests your doctor may perform to diagnose the cause of your constipation include:

• Blood tests if a hormonal imbalance is suspected.

• Barium studies to look for obstruction of the colon.

• Colonoscopy to look for obstruction of the colon.

The vast majority of patients with constipation do not have any obvious illness to explain their symptoms and suffer from one of two problems:

• Colonic inertia: A condition in which the colon contracts poorly and retains stool.

• Obstructed defecation: A condition in which the person excessively strains to expel stool from the rectum.

If you are constipated, try the following:

• Drink two to four extra glasses of water a day (unless fluid restricted).

• Try warm liquids, especially in the morning.

• Add fruits and vegetables to your diet.

• Eat prunes and/or bran cereal.

• If needed, use a very mild stool softener or laxative (such as Peri-Colace or Milk of Magnesia). Do not use laxatives for more than two weeks without calling your doctor, as laxative overuse can aggravate your symptoms.

Call your doctor if:

• Constipation is a new problem for you.

• You have blood in your stool.

• You are losing weight even though you are not dieting.

• You have severe pain with bowel movements.

• Your constipation has lasted more than two weeks

The first way that your GP will treat your constipation is by advising you about ways you can change your diet and lifestyle. Changing what you eat and drink may mean that your constipation passes without the use of medication.
Some of the ways that you can help treat your constipation are outlined below.

• Increasing your daily intake of fibre. You should be eating at least 18-30g of fibre a day. High fibre foods include fruit, vegetables, and cereals.

• Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.

• Increasing your fluid intake. It is best for you to drink water, and you should be drinking at least 1.2 liters (6-8 glasses) a day.

• Getting more exercise by going for a daily walk or run.

• If your constipation is causing you pain, or discomfort, you may want to take a painkilling medication, such as paracetamol. Make sure that you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.

See the 'prevention' section for more information about ways to change your diet and lifestyle.
If these diet and lifestyle changes do not help, your GP may prescribe an oral laxative for you.
Laxatives
Laxatives are a type of medicine that helps you to pass stools. There are several different types of laxative and each one has a different effect on your digestive system.
Bulk-forming laxatives
Your GP will normally start your laxative treatment by using a bulk-forming laxative. These types of laxatives work by helping your stools to retain fluid. This means that they are less likely to dry out, which can lead to faecal impaction (see 'complications' section). Bulk-forming laxatives also make your stools denser and softer which means that they should be easier to pass.
Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose, and sterculia. When taking this type of laxative, you must make sure that you drink plenty of fluids. Also, you should not take them before going to bed. It will usually be 2-3 days before you feel the effects of a bulk-forming laxative.
Osmotic laxatives
If your stools remain hard after you have taken a bulk-forming laxative, your GP may prescribe you an osmotic laxative instead. Osmotic laxatives work by increasing the amount of fluid in your bowels. This helps to stimulate your body to pass stools. Osmotic laxatives can also help by softening your stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, you should make sure that you are drinking enough fluids. It will usually be 2-3 days before you feel the effect of the laxative.
Stimulant laxatives
If your stools are soft, but you are still having difficulty passing them, your GP may prescribe you a stimulant laxative. This type of laxatives works by stimulating the muscles which line your digestive tract, helping them to move stools and waste products along the large intestine (colon) to the anus.
The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These types of laxative are usually only used on a short-term basis, and you will usually start to feel them working within 6-12 hours.
According to your individual preference, and the speed with which you require relief, your GP may decide to combine different laxatives.

If you have only experienced constipation for a short period of time, your GP will normally recommend that you can stop taking the laxative once your stools are soft and easily passed.
However, if you have constipation due to a constipating medicine, or an underlying medical condition, you may have to take laxatives for much longer. Sometimes, you will have to take them for many months, even years.
If you have been taking laxatives for some time, you may have to gradually reduce your dosage, rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Your GP will advise you about when it is best to stop taking your laxatives. You should never stop taking any form of medication unless your GP advises you to.

If you are pregnant, there are ways for you to safely treat constipation without causing any harm to you or your baby. As with most adults who are constipated, your GP will first advise you to change your diet by increasing your fibre and fluid intake. You will also be advised to take gentle exercise.
If dietary and lifestyle changes fail to work, you may be prescribed a laxative to help you pass stools more regularly. There are lots of laxatives that are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the bulk-forming laxatives lactulose, and macrogols. If these laxatives do not work, your GP may advise a small dose of bisacodyl, or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.

Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make sure that you still make the formula as directed by the manufacturer - do not dilute the mixture.
You might want to try gently moving your baby's legs in a bicycling motion, or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, make sure that you give them plenty of water, or diluted fruit juice. Try to encourage them to eat fruit which can be pureed, or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
• apples,
• apricots,
• grapes,
• peaches,
• pears,
• plums,
• prunes,
• raspberries, and
• Strawberries.
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle, and your child may start to think of eating as being a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this fails to work, they can be prescribed a stimulant laxative.
Children
As with babies and adults, children with constipation will first be advised to change their diet. If this fails to work, laxatives can be prescribed, usually an osmotic laxative followed, if necessary, by a stimulant laxative.
As well as eating fruit, older children should have a well balanced diet, which also contains vegetables and wholegrain foods, such as whole meal bread and pasta.
Try to minimize any stress or conflict associated with using the toilet, and with meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet, to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, you might want to try making a diary of your child's bowel movements which is linked to a reward system. This can help them to focus on using the toilet successfully, rather than the more negative aspects, such as faecal incontinence (when you uncontrollably leak solid or liquid stools).

There are several things you can do to prevent constipation. Among them:

• Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereal (especially bran). Fiber and water help the colon pass stool.

• Drink 1 1/2 to 2 quarts of water and other fluids a day (unless fluid restricted for another medical condition). Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal. Some people may need to avoid milk, as dairy products may be constipating for them.

• Exercise regularly.

• Move your bowels when you feel the urge.

Although constipation can be extremely bothersome, it usually isn't serious. If it persists, and especially if straining results, you may develop certain complications:

• Hemorrhoids or cracks (fissures) in your anus may result when hard stool stretches the sphincter muscle.

• Fecal impaction occurs when you accumulate a mass of hardened stool that can't be eliminated by a normal bowel movement. You may need to have impacted stool removed manually.

• Rectal prolapse occurs when a small amount of rectal tissue pushes out through the anus. This condition may lead to a secretion of mucus from the anus.

• Lazy bowel syndrome may occur if you use laxatives frequently, causing your bowels to become dependent on them for proper function. Laxative use can also lead to other problems, including poor absorption of vitamins and other nutrients and damage to your intestinal tract.