Editing Constipation (section)

{{Short description|Infrequent or difficult bowel movements}}
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{{Infobox medical condition (new)
| name            = Constipation
| image           = Constipation.JPG
| caption         = Constipation in a young child seen on X-ray. Circles represent areas of [[fecal matter]] (stool is white surrounded by black bowel gas).
| field           = [[Gastroenterology]]
| synonyms        = Costiveness,<ref>{{Cite web |url=http://www.merriam-webster.com/dictionary/costiveness |title=Costiveness&nbsp;– Definition and More from the Free Merriam-Webster Dictionary |url-status=live |archive-url=https://web.archive.org/web/20100411110846/http://www.merriam-webster.com/dictionary/costiveness |archive-date=11 April 2010 }}</ref> dyschezia<ref name=Review09/>
| symptoms        = Infrequent or hard to pass [[bowel movements]], abdominal pain, bloating<ref name=Review09/><ref name=AGA2013/>
| complications   = [[Hemorrhoids]], [[anal fissure]], [[fecal impaction]]<ref name=NIH2015/>
| onset           =
| duration        =
| types           =
| causes          = Slow movement of stool within the colon, [[irritable bowel syndrome]], [[celiac disease]], [[non-celiac gluten sensitivity]], [[pelvic floor]] disorders<ref name=NIH2015/><ref name=SymptomsCausesNIDDK/><ref name=MakhariaCatassi2015/>
| risks           = [[Hypothyroidism]], [[diabetes]], [[Parkinson's disease]], [[gluten-related disorders]], [[colon cancer]], [[ovarian cancer]], [[diverticulitis]], [[inflammatory bowel disease]], certain medications<ref name=NIH2015/><ref name=SymptomsCausesNIDDK/><ref name=MakhariaCatassi2015/>
| diagnosis       =
| differential    =
| prevention      =
| treatment       = Drinking enough fluids, eating more [[dietary fiber|fiber]], [[exercise]]<ref name=NIH2015/>
| medication      = [[Laxative]]s of the [[bulk forming agent]], [[Laxative#Hyperosmotic agents|osmotic agent]], [[stool softener]], or [[Laxative#Lubricant agents|lubricant type]]<ref name=NIH2015/>
| prognosis       =
| frequency       = 2–30%<ref name=And2006/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Constipation''' is a [[bowel]] dysfunction that makes [[bowel movement]]s infrequent or hard to pass.<ref name="Review09">{{cite journal |vauthors=Chatoor D, Emmnauel A | title = Constipation and evacuation disorders | journal = Best Pract Res Clin Gastroenterol |publisher=Baillière Tindall| volume = 23 | issue = 4 | pages = 517–30 | year = 2009 | pmid = 19647687 | doi = 10.1016/j.bpg.2009.05.001 }}</ref> The [[Human feces|stool]] is often hard and dry.<ref name="NIH2015" /> Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement.<ref name="AGA2013">{{cite journal|last1=Bharucha|first1=A. E.|last2=Dorn|first2=S. D.|last3=Lembo|first3=A.|last4=Pressman|first4=A.|date=January 2013|title=American Gastroenterological Association medical position statement on constipation|journal=Best Practice & Research: Clinical Gastroenterology|publisher=[[Bailliere Tindall|Baillière Tindall]]|type=Review|volume=144|issue=1|pages=211–217|doi=10.1053/j.gastro.2012.10.029|pmid=23261064|doi-access=free}}</ref> Complications from constipation may include [[hemorrhoids]], [[anal fissure]] or [[fecal impaction]].<ref name="NIH2015" /> The normal frequency of bowel movements in adults is between three per day and three per week.<ref name="NIH2015" /> Babies often have three to four bowel movements per day while young children typically have two to three per day.<ref name="Col2015">{{Cite journal|last1=Colombo|first1=Jennifer M.|last2=Wassom|first2=Matthew C.|last3=Rosen|first3=John M.|date=2015-09-01|title=Constipation and Encopresis in Childhood|journal=Pediatrics in Review|volume=36|issue=9|pages=392–401; quiz 402|doi=10.1542/pir.36-9-392|issn=1526-3347|pmid=26330473|s2cid=35482415 }}</ref>

<!-- Cause and diagnosis -->
Constipation has many causes.<ref name="NIH2015" /> Common causes include slow movement of stool within the colon, [[irritable bowel syndrome]], and [[pelvic floor]] disorders.<ref name="NIH2015" /> Underlying associated diseases include [[hypothyroidism]], [[diabetes]], [[Parkinson's disease]], [[celiac disease]], [[non-celiac gluten sensitivity]], [[Vitamin B12 deficiency|vitamin B<sub>12</sub> deficiency]], [[colon cancer]], [[diverticulitis]], and [[inflammatory bowel disease]].<ref name="NIH2015">{{cite web|url=https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/all-content|title=Constipation|date=February 2015|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=14 March 2017|archive-url=https://web.archive.org/web/20170315085221/https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/all-content|archive-date=15 March 2017}}</ref><ref name="SymptomsCausesNIDDK">{{cite web|title=Symptoms & Causes of Celiac Disease {{!}} NIDDK|url=https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=24 April 2017|date=June 2016|url-status=live|archive-url=https://web.archive.org/web/20170424175500/https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes|archive-date=24 April 2017}}</ref><ref name="MakhariaCatassi2015" /><ref>{{cite journal|vauthors=Bharucha AE, Pemberton JH, Locke GR 3rd |title=American Gastroenterological Association technical review on constipation.|journal=Gastroenterology|date=January 2013|volume=144|issue=1|pages=218–38|pmid=23261065|doi=10.1053/j.gastro.2012.10.028|pmc=3531555}}</ref><ref>{{Cite web |title=Pernicious Anemia Clinical Presentation: History, Physical Examination |url=https://emedicine.medscape.com/article/204930-clinical |access-date=2023-04-06 |website=emedicine.medscape.com |language=en}}</ref> Medications associated with constipation include [[opioids]], certain [[antacids]], [[calcium channel blockers]], and [[anticholinergics]].<ref name="NIH2015" /> Of those taking [[opioids]] about 90% develop constipation.<ref name="Cad2014" /> Constipation is more concerning when there is weight loss or [[anemia]], [[hematochezia|blood is present in the stool]], there is a history of inflammatory bowel disease or colon cancer in a person's family, or it is of new onset in someone who is older.<ref name="Br2016">{{cite journal|last1=Brenner|first1=DM|last2=Shah|first2=M|title=Chronic Constipation.|journal=Gastroenterology Clinics of North America|date=June 2016|volume=45|issue=2|pages=205–16|pmid=27261894|doi=10.1016/j.gtc.2016.02.013}}</ref>

<!-- Treatment -->
Treatment of constipation depends on the underlying cause and the duration that it has been present.<ref name="NIH2015" /> Measures that may help include drinking enough fluids, eating more [[dietary fiber|fiber]], consumption of [[honey]]<ref>{{cite journal|title=Gut microbiota is involved in the alleviation of loperamide-induced constipation by honey supplementation in mice|last1=Li|first1=Yuyuan|last2=Long|first2=Shangqin|last3=Liu|first3=Qiaochu|last4=Ma|first4=Hong|last5=Li|first5=Jianxin|last6=Xiaoking|first6=Wei|last7=Yuan|first7=Jieli|last8=Li|first8=Ming|last9=Hou|first9=Minmin|journal=Food Science & Nutrition|publisher=[[National Institute of Health|NIH]]|quote=The results of this study suggested that honey can improve the symptoms of constipation by elevating fecal water content and intestinal transit rate in loperamide‐induced constipation model.|date=8 August 2020|volume=8|issue=8|pages=4388–4398|doi=10.1002/fsn3.1736|pmid=32884719|pmc=7455974}}</ref> and [[exercise]].<ref name="NIH2015" /> If this is not effective, [[laxative]]s of the [[bulk-forming agent]], [[Laxative#Hyperosmotic agents|osmotic agent]], [[stool softener]], or [[Laxative#Lubricant agents|lubricant type]] may be recommended.<ref name="NIH2015" /> [[Stimulant laxatives]] are generally reserved for when other types are not effective.<ref name="NIH2015" /> Other treatments may include [[biofeedback]] or in rare cases surgery.<ref name="NIH2015" />

<!-- Epidemiology and culture -->
In the general population rates of constipation are 2–30 percent.<ref name=And2006>{{cite journal |vauthors=Andromanakos N, Skandalakis P, Troupis T, Filippou D | title = Constipation of anorectal outlet obstruction: Pathophysiology, evaluation and management | journal = Journal of Gastroenterology and Hepatology | volume = 21 | issue = 4 | pages = 638–646 | year = 2006 | pmid = 16677147 | doi = 10.1111/j.1440-1746.2006.04333.x | s2cid = 30296908 | doi-access =  }}</ref> Among elderly people living in a care home the rate of constipation is 50–75 percent.<ref name=Cad2014>{{cite book |author1=Canadian Agency for Drugs and Technologies in Health|title=Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness|date=26 June 2014|pmid=25520993}}</ref> People in the United States spend more than {{US$|250{{nbsp}}million|link=yes}} on medications for constipation a year.<ref>{{cite book|last1=Avunduk|first1=Canan|title=Manual of gastroenterology: diagnosis and therapy|date=2008|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-6974-7|page=240|edition=4th|url=https://books.google.com/books?id=PekixjgbRlcC&pg=PA240|url-status=live|archive-url=https://web.archive.org/web/20160911004050/https://books.google.com/books?id=PekixjgbRlcC&pg=PA240|archive-date=11 September 2016}}</ref>
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