Editing Constipation (section)

==Causes==
The causes of constipation can be divided into [[congenital]], primary, and secondary.<ref name=Review09/> The most common kind is primary and not life-threatening.<ref name=AGA2000/> It can also be divided by the age group affected such as children and adults.

Primary or [[functional constipation]] is defined by ongoing symptoms for greater than six months not due to an underlying cause such as medication [[side effects]] or an underlying medical condition.<ref name=Review09/><ref name=AFP05/> It is not associated with abdominal pain, thus distinguishing it from [[irritable bowel syndrome]].<ref name=Review09/> It is the most common kind of constipation, and is often multifactorial.<ref name="AGA2000"/><ref name=CC:CriticalReview>{{Cite journal|last1=Basilisco|first1=Guido|last2=Coletta|first2=Marina|title=Chronic constipation: A critical review|journal=Digestive and Liver Disease|volume=45|issue=11|pages=886–893|doi=10.1016/j.dld.2013.03.016|pmid=23639342|year=2013|doi-access=free}}</ref> In adults, such primary causes include: dietary choices such as insufficient dietary fiber or fluid intake, or behavioral causes such as decreased [[physical activity]]. In children, causes can include diets low in fiber and fluids, underlying medical conditions, and reluctance to go to the bathroom.<ref>{{Cite web |title=Pediatric Chronic Constipation {{!}} Children's National Hospital |url=https://www.childrensnational.org/get-care/health-library/chronic-constipation}}</ref> In the elderly, common causes have been attributed to insufficient dietary fiber intake, inadequate fluid intake, decreased [[physical activity]], side effects of medications, [[hypothyroidism]], and obstruction by [[colorectal cancer]].<ref name=Le2007/> Evidence to support these factors however is poor.<ref name=Le2007>{{cite journal | author = Leung FW | title = Etiologic factors of chronic constipation: review of the scientific evidence | journal = Dig. Dis. Sci. | volume = 52 | issue = 2 | pages = 313–6 | date = February 2007 | pmid = 17219073 | doi = 10.1007/s10620-006-9298-7 | s2cid = 608978 }}</ref>

Secondary causes include side effects of medications such as opiates, endocrine and metabolic disorders such as [[hypothyroidism]], and obstruction such as from [[colorectal cancer]]<ref name=CC:CriticalReview/> or [[ovarian cancer]].<ref name="CDCsep2016">{{cite web|url=https://www.cdc.gov/cancer/ovarian/pdf/ovarian_facts.pdf|title=Ovarian Cancer, Inside Knowledge, Get the Facts about Gynecological Cancer|date=September 2016|publisher=Centers for Disease Control and Prevention|access-date=17 June 2017|url-status=live|archive-url=https://web.archive.org/web/20170616220028/https://www.cdc.gov/cancer/ovarian/pdf/ovarian_facts.pdf|archive-date=16 June 2017}}{{CDC}}</ref> [[Celiac disease]] and [[non-celiac gluten sensitivity]] may also present with constipation.<ref name=SymptomsCausesNIDDK/><ref name=WGO2016>{{cite web|url=http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english|title=Celiac disease|date=July 2016|publisher=[[World Gastroenterology Organisation]] Global Guidelines|access-date=23 April 2017|url-status=live|archive-url=https://web.archive.org/web/20170317123604/http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english|archive-date=17 March 2017}}</ref><ref name=MakhariaCatassi2015>{{cite journal| vauthors = Makharia A, Catassi C, Makharia GK | title=The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma | journal=Nutrients | year= 2015 | volume= 7 | issue= 12 | pages= 10417–26 | pmid=26690475 | doi=10.3390/nu7125541 | pmc=4690093 | type=Review | doi-access=free }}</ref> Cystocele can develop as a result of chronic constipation.<ref>{{Cite news|url=https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women/cystocele-prolapsed-bladder|title=Cystocele (Prolapsed Bladder) {{!}} NIDDK|work=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=2017-12-02|language=en-US}}</ref>

===Diet===
Constipation can be caused or exacerbated by a low-fiber diet, low liquid intake, or dieting.<ref name="walia"/><ref name="mccallum">{{cite journal|year=2009|title=Chronic constipation in adults|journal=The BMJ|volume=338|pages=b831|doi=10.1136/bmj.b831|pmid=19304766|vauthors=McCallum IJ, Ong S, Mercer-Jones M|s2cid=8291767}}</ref> Dietary fiber helps to decrease colonic transport time, increases stool bulk but simultaneously softens stool. Therefore, diets low in fiber can lead to primary constipation.<ref name=CC:CriticalReview/>

===Medications===
Many medications have constipation as a side effect. Some include (but are not limited to) [[opioid]]s, [[diuretics]], [[antidepressant]]s, [[antihistamine]]s, [[antispasmodic]]s, [[anticonvulsant]]s, [[tricyclic antidepressant]]s, [[antiarrythmics]], [[Beta blocker|beta-adrenoceptor antagonists]], [[anti-diarrheal]]s, 5-HT3 receptor antagonists such as [[ondansetron]], and aluminum [[antacid]]s.<ref name=walia/><ref name="ap01">{{Cite journal|date=August 2010|title=Managing constipation in adults|journal=Australian Prescriber|volume=33|issue=4|pages=116–9|author=Selby, Warwick|author2=Corte, Crispin|doi=10.18773/austprescr.2010.058|doi-access=free}}</ref> Certain [[calcium channel blocker]]s such as [[nifedipine]] and [[verapamil]] can cause severe constipation due to dysfunction of motility in the [[rectosigmoid colon]].<ref>{{cite journal|vauthors=Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM |title=Chronic constipation in the elderly|journal=The American Journal of Gastroenterology|volume=107|issue=1|pages=18–25|date=January 2012|pmid=21989145|doi=10.1038/ajg.2011.349|s2cid=205099253|type=Review}}</ref> Supplements such as calcium and iron supplements can also have constipation as a notable side effect.<ref>{{cite journal|first1=Kelvin|last1=Li|first2=Xia-Fang|last2=Wang|first3=Ding-You|last3=Li|first4=Yuan-Cheng|last4=Chen|title=The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health|journal=Clinical Interventions in Aging|date=28 November 2018|issn=1176-9092|pages=2443–2452|volume=13|pmid=30568435|pmc=6276611|doi=10.2147/CIA.S157523|first5=Lan-Juan|last5=Zhao|first6=Xiao-Gang|last6=Liu|first7=Yan-Fang|last7=Guo|first8=Jie|last8=Shen|first9=Xu|last9=Lin|first10=Jeffrey|last10=Deng|first11=Rou|last11=Zhou|first12=Hong-Wen|last12=Deng|doi-access=free }}</ref><ref name="q220">{{cite journal | last1=Parvataneni | first1=Swetha | last2=Maw | first2=Min | title=Ileus Due to Iron Pills: A Case Report and Literature Report on the Importance of Stool Softeners | journal=Cureus | publisher=Cureus Inc. | volume=12 | issue=6 | date=2024-03-14 | pages=e8392 | pmid=32637274 | doi=10.7759/cureus.8392 | doi-access=free | pmc=7331903 }}</ref>

===Medical conditions===
Metabolic and endocrine problems which may lead to constipation include: [[pheochromocytoma]], [[hypercalcemia]], [[hypothyroidism]], [[hyperparathyroidism]], [[porphyria]], [[chronic kidney disease]], [[pan-hypopituitarism]], [[diabetes mellitus]], and [[cystic fibrosis]].<ref name=walia/><ref name=AGA2000/> Constipation is also common in individuals with muscular and myotonic dystrophy.<ref name=walia/>

[[Systemic disease]]s that may present with constipation include [[celiac disease]] and [[systemic sclerosis]].<ref name=SymptomsCausesNIDDK/><ref name=WGO2016/><ref name=GygerBaron2015>{{cite journal| author=Gyger G, Baron M| title=Systemic Sclerosis: Gastrointestinal Disease and Its Management. | journal=Rheum Dis Clin North Am | year= 2015 | volume= 41 | issue= 3 | pages= 459–73 | pmid=26210129 | doi=10.1016/j.rdc.2015.04.007 |type=Review }}</ref>

Constipation has a number of structural (mechanical, morphological, anatomical) causes, namely through creating space-occupying lesions within the colon that stop the passage of stool, such as [[colorectal cancer]], [[Stenosis|strictures]], [[Rectocele|rectocoles]], [[Human anus|anal sphincter]] damage or malformation and post-surgical changes. Extra-intestinal masses such as other malignancies can also lead to constipation from external compression.<ref>{{Cite journal|last1=Rao|first1=Satish S. C.|last2=Rattanakovit|first2=Kulthep|last3=Patcharatrakul|first3=Tanisa|title=Diagnosis and management of chronic constipation in adults|journal=Nature Reviews Gastroenterology & Hepatology|volume=13|issue=5|pages=295–305|doi=10.1038/nrgastro.2016.53|pmid=27033126|year=2016|s2cid=19608417}}</ref>

Constipation also has neurological causes, including [[anismus]], [[descending perineum syndrome]], [[desmosis]] and [[Hirschsprung's disease]].<ref name="And2006"/> In infants, Hirschsprung's disease is the most common medical disorder associated with constipation. Anismus occurs in a small minority of persons with chronic constipation or obstructed defecation.<ref>{{cite journal|year=1997|title=Anismus: fact or fiction?|journal=Diseases of the Colon and Rectum|volume=40|issue=9|pages=1033–1041|doi=10.1007/BF02050925|pmid=9293931|vauthors=Schouten WR, Briel JW, Auwerda JJ, van Dam JH, Gosselink MJ, Ginai AZ, Hop WC|s2cid=23587867}}</ref>

Spinal cord lesions and neurological disorders such as [[Parkinson's disease]] and [[pelvic floor dysfunction]]<ref name="AGA2000"/> can also lead to constipation.

[[Chagas disease]] may cause constipation through the destruction of the [[myenteric plexus]].<ref>{{cite journal |last1=Pérez-Molina |first1=José A. |last2=Molina |first2=Israel |title=Chagas disease |journal=The Lancet |date=6 January 2018 |volume=391 |issue=10115 |pages=82–94 |doi=10.1016/S0140-6736(17)31612-4 |pmid=28673423 |s2cid=4514617 }}</ref><ref>{{cite journal |last1=Nguyen |first1=Tina |last2=Waseem |first2=Muhammad |title=Chagas Disease |journal=StatPearls |date=2022 |url=https://www.ncbi.nlm.nih.gov/books/NBK459272/ |publisher=StatPearls Publishing|pmid=29083573 }}</ref>

===Psychological===
Voluntary withholding of the stool is a common cause of constipation.<ref name=walia/> The choice to withhold can be due to factors such as fear of pain, fear of public restrooms, or laziness.<ref name=walia/> When a child holds in the stool a combination of encouragement, [[drink|fluids]], [[dietary fiber|fiber]], and [[laxative]]s may be useful to overcome the problem.<ref>{{cite journal | author = Cohn A | title = Stool withholding | journal = Journal of Pediatric Neurology | year = 2010 | volume = 8 | issue = 1 | pages = 29–30 | doi = 10.3233/JPN-2010-0350 | url = http://www.anthonycohnpaediatrics.co.uk/jpn.pdf | access-date = 7 September 2011 | pmid = <!-- none--> | s2cid = 257155678 | url-status = live | archive-url = https://web.archive.org/web/20110907082744/http://www.anthonycohnpaediatrics.co.uk/jpn.pdf | archive-date = 7 September 2011 }}</ref> Early intervention with withholding is important as this can lead to [[anal fissure]]s.<ref name=AmericanGATReview/>

=== Congenital ===
[[Congenital disorder|A number of diseases present at birth]] can result in [[constipation in children]]. They are as a group uncommon with Hirschsprung's disease (HD) being the most common.<ref>{{Cite book|title=Constipation: etiology, evaluation and management|last=Wexner|first=Steven|publisher=Springer|year=2006|location=New York}}</ref> There are also congenital structural anomalies that can lead to constipation, including anterior displacement of the anus, [[imperforate anus]], strictures, and small left colon syndrome.<ref name =JournalOPGAN/>