Constipation Constipation describes a change in bowel habits, to one in which stool amount is decreased, hard, decreased in frequency, or there is excessive straining during defecation. Normal frequency and consistency of bowel movement varies from individual to individual (three to twelve bowel movements per week is probably "normal"). What is important is a change in bowel movement from one's normal routine. Abdominal discomfort or Bloating Low fiber diet Dehydration Decreased mobility Medications, especially narcotics (e.g., Codeine), tricyclic antidepressants (e.g., Elavil), and Verapamil Colonic lesions, e.g., Colon Cancer Hirschsprung's disease Hypothyroidism Low Potassium level Low Calcium level Diabetic gastroenteropathy Parkinson's disease Multiple Sclerosis Rectal fissure, Abscess, or hemorrhoid Previous radiation treatment to the area Physical exam including rectal exam and hemoculture (stool checked for blood) Complete blood count, blood chemistries, and thyroid function tests should be performed GI testing -- colonoscopy or similar testing Treat the underlying cause Increase dietary fiber, i.e., eat whole grain breads and pastas. Increase fresh fruit and vegetable intake. Eat supplementary bran, either in cereal or flakes supplemented to food Prune juice or prunes Psyllium fiber -- whole husk-type found in health food stores is more effective than processed forms (Metamucil), but either may be tried. Take with complementary amount of liquid. Stool softeners, e.g. doculasate sodium (Colace) are helpful Senekot is a natural stimulant laxative Lactulose by prescription Magnesium Citrate for severe constipation (should not be taken by those with kidney disease) Polyethylene glycol solution (GoLYTELY) for severe constipation Mineral oil Enemas -- fleet or tap water for typical constipation, and mineral oil enema for hard or impacted stool Fecal impaction -- occurs when constipation is so severe that the entire rectum fills with a hard ball of stool. In this case, medications usually do not work, and manual disimpaction is needed (medical personnel remove the blockage manually) Special Consideration New onset of constipation in patients over 45 years old is a serious concern, because it may indicate Colon Cancer or other serious medical problems. If it does not resolve rapidly with treatment (less than seven days), the patient should be evaluated for other causes, such as Colon Cancer. Do not merely take medications to "fix" the constipation. Doing so could mask more serious causes that could avoid further development if treated early. All cases of persistent constipation, even in younger individuals, should be evaluated by a physician. Though rare, rectal and Colon Cancer does occur in patients below 35 years of age.