DEFINITION
Constipation is a symptom that includes hard feces that are difficult to pass through, or a state of having less than three stools per week. It involves varying degrees of severity and it is defined in a slightly different way, depending on the person who experiences it. This is because each individual has a different bowel function; one person may pass stool every day, whereas another may do so 4 times a week. In this sense, if they both experience a change of habits and they pass stool 3 times a week, the first person will feel constipated, but the second will not.

CAUSES
Constipation is a very common symptom, one that all people are expected to experience at some point of their lives. Although it results in an unpleasant feeling, it most of the times suggests no other serious causative disease; dietary and lifestyle factors are the most common culprits behind an episode of constipation, including:
• Poor fiber intake (vegetables, fruit)
• Inadequate water or other fluid consumption
• Lack of exercise
• Emotional stress or depression
• Old age
• Pregnancy

Sometimes, people tend to refrain from going to the toilet, because they find themselves in an environment that is not familiar or because they may be on the go and can find no available toilet. This can also lead to constipation.

Some medical conditions can also lead to constipation, as one of the symptoms. These may be: • Thyroid problems. Hypothyroidism, in other words a thyroid that is under-functioning, leads to multiple symptoms, one of which is constipation.
• Diabetes
• Multiple sclerosis
• Paralysis
• Various conditions affecting the bowels (irritable bowel syndrome etc.)
• Bowel obstruction

Keep in mind that, of the medical conditions leading to constipation, the hypothyroidism and diabetes will present with multiple symptoms, not just constipation. So do not fear that you are suffering from them as soon as you get constipated. Multiple sclerosis and paralysis are also first diagnosed and then, constipation occurs; they do not present with constipation. Bowel obstruction, however, is a medical emergency under some circumstances, and constipation is one of the main problems, as will be explained below.

HOW COMMON IS CONSTIPATION?
Constipation is a very common symptom, and everyone will experience it at some point. It has been reported that people who suffer from chronic constipation pay 2.5 million visits to their physicians for this problem each year in the United States.

PRESENTATION
Constipation is a problem that may be experienced rarely, periodically or frequently by an individual. People who feel constipated for weeks at a time or generally produce hard feces, even though they do it every day or every other day, are considered chronically constipated. In general, constipation is the state of passing stools infrequently, less than three times in a week, or when one’s stool is hard and does not pass easily through the rectum (anus).

Constipation is a subjective symptom and its definition varies depending on each person’s own bowel habits. If one passes stool every day and then starts to do so 4 or less times a day, it is defined as constipation. There are others, however, who pass stool 4 times per week and it is normal for them. Another characteristic is the hard feces, which cause pain when one is trying to pass stool and the process lasts for longer than expected. People who experience constipation also feel bloated, may have a swollen belly and, after emptying their bowel, still have the feeling that they “have to go” again. Feces are often small and constipated patients may need to sit on the toilet for too long, something that may additionally lead to hemorrhoids.

LARGE BOWEL OBSTRUCTION
Large bowel obstruction is the most urgent of the causes of constipation and can lead to serious complications, if immediate treatment is not provided. It occurs when stool cannot pass through the large bowel due to many reasons. It involves a period of time when a person is severely constipated, in the sense that they pass absolutely no stool and gas whatsoever. Severe abdominal cramps, nausea, vomiting and swelling of the abdomen are characteristic symptoms if the obstruction is complete. Large bowel obstruction usually affects the elderly, unless an underlying condition is present or other circumstances arise and can lead to detrimental complications such as necrosis (tissue death) and peritonitis (infection of the abdomen).

WHEN TO SEEK TREATMENT
If you start to experience symptoms related to a potential large bowel obstruction, like inability to pass stool or gas, severe pain in the abdomen and nausea, immediately call your doctor. If you are experiencing constipation that lasts for too long, more than 5-6 days, it is not normal for you, and it does not get better with simple dietary adaptations, do contact your doctor.

WORKUP
Depending on your age, other co-existing conditions and specific symptoms, the doctor will proceed to a physical examination of the abdomen and, perhaps, the rectum (rectal examination). Laboratory tests include a complete blood count, thyroid tests, and various other tests that will show the patient’s general status. Abdominal x-rays or computerized tomography scans (CT scans) are used if a more serious underlying disease is suspected. Endoscopy is the procedure of visualizing the inside of the colon via a flexible tube with a camera attached to the front end, and may be advisable in some cases.

TREATMENT
Most cases of constipation can be treated with some easy dietary and lifestyle adaptations, some of which are: • Consuming more vegetables and fruit on a daily basis, so that one ingests more fiber.
• Drinking more water or fluids in general
• Engaging in more physical activity
• Fighting stress and depression
• Reducing the amount of milk one consumes. Some people experience constipation when consuming milk or dairy products in general.

Contact your doctor if you are not getting better despite the advice mentioned above. A doctor may give you laxatives, but do not take them of your own accord.

POPULAR MISCONCEPTIONS
• When I am on vacation I am always constipated. I am starting to worry.
When in a new environment, many people experience constipation. This is a very common problem and should not worry you more, provided that, when you return home, the problem resolves on its own. However, make sure you drink fluids, consume fiber and walk a lot when on vacation- these simple habits can help you fight it, so that you can have a good time.