Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is constipation?

Constipation is when you have trouble having bowel movements. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you've had one.

How often should I have a bowel movement?

Not everyone has bowel movements once a day. Don't believe ads that say you must have a daily bowel movement to be "regular." A normal range is three times a day to three times a week. You may be getting constipated if you begin to have bowel movements much less often than you usually do.

What causes constipation?

As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motion).
A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating fibre, taking certain drugs, not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation.

How is constipation treated?

The main thing in treating constipation is to be sure you're eating enough fibre and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how much you exercise will also help.
Talk to your family doctor if you notice any blood in your stools, if constipation is new and unusual for you, if you also have frequent bouts of diarrhea, or if you have pain with bowel movements.

Fibre-rich foods

	Unprocessed wheat bran
	Unrefined breakfast cereals
	Whole wheat and rye flours
	Grainy breads, such as whole wheat, rye or pumpernickel
	Fresh fruits except for bananas
	Dried fruits, such as prunes, apricots and figs
	Vegetables except for potatoes
	Legumes, such as chick peas, baked beans, lima beans and soybeans

What should I eat?

Eat plenty of fibre. Two to four servings of fruits and three to five servings of vegetables a day is ideal. Add extra fibre to your diet by eating cereals that contain bran. You can also add bran as a topping on your fruit or cereal.

Should I use laxatives?

Laxatives should usually be avoided. They aren't meant for long-term use. An exception to this is bulk-forming laxatives.
Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more comfortably through your intestines. Bulk-forming laxatives can be used every day. They include bran, psyllium (some examples are Metamucil, Fibrepur, Prodiem Plain, Novo-Mucilax) and others (an example is Fibyrax).
Other kinds of laxatives generally work by stimulating muscle contractions of the intestine. These types of laxatives can cause problems if they're used too often (see below). These problems are most likely to occur if you use laxatives regularly.

Problems long-term use of laxatives can cause

	Laxatives can cause your intestines to become lazy and not work as well, which can make you even more constipated when you stop using them.
	Laxatives can also cause problems with your body's abilities to use drugs.
	Laxatives can cause food to move too fast through your system so that nutrients can't be absorbed by your body.
	Laxatives can cause you to lose too much water in your stools.

How are bulk-forming laxatives used?

You must use bulk-forming laxatives daily for them to work. Start slowly and drink plenty of fluids. They may not help for several days to a week or more.
To give your system time to adjust, gradually increase how much you use every 3 to 5 days (as you get used to it), until you get the effect you want. You can help bulk-forming laxatives taste better by mixing them with fruit juice or fluids other than water.
If you choose to add bran to your diet, start slowly - begin with about 1 teaspoon a day and increase the amount every 3 to 5 days, up to 3 to 4 tablespoons, 6 teaspoons a day is usually plenty.

Do bulk-forming laxatives have side effects?

You may notice some bloating, gas or cramping at first, especially if you start with taking too much bran or other bulk-forming laxatives, or increase the amount you're using too quickly. These symptoms should go away in a few weeks or less.

Are mineral oil and caster oil good laxatives?

These two laxatives should generally be used only when your doctor recommends them, such as if you've just had surgery and shouldn't strain to have a bowel movement.
While both mineral oil and castor oil have their place as laxatives, they shouldn't be used regularly. If mineral oil is used regularly, it can cause deficiencies of vitamins A, D, E and K. Castor oil can lead to serious problems if it's used regularly.

Should I try enemas?

Enemas aren't usually needed. It's better to let your body work more naturally.

	Tips on preventing constipation
	Don't resist the urge to have a bowel movement.
	Set aside time to have a bowel movement. A good time may be after breakfast or any other meal.
	Eat more fibre.
	Drink plenty of fluids-at least eight glasses a day. Fluids can include water, juices, soup, tea and other drinks.
	Don't take laxatives too often.
	Exercise or move around more.

What if I've been using enemas or laxatives for a long time?

You may have to retrain your body to go without laxatives or enemas if you've been using them for a long time. This means eating plenty of fibre and using a bulk-forming laxative, drinking plenty of water, exercising, and learning to give yourself time to have a bowel movement.
If you've used laxatives and enemas for a long time, your family doctor may suggest that you wean yourself off of them slowly to give your system a chance to return to normal. Be patient - it may take many months for your bowels to get back to normal if you've been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.