Constipation In Adults : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 30/07/2022

Constipation in adults is a decrease in the frequency of stools in adulthood, which is accompanied by a change in the consistency of feces, difficulty and pain during defecation. The symptom is caused by alimentary and psychogenic factors, functional intestinal disorders, inflammatory and tumor processes. To verify the cause of constipation, irrigoscopy, colonoscopy, coprogram and blood tests are performed. To normalize bowel movements, prescribe a special diet, enemas, laxatives.

Causes of constipation in adults

Food habits

Unbalanced nutrition is the most common etiological factor in the reduction of bowel movements. Constipation is caused by a lack of fibrous food and vegetable fiber in the diet, which contribute to the formation of feces of normal consistency and facilitate their movement through the intestines. The basis of the diet of most people are easily digestible carbohydrates (white bread, premium cereals, sweets), animal proteins and fats.

These reasons contribute to a decrease in intestinal motility, as a result of which feces stagnate in the colon. Adults complain of chronic constipation, stools are observed every 2-3 days. In this case, painful sensations are characteristic, when emptying, one has to strain strongly. Often there is a feeling of incomplete emptying of the intestine and discomfort in the rectal region.

Psychogenic factors

According to medical statistics, constipation in adults, caused by psychological discomfort, ranges from 13% to 23% of all cases of violations of the act of defecation. The chair is delayed by various reasons - from the usual quarrel with a loved one or colleague to severe stress and depression. Short-term (1-2 days) lack of bowel movements is possible after a change of scenery, on a business trip or during a vacation trip.


The process of defecation is a partially arbitrary reflex act, if desired, a person can suppress the urge to visit the toilet. The most physiological is the stool in the morning, but adults who live in a constant rush often do not have time to empty their intestines. Gradually, to form the urge to defecate, more feces are required in the rectum, so the frequency of bowel movements decreases.

Chronic constipation is typical for adults leading a sedentary lifestyle. Their pelvic floor muscles weaken, and intestinal motility becomes sluggish, as a result, defecation is difficult. Due to a long stay in the rectal cavity, the feces lose water, become dry and lumpy, and going to the toilet is accompanied by painful sensations. Absence of stool associated with intestinal atony occurs in patients who comply with bed rest.


The main causes of constipation in pregnant women are the mechanical pressure of the enlarged uterus on the intestines and the action of the hormone progesterone. The symptom worries a woman from the second half of pregnancy, and reaches its greatest severity at a period of 35-37 weeks, when the uterus drops a little and strongly compresses the large intestine. Pregnant women are afraid to strain strongly during bowel movements, so as not to increase the tone of the uterus, so the stool sometimes lingers for 3-4 days.

irritable bowel syndrome

This functional disorder affects an average of 10-15% of the adult population, and the most pronounced manifestations begin after 3 years. A person notices periodic stool disorders like constipation, accompanied by pain in the abdomen. Symptoms are more often observed in the morning: 30-4 minutes after waking up, severe abdominal cramps and the urge to defecate develop, but emptying does not occur. Sometimes constipation is replaced by loose stools.

IBS is characterized by a chronic course, the duration of the main symptoms is more than 6 months. Patients complain of pain in the anus during bowel movements, difficulty in emptying the bowels, and the need for manual assistance to remove feces from the rectum. The frequency of bowel movements without taking laxatives is less than 3 times a week. In the presence of such signs, a doctor's consultation is required to exclude more severe somatic causes of constipation.

Rectal injury

With hemorrhoids, anal fissures, patients experience severe pain during the discharge of feces, so they try to consciously suppress the urge to remove feces and reduce the amount of food eaten. Permanent constipation is also due to reflex rectal spasm in response to the inflammatory process, which is why feces accumulate for a long time, acquiring a stony density.

As a rule, independent defecation is impossible, constipation lasts up to 7 days. In the feces that appear after taking laxatives or setting an enema, inclusions of pus and blood are visible. Stool retention worsens the course of proctological diseases, provokes further damage to the mucosa. In the initial stages of hemorrhoids, independent defecation persists, bright red blood is visible on the surface of the feces.


Intestinal obstruction

Prolonged constipation in adults is observed with obstruction of the intestinal lumen and the inability to move feces through the intestines. With intestinal obstruction, defecation is completely absent, against which a sharp diffuse pain in the abdomen develops, flatulence, in which gases do not leave. May be disturbed by painful ineffectual urge to remove feces. The most common causes of mechanical intestinal obstruction are:

  • Intestinal hernias . When the intestinal area enters the hernial sac in adults, chronic constipation occurs. Gradually, the intervals between bowel movements lengthen. The symptom is accompanied by dull pain and heaviness in the abdomen. Unpleasant sensations intensify after physical exertion, weight lifting.
  • Polyps . These benign formations, as they increase in size, clog the intestinal lumen and lead to stool retention in adults. At the beginning of the disease, an independent stool is possible, but with large polyps, defecation occurs only after an enema or medication.
  • Cancer . Colon tumors are characterized by fairly rapid growth, they delay the passage of feces and cause chronic constipation. There is also constant pain in the lower abdomen with irradiation to the anal area. Dry lumpy or ribbon-like feces with blood inclusions are allocated.

Inflammatory diseases of the gastrointestinal tract

Prolonged constipation occurs with various intestinal lesions with predominant involvement in the process of the colon - colitis, enterocolitis. First, an adult develops abdominal pain, rumbling and flatulence, later the stool begins to linger. In this case, tenesmus is possible, after which a small amount of mucus or pus is released from the anus.

Missing stool is one of the signs of non-specific ulcerative colitis. With UC, constipation in adults is accompanied by dyspeptic symptoms, pain and spasms, which are more pronounced in the lower abdomen. The disease is chronic, the change of periods of exacerbation and prolonged constipation is provoked by the following reasons: diet errors, emotional upheavals, antibiotics or hormonal drugs.

Damage to the pelvic organs

In women, bowel retention is often due to pathological processes in the uterus and appendages. In acute oophoritis, salpingitis, there are sharp pains in the lower abdomen, causing spasm of the anal sphincters. Defecation is usually absent. Constipation lasts for several days, sometimes self-emptying of the intestines is possible, but more often it is necessary to resort to enemas. Stool disorders persist throughout the period of acute inflammation of the reproductive organs.

Peripheral neuropathies

The symptom occurs in diseases of the spinal cord, in which the distal sacral segments are damaged - transverse myelitis, poliomyelitis, trauma. There is a delay in stool without the urge to defecate. The accumulation of feces and the absorption of decay products into the bloodstream causes a state of intoxication. Constipation in adults appears with Hirschsprung's disease, which occurs with damage to a small area of ​​the colon.

Endocrine pathology

With hypothyroidism in adults, prolonged constipation occurs for no apparent reason, which occurs without severe pain or other dyspeptic disorders. A rare discharge of feces is associated with a decrease in intestinal motility, when trying to empty a person, you need to strain hard, help yourself with your hands. Persistent constipation is noted in diabetic neuropathy, especially in type 2 diabetes.


Prolonged absence of stool is provoked by poisoning with salts of heavy metals. Constipation is most typical for occupational lead intoxication. Lack of bowel movements is accompanied by severe pain in the abdomen, fever. Constipation also worries with uremia, liver failure - conditions that are characterized by endogenous intoxication.

Complications of pharmacotherapy

Most often, constipation develops against the background of prolonged abuse of laxatives. Over time, there is a suppression of the natural reflex act responsible for normal defecation, there is no urge to stool. There are other medicinal causes of prolonged constipation in adults:

  • Analgesics : opioids, some non-steroidal anti-inflammatory drugs.
  • Psychotropic drugs : antidepressants, anticonvulsants and antiparkinsonian drugs.
  • Trace elements : iron preparations, antacids with calcium and magnesium, aluminum salts of phosphoric acid (phosphalugel).
  • Antihypertensive drugs : beta-blockers, diuretics, calcium channel blockers.

Rare Causes

  • CNS diseases : multiple sclerosis, brain tumors, Parkinson's disease.
  • Systemic connective tissue damage : scleroderma, dermatomyositis, systemic lupus erythematosus.
  • Metabolic disorders : porphyria, hypercalcemia, hypokalemia.


Adults with complaints of constipation are sent for examination to a gastroenterologist. The doctor collects an anamnesis, provides a physical examination. The complex of mandatory diagnostic measures for defecation disorders includes modern instrumental methods for examining the gastrointestinal tract, which refine laboratory methods. The most informative are:

  • Irrigoscopy . The method with double contrasting allows to evaluate the anatomical and functional features of the large intestine, reveals deformations of the intestinal contours, volumetric formations and filling defects. For a detailed study of the digestive system, radiography of the passage of barium is used.
  • Colonoscopy . Endoscopic examination is intended for a thorough examination of the intestinal mucosa and the detection of diseases that are manifested by constipation. During the study, a biopsy of the intestine is taken to clarify the causes of the disease. In the obtained biopsy specimens, the cellular composition and the number of intramural nerve ganglia are evaluated.
  • Sonography . Ultrasound of the abdominal cavity is informative for the diagnosis of tumor neoplasms, adhesions. An ultrasound examination is recommended in the area of ​​the umbilical ring, the outer ring of the inguinal canal to exclude hernial protrusions or infringement of intestinal loops. In women, ultrasound of the pelvic organs is mandatory.
  • Coprogram . Macroscopically determine the dry solid consistency of feces, "sheep" or "pencil" feces. Microscopic examination reveals an increased content of leukocytes, decay products. The analysis of feces for helminth eggs, bacteriological culture, the Gregersen reaction for the detection of occult blood are shown.
  • Blood tests . An extended biochemical analysis is carried out with the measurement of the concentration of glucose and electrolytes. It is necessary to establish the amount of free thyroxine, TSH of the pituitary gland. If glucose tolerance is impaired, an oral exercise test is performed. To exclude chronic posthemorrhagic anemia, a clinical blood test is done.


Help before diagnosis

The main method of eliminating constipation in adults, which can be used at home, is to change the diet. It is important to increase the amount of vegetable fiber, which helps to increase the volume of feces and stimulates the urge to defecate. Fiber is recommended to be taken in the form of wheat bran (3-4 tablespoons per day), whole grain bread, fresh fruits and vegetables should be added to the diet.

It is necessary to increase fluid intake to 2.5 liters per day, which helps soften the stool. To stimulate intestinal motility, you should add regular physical activity, try to empty the intestines at the same time, in the morning after breakfast. When constipation is combined with severe pain in the abdomen, fever, blood in the stool, you should consult a doctor.


Conservative therapy

Medications that are prescribed for the treatment of constipation in adults are selected taking into account the clinic and the cause of defecation disorders. To quickly completely empty the intestines and prevent intoxication, cleansing or siphon enemas with hypertonic solutions are placed. To reduce pain in rectal pathology, therapeutic enemas with oils and anesthetics are administered. For the treatment of constipation use:

  • Laxatives . Osmotic drugs and rectal suppositories of bisacodyl, which stimulates peristalsis, are recommended. Strictly control the frequency of administration and dosage of drugs, so as not to aggravate the patient's condition. The course of treatment is no more than 2-3 months.
  • Enterosorbents . The drugs reduce gas formation in the intestines, reduce the manifestations of flatulence and pain in the abdomen. To improve digestion and eliminate the cause of constipation, take probiotics that improve the colonic microflora.
  • Antibiotics . In colitis and other inflammatory processes of bacterial etiology, agents are shown that act exclusively in the intestinal lumen. Parasites are eliminated with the help of specific anthelmintic drugs.
  • Antispasmodics . They are used to reduce pain and spasm of the rectal sphincters, which makes it easier to defecate in adults. With unbearable pain, they are combined with non-narcotic analgesics, methods of physiotherapy.
  • Detox solutions . To eliminate poisoning as the cause of the absence of bowel movements, saline solutions are used, which are administered in large volumes, the technique of forced diuresis. In case of intoxication with metals, complexones are prescribed.


With hernias, an opening of the hernial sac is shown, followed by hernioplasty. Treatment of constipation in adults associated with intestinal obstruction includes laparotomy with a thorough exploration of the intestine. If a non-viable part of the intestine is detected, a segmental resection is provided, followed by the formation of an anastomosis. For colon cancer, a hemicolectomy or total colectomy is performed.

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