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Neurogastroenterology and Motility
The Bowel Management Program at Mass General for Children (MGfC) is an intensive outpatient program for pediatric patients who have difficulty controlling their bowel movements.
The Colorectal Center at the Massachusetts General Hospital Digestive Healthcare Center offers comprehensive detection, treatment and management options for patients with acute and chronic colorectal conditions.
The Diagnostic and Therapeutic Gastroenterology Program at Massachusetts General Hospital offers comprehensive detection, treatment and management options for patients with acute and chronic gastrointestinal conditions.
The Pediatric Gastrointestinal Motility Program at Mass General for Children evaluates, treats and follows children with a wide variety of gastrointestinal motility disorders.
The Pediatric Surgery service at Mass General for Children is an international referral center for the complete spectrum of general and thoracic pediatric and neonatal surgical services.
What is constipation?
Constipation is when your stools are painful. Or they don't happen often enough. It's the most common GI (gastrointestinal) problem.
You may have constipation if:
You have bowel movements less than 3 times a week
Your stool is hard, dry, and in small pieces
Normal bowel movements vary depending on the person. They may happen as often as 3 times a day. Or they may happen just 3 times a week.
What causes constipation?
Your stool gets hard and dry when your colon (large intestine) absorbs (soaks up) too much water.
In most cases, as food moves through your colon, the colon absorbs water while it makes stool. Muscle movements (contractions) push the stool toward your rectum. When the stool gets to the rectum, most of the water has been soaked up. The stool is now solid.
If you have constipation, your colon's muscle movements are too slow. This makes the stool move through your colon too slowly. The colon absorbs too much water. The stool gets very hard and dry.
Some of the most common diet and lifestyle causes of constipation are:
Not getting enough exercise
Not drinking enough liquids
Not eating enough fiber
Not moving your bowels when you feel the urge to
Changes in your lifestyle, such as travel, pregnancy, and old age
Other causes of constipation include:
A problem with how your stomach and bowels work (such as irritable bowel syndrome)
Your intestine does not work well
Metabolic problems, such as thyroid disease
What are the symptoms of constipation?
Each person’s symptoms may vary. Symptoms of constipation may include:
Difficult and painful bowel movements
Less than 3 bowel movements a week
Belly (abdominal) pain or discomfort
Ineffective straining to move your bowels
Many of these symptoms may be caused by other health problems. Always talk with your healthcare provider to be sure.
How is constipation diagnosed?
Most people have constipation at one time or another. To see if you have constipation, your healthcare provider will do several tests. These tests will depend on how long you have had symptoms and how serious your case is.
First your healthcare provider will look at:
If you have any blood in your stool
Any changes in your bowel habits
Your provider will likely:
Ask about your past health. You will be asked to give details about your constipation, such as how long you have had symptoms and how often you have bowel movements.
Give you a physical exam. Your healthcare provider will do a full physical exam.
Give you a digital rectal exam. This exam helps tell if the area is soft, blocked, or bloody. It can also check how much and what kind of stool you have. Your provider will also see if your rectum is bigger than normal. And they'll check the anal sphincters (muscles).
You may also need other tests, such as:
Abdominal X-ray. This X-ray test can show the fullness of the bowels.
Blood work. Blood is taken for testing.
Lower GI series (also called barium enema). This is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine. You will be given a fluid called barium. It coats the organs, so that they can be seen on an X-ray. An X-ray of your belly will show if you have any narrowed areas (strictures), blockages, or other problems. An X-ray of the area around the anus and rectum (called a defecogram) may be done to see how well you can hold and release stool. .
Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding.
Sigmoidoscopy. This test lets your healthcare provider check the inside of part of your large intestine. It helps to tell what is causing constipation.
Colorectal transit study. This test shows how long it takes for food to move through your colon. You will be asked to swallow pills (capsules) filled with small markers that can be seen on an X-ray. The X-rays will show how the capsules moved through your colon.
Anus and rectum (anorectal) function tests. These tests can tell if you are constipated because your anus or rectum is not working well.
How is constipation treated?
Your healthcare provider will come up with a care plan for you based on:
Your age, overall health, and past health
How serious your case is
How well you handle certain medicines, treatments, or therapies
If your condition is expected to get worse
Your opinion and what you want to do
In most cases, diet and lifestyle changes can help reduce constipation symptoms. They can also stop it from happening. These changes may include:
Drinking more water and juice.
Getting regular exercise.
Giving yourself time to have a bowel movement each day. Sitting for 10 minutes after meals can be helpful.
Eating more fiber. If you don't eat enough fiber, add a fiber supplement.
Taking laxatives. Your provider can discuss your choices.
Stopping or changing medicine.
Add a footstool in front of your toilet to raise your legs. This puts you in a better position to move your bowels.
Doing physical therapy with or without biofeedback (part of a special physical therapy program).
Whole-wheat bread, granola bread, wheat bran muffins, grain bars, waffles, popcorn
100% whole-grain cereals, oatmeal, granola, and oat bran
100% bran cereals
Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Apples with peel, dates, papayas, mangoes, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins
Cooked prunes, dried figs
Peanut butter, nuts
Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix
What are possible complications of constipation?
Constipation can cause other health problems, such as:
Hemorrhoids. Red, swollen veins in the rectum. They happen when you need to keep straining to have a bowel movement.
Anal fissures. Tears in the skin around the anus. They happen when hard stool stretches your sphincter muscle. They can cause bleeding in your rectum.
Rectal prolapse. This is when a small amount of your intestinal lining pushes out from your anal opening. It is caused by straining to have a bowel movement.
Fecal impaction. This is when a large lump of hard, dry stool stays stuck in your rectum. The colon’s normal pushing action can’t push out the stool. This is seen mostly in children and older adults.
Can constipation be prevented?
Many of the same lifestyle changes that help treat constipation may also help to stop it from happening:
Have plenty of fiber, water, and liquids each day.
Get daily regular exercise. Adults should do 150 minutes (2 hours and 30 minutes) of moderate intensity exercise every week. If you are new to exercise, this can be broken down into 10-minute periods of activity during the day. Daily movement activities, such as walking, gardening, house cleaning. count. They can make a big difference in how you feel.
Allow plenty of time for bowel movements. When you feel the urge to have a bowel movement, be sure to do it.
Try to have a bowel movement at the same time each day.
If another health problem makes you more likely to have constipation, take your provider’s advice for treating that problem.
When should I call my healthcare provider?
Most people have constipation at one time or another. But call your healthcare provider if:
Constipation lasts longer than 3 weeks
Constipation pain is stopping you from doing your daily activities
You have lasting pain in the rectum or belly
You have unexplained weight loss
You have symptoms of any of the complications of constipation
You have rectal bleeding
Key points about constipation
Constipation is the most common GI (gastrointestinal) problem.
You may be constipated when your stools are painful and happen less than 3 times a week.
Your stool will be hard, dry, and in small pieces.
Your stools get hard and dry when your colon absorbs too much water.
Constipation symptoms can include stomach cramps and feeling tired.
Constipation can cause other health problems, such as hemorrhoids (red, swollen veins in the rectum).
Making diet and lifestyle changes can reduce constipation symptoms. These changes can also stop constipation from happening.
Tips to help you get the most from a visit to your healthcare provider:
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your healthcare provider gives you.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions.
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