Some Causes and Features of Constipation

Cause

Examples/Common Features*

Tests

Acute constipation†

Acute intestinal obstruction

Twisting of a loop of intestine (volvulus), hernia, adhesions, and fecal impaction

Usually vomiting, crampy abdominal pain, and a distended abdomen

Abdominal x-rays

Sometimes CT

Ileus (temporary absence of the contractile movements of the intestine)

Major acute illness, such as sepsis (a severe infection of the bloodstream)

Immediately after abdominal surgery

Recent head or spinal cord injury

Prolonged bed rest

Abdominal x-rays

Medications and illicit drugs

Medications with anticholinergic effects, such as antihistamines, some antidepressants, antipsychotics, medications used to treat Parkinson disease, and medications that reduce or stop muscle spasms in the digestive tract (antispasmodics)

Medications containing certain metals (iron, aluminum, calcium, barium, or bismuth)

Opioids

Calcium channel blockers

Usually constipation that begins shortly after starting a new medication

A doctor's examination to exclude other causes of constipation

Sometimes stopping the medication to see whether constipation resolves

Chronic constipation‡

Colon cancer

Often constipation that has recently developed, persists for weeks, and gradually worsens as the tumor grows

Sometimes blood in stool (blood may be visible or detected during a doctor's examination)

Colonoscopy with biopsy

Metabolic disorders

Diabetes mellitus, an underactive thyroid gland (hypothyroidism), high levels of calcium in the blood (hypercalcemia), kidney failure, or pregnancy

Blood tests

Central nervous system disorders (affecting the brain or spinal cord)

Parkinson disease, multiple sclerosis, stroke, or spinal cord injury or disorders

MRI and/or CT

Peripheral nervous system disorders (affecting nerves outside the brain and spinal cord)

Hirschsprung disease, neurofibromatosis, or autonomic neuropathy

A doctor’s examination

Sometimes x-rays after barium is inserted in the rectum (barium enema) and/or biopsy

Dyssynergic defecation (dysfunction affecting nerves and muscles in the pelvis that coordinate defecation)

Straining

Needing to use fingers to have a bowel movement

Pressure measurements of the anus and rectum (anorectal manometry)

Systemic disorders

Systemic sclerosis, amyloidosis, skin inflammation plus muscle inflammation and muscle degeneration (dermatomyositis), or weakness and stiff muscles (myotonic dystrophy)

A doctor’s examination

Sometimes biopsy and/or blood tests

Functional disorders

Inactive colon (colonic inertia), irritable bowel syndrome, functional constipation, or disordered defecation

Often a sense of a blockage in the anus and/or rectum, prolonged or difficult defecation, or excessive straining

A doctor’s examination

Sometimes sigmoidoscopy

Dietary factors

Low-fiber diet or chronic laxative abuse

A doctor’s examination

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† There is some overlap between causes of acute and chronic constipation. In particular, medications are common causes of both.

CT = computed tomography; MRI = magnetic resonance imaging.

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