Bowel movements may vary for each individual and across cultures depending on the intake of fibre in the diet. Normal bowel movements may vary from 3 per day to 3 per week. When a person has infrequent or hard stools or has to exert considerable effort while passing stool, he may be said to have constipation.

Constipation may be due to various physiological and psychological conditions. Most people experience constipation that may be due to dietary changes, but this is temporary and corrects by itself. If it continues over a long period of time and recurs often, permanent dietary modification might be needed. Some of the common causes of constipation are:

1. Poor diet – diets rich in animal meats but low in fibre are the most common cause of constipation. Fibre helps bowel movements to be easy and regular.
   
2. Poor bowel habits - this is a common cause especially in children. Once children are toilet trained, they must be encouraged to go to the toilet regularly everyday. Adults usually suffer from the problem when they ignore the urge to evacuate over a long period of time. This may be because of lack of time or some other reason. After some time they stop getting the urge to use the toilet leading to progressive constipation.
   
3. Fissures or haemorrhoids – certain painful conditions like anal fissures or haemorrhoids may prevent a person from wanting to evacuate. Such people have chronic constipation.
   
4. Inadequate physical activity.
   
5. Hormonal changes as during pregnancy.
   
6. Anxiety, depression and other emotional conditions may sometimes cause constipation.
   
7. Medications – certain medications such as those given for pain relief, depression and some narcotics cause constipation.
   
8. Laxatives – many people who become used to taking laxatives for inducing bowel may become dependent on it and may have difficulty in evacuation without a laxative.

The most common symptoms a person with constipation may experience are:

• Infrequent passage of stool
  
• Difficulty in bowel movement
  
• Bloated feeling in the stomach after a meal
  
• Feeling of incomplete evacuation
  
• General feeling of discomfort and malaise.

There are no specific tests to diagnose constipation. The patient comes to know himself when he has trouble in passing stool. The doctor is then informed who will prescribe medications.

Although treatment depends on the cause, severity, and duration of the constipation, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent them from recurring.

Diet

A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool. A dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.

Lifestyle Changes

Other changes that may help treat and prevent constipation include drinking enough water and other liquids, such as fruit and vegetable juices and clear soups, so as not to become dehydrated, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored. If the person is leading a sedentary lifestyle, the doctor will delineate an exercise regime to regulate activity of the alimentary tract. Bowel habits may also need to be improved to prevent another bout in the future.

Laxatives

Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, a doctor may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, helps prevent constipation. People who are dependent on laxatives need to slowly stop using them. For most people, stopping laxatives restores the colon’s natural ability to contract.

Treatment for constipation may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an ano-rectal problem such as rectal prolapse, a condition in which the lower portion of the colon turns inside out.

People with chronic constipation caused by ano-rectal dysfunction can use biofeedback to retrain the muscles that control bowel movements. Biofeedback involves using a sensor to monitor muscle activity, which is displayed on a computer screen, allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to retrain these muscles.

Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhoea.