Constipation is a condition that varies from person to person. Generally speaking, constipation refers to less frequent bowel movements, but it can also be described as a decrease in the volume or weight of stool, which usually requires straining, a feeling of incomplete evacuation, or the need for enemas, suppositories, or laxatives to maintain a normal bowel movement pattern. For most people, the normal bowel pattern is 3 times a day to 3 times a week; some people have bowel movements once a week or more without feeling uncomfortable or experiencing any adverse effects. Normal bowel habits are related to diet. Although we recommend 25-30 grams of fiber and 60-80 ounces of fluid per day to maintain normal bowel function, the average American diet contains only 12-15 grams of fiber per day. Increased exercise can also help with bowel function. Eating foods high in fiber, including bran, cereal, whole wheat bread, fruits, and vegetables can help with bowel movements. About 80% of people experience constipation at some point in their lives, so short-term constipation is normal. Constipation can be diagnosed if the number of bowel movements is less than 3 per week. Requiring at least one bowel movement per day may lead to the abuse of laxative medications. What can cause constipation? Inadequate fiber or fluid intake, sedentary habits, or environmental changes can cause constipation. Constipation can be aggravated when traveling, during pregnancy, or when changing diets. In some people, constipation may occur because they are busy at work and neglect to have a bowel movement when the urge to have a bowel movement comes repeatedly. Additional causes of severe constipation include narrowing of the colon lumen or growth of a mass, so you may want to seek the help of a colorectal surgeon if you have persistent constipation. Can medications cause constipation? Yes, many medications, including painkillers, antidepressants, sedatives, blood pressure medications, diuretics, iron supplements, calcium supplements, and aluminum-containing acid suppressants, can cause constipation. In addition, some people who do not in fact suffer from constipation may become dependent on laxatives as they attempt to use this method to maintain their daily bowel habits, and many reasons to abuse laxatives will lead to harm to themselves. When should I seek medical help for constipation? Any persistent change in bowel habits: an increase or decrease in the frequency of bowel movements, a change in stool volume, or an increase in difficulty in passing stools, should be seen by your physician whenever your constipation symptoms last for more than 3 weeks. If you have blood in your stool, you should consult your colorectal surgeon immediately. How can I determine the cause of constipation? There are many causes of constipation, and identifying the cause of constipation will allow us to treat it. Your physician will examine any anatomical causes, such as checking for narrowing of the lumen of the colon or the presence of a mass growth. Anorectal examination is usually the first step in the examination and can provide clues as to the underlying cause of constipation. An examination of the bowel with a bendable lighted instrument or a barium sulfate study can help pinpoint the problem and rule out serious causes of constipation such as polyps, tumors, or diverticulosis that are already known to cause constipation. If the test reveals an anatomical abnormality, then we can treat the abnormal part directly. How is constipation treated? Most patients with constipation can be successfully treated by increasing the intake of high fiber foods such as bran, cereal, whole wheat bread, fruits, vegetables, and increasing fluid intake. Your physician may recommend a lifestyle change to include fiber supplements that contain indigestible plant fiber, such as bran, which is often recommended and very beneficial in relieving constipation symptoms. Fiber can help lower cholesterol levels, reduce risk factors for colon polyps or cancer, and prevent symptomatic hemorrhoids. Fiber intake may take a few weeks, possibly months, to take full effect, but it does not help with good bowel habits. When you use certain stimulant laxatives, it may lead to their overuse or abuse. However, other laxative enemas or suppositories should be used under the advice and supervision of your colorectal surgeon. For some patients, it may also be helpful to designate a specific time of day for bowel movements. In some cases, biofeedback can also be used to help re-establish anal sphincter function. Only in rare cases is surgery required to treat constipation. Your colorectal surgeon will take into account your overall condition to determine the best course of treatment.