Severe cases ("fecal impaction" or malignant constipation) may exhibit symptoms of bowel obstruction (nausea, vomiting, tender abdomen) and encopresis, where soft stool from the small intestine bypasses the mass of impacted fecal matter in the colon. Epidemiology
Constipation is the most common chronic gastrointestinal disorder in adults. Depending on the definition employed, it occurs in 2% to 20% of the population. It is more common in women, the elderly and children. Specifically constipation with no known cause affects females more often affected than males. The reasons it occurs more frequently in the elderly is felt to be due to an increasing number of health problems as humans age and decreased physical activity. 12% of the population worldwide reports having constipation. Chronic constipation accounts for 3% of all visits annually to pediatric outpatient clinics. Constipation-related health care costs total $6.9 billion in the US annually. More than four million Americans have frequent constipation, accounting for 2.5 million physician visits a year. Around $725 million is spent on laxative products each year in America. History
Since ancient times different societies have published medical opinions about how health care providers should respond to constipation in patients. In various times and places, doctors have made claims that constipation has all sorts of medical or social causes. Doctors in history have treated constipation in reasonable and unreasonable ways, including use of a spatula mundani.After the advent of the germ theory of disease then the idea of "auto-intoxication" entered popular Western thought in a fresh way.
It has not been shown to have a benefit on constipation, while potentially causing cardiac arrhythmias and deaths. Enemas
Enemas can be used to provide a form of mechanical stimulation. A large volume or high enema can be given to cleanse as much of the colon as possible of feces, and the solution administered commonly contains castile soap which irritates the colons lining resulting in increased urgency to defecate. However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract. Physical intervention
Constipation that resists the above measures may require physical intervention such as manual disimpaction (the physical removal of impacted stool using the hands; see fecal impaction). Regular exercise
Regular exercise can help improve chronic constipation. Surgical intervention
In refractory cases, procedures can be performed to help relieve constipation. Sacral nerve stimulation has been demonstrated to be effective in a minority of cases. Colectomy with ileorectal anastomosis is another intervention performed only in patients known to have a slow colonic transit time and in whom a defecation disorder has either been treated or is not present. Because this is a major operation, side effects can include considerable abdominal pain, small bowel obstruction, and post-surgical infections. Furthermore, it has a very variable rate of success and is very case dependent. Prognosis
Complications that can arise from constipation include hemorrhoids, anal fissures, rectal prolapse, and fecal impaction. Straining to pass stool may lead to hemorrhoids. In later stages of constipation, the abdomen may become distended, hard and diffusely tender.