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What are the risk factors and causes of constipation?
There are many risk factors for constipation, some of which are surprising. Constipation is associated with inactivity, low calorie intake, medication use (the number of medications used) low income, and low education level.
Contrary to popular belief, constipation has not been reported to be associated with a low intake of fiber in any study to date. This fact is confused by the fact that fiber intake is mildly helpful in the treatment of constipation. Fiber intake does not appear to prevent or be the cause of constipation. In fact, a high-fiber diet, without adequate water or fluid intake, can result in serious constipation.
Constipation is associated with depression as well as physical and sexual abuse. Diseases of the bowel, such as irritable bowel syndrome, pregnancy, hemorrhoids, certain medical conditions (like an underactive thyroid or cystic fibrosis) are also among the reasons for constipation. Less common but serious causes of constipation include colon and rectal cancer.
The risk factors for constipation are not necessarily the cause of constipation. Rather, these risk factors simply place the patient at greater risk of constipation. Treatment directed toward the modification of risk factors does not necessarily result in improved bowel function. For example, inactivity is associated with constipation, but exercise has not clearly been shown to be an effective treatment.
The age of the patient is an important factor. Not only because the incidence of constipation increases with age, but because the cause of constipation in older patients is usually due to more than one factor. These causes range from the simple (inactivity) to the complex (neurological problems and gastrointestinal diseases).
Childhood constipation is more likely to have a single, common problem (e.g., irritable bowel syndrome), or an unusual cause (e.g., Hirschsprung's disease or abnormal anal sphincter physiology), or be the result of avoidance (holding stool to avoid going to the bathroom).
Infant constipation is often misunderstood. Breastfed infants can go as long as seven days without a bowel movement, and are not considered to be constipated. Infants also strain, make faces and raise their legs in order to pass stool. This is a result of passing stool while lying down, and not a symptom of constipation. An infant that has not passed his first stool within 24 hours after birth must be immediately evaluated for life-threatening, physical causes of constipation such as anatomical abnormalities. Serious signs of constipation among infants greater than one week old are the vomiting green liquid (bile) after eating, and a swollen abdomen.
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