1. 31 Possible Causes of Abdominal
Bloating and Abdominal Pain
3. Constipation
Dr. Yousef Elshrek

2. •Constipation
• What Is Constipation?
• Constipation is most often defined as having a bowel
movement less than 3 times per week.
• It usually is associated with hard stools or difficulty
passing stools.
• You may have pain while passing stools or may be unable
to have a bowel movement after straining or pushing for
more than 10 minutes ,or
• a condition in which there is difficulty in emptying the
bowels, usually associated with hardened feces.

3. • What Causes Constipation?
• Your colon’s job is to absorb water and salt from food as it’s passing
through your digestive system.
• It then creates stool (waste).
• The colon’s muscles eventually propel the waste out through the
rectum to be eliminated.
• If stools remain in the colon too long, they can become hard and
difficult to pass.
• Poor diet frequently causes constipation, since dietary fiber and
adequate water intake are necessary to help keep stools soft.
• Fiber-rich foods are plant foods that your body is not able to digest.

4. • Fiber comes in two forms:
• soluble and insoluble.
1. The soluble fiber can dissolve in water, and it creates a soft, gellike material as it passes through the digestive system.
2. Insoluble fiber retains most of its structure as it goes through the
digestive system.
• Fiber is very helpful in easing constipation, as both forms of the fiber
join with the dry, hard stools—increasing their weight and size while
also softening the stools, making it easier for them to pass through
the rectum.
• Changes in routine, stress, and other conditions that slow muscle
contractions of the colon or delay your urge to “go” may also lead to
constipation

5. • Common Constipation Causes
• low-fiber diet (particularly diets high in meat, milk, or cheese)
• dehydration
• lack of exercise
• delaying the impulse to have a bowel movement
• travel or other changes in routine
• certain medications, such as antacids and pain medications
• pregnancy
• Underlying Medical Problems That Can Cause Constipation
• certain diseases, such as stroke, Parkinson’s disease, diabetes, and lupus
problems with the colon or rectum, including intestinal obstruction, irritable
bowel syndrome, or diverticulosis overuse or misuse of laxatives (medications
to loosen stools) hormonal problems, including an underactive thyroid gland
anal fissures (tears) or hemorrhoids

6. • What Are the Symptoms of Constipation?
• Every person’s definition of “normal” bowel movements may
be different.
• Some individuals go three times a day, while others go three
times a week.
• However, you may be constipated if you experience the
following symptoms:
1. fewer than three bowel movements a week
2. passing hard, dry stools
3. straining or pain during bowel movements
4. a feeling of fullness, even after having a bowel
movement
5. experiencing a rectal blockage

7. • Who is at risk for constipation?
• Eating a poor diet and not exercising are major risk factors for
constipation.
• However, you may be at greater risk if you are:
1. 65 or older: Older adults tend to be less physically active, may
have underlying diseases, and may eat poorer diets that lead to
constipation.
2. confined to bed: Those who have certain medical conditions,
such as spinal cord injuries, often have difficulty with bowel
movements.
3. a woman or a child: Women have more frequent episodes of
constipation than men, and children are more often affected
than adults.
4. pregnant: Hormonal changes and pressure on your intestines
from your growing baby can lead to constipation.

8. • How Is Constipation Diagnosed?
• Many people affected by constipation choose to self-treat by
changing their diets, increasing their exercise, or using over-thecounter laxatives.
• However, laxatives should not be used for more than two weeks
without consulting a physician because your body can become
dependent on them for colon function.
• You should talk to your general or family physician if:
1. you have had constipation for more than three weeks
2. you have blood in your stool
3. you are experiencing pain during bowel movements
4. you are losing weight
5. you have sudden changes in your bowel movements

9. • Your doctor will ask questions about your symptoms, medical history, and any medications or
underlying medical conditions.
• A physical examination may include a rectal exam and blood tests to check your thyroid
function.
• In severe cases, additional tests may be required to identify the cause of your symptoms.
• These may include:
1. An examination of how food is moving through your colon, called a marker study or
colorectal transit study.
• For this test, you will swallow a pill that contains tiny markers that will show up on an
X-ray.
• Numerous abdominal X-rays will be taken over the next few days so the doctor can
visualize how the food is moving through your colon and how well the intestinal
muscles are working.
• You may also be asked to eat a diet high in fiber during the test.
2. An examination of the anal sphincter muscle function, called an anorectal manometry.
• For this test, your doctor will insert a thin tube with a balloon-tip into your anus.
• When the tube is inside, the doctor will then inflate the balloon and slowly pull it out.
• This test allows him or her to measure your anal sphincter’s muscle strength and see
if your muscles are contracting properly.

10. • An examination of the colon with a barium enema X-ray.
• For this test, you will drink a special liquid the night before the test to clean out
the bowel.
• The actual test involves the insertion of a dye called barium into your rectum,
using a lubricated tube.
• The barium highlights the rectum and colon area, allowing the doctor to better
view them on an X-ray.
• An examination of the colon with a colonoscopy.
• In this test, your doctor will examine your colon
using a tube that is outfitted with a camera
(colonoscope).
• A sedative is often given, so you will feel no pain.
• To prepare for this test, you will be on a liquid-only
diet for one to three days, and may have to take a

11. • How to Treat and Prevent Constipation
• Changing your diet and increasing your physical activity level are the
easiest and fastest ways to treat and prevent constipation.
• Try the following techniques as well:
1. Every day, drink 1.5 to 2 quarts of fluids, such as water or juice, to
hydrate the body.
2. Limit consumption of alcohol and caffeinated drinks, which cause
dehydration.
3. Add fiber-rich foods to your diet, such as raw fruits and vegetables,
prunes, or bran cereal. Your daily intake of fiber should be between
20 and 35 grams.
4. Cut down on low-fiber foods, such as meat, milk, cheese, and
processed foods.
5. Aim for about 150 minutes of moderate exercise every week (about
20 minutes a day), such as walking, swimming, or biking.

12. 6. If you feel the urge to have a bowel movement, don’t delay, The
longer you wait, the harder your stool will become.
7. Add fiber supplements to your diet if needed, Just remember to
drink plenty of fluids because you can aggravate constipation if you
add extra fiber without also adding fluids to your diet.
8. Use laxatives sparingly. Your doctor may prescribe laxatives or
enemas for a short period of time to help soften your stools. Never
use laxatives for more than two weeks without talking to your
doctor because you can cause your body to become dependent on
them for proper colon function.
9. Your doctor may also advise that you stop taking certain
medications that may cause constipation. More severe colon or
rectal problems may require manual procedures to clear the colon
of impacted stool, therapy to retrain slow muscles, or surgery to
remove the problem part of your colon.

13. 31 Possible Causes of Abdominal
Bloating and Abdominal Pain
4. Intestinal obstruction
Dr. Yousef Elshrek