Constipation Requiring Medical Attention
Can constipation require medical attention?
Question – How long can a person go without having a bowel movement before seeking medical attention? Could this ever become urgent and warrant a trip to the emergency room?
Answer – Constipation is a symptom, not a disease. The exact definition of constipation is problematic. Patients and doctors often define constipation differently. Doctors relate primarily to the frequency of bowel movements in a given time period (usually per week). Patients usually relate to the effort required (straining), to the consistency of the stool (hard), and to the feeling that they cannot entirely empty themselves.
Most people have their own 'personal' bowel habit. They may have a few bowel movements a day or a bowel movement every few days. Doctors usually define constipation as less than three bowel movements per week and may define severe constipation as waiting more than a week for a bowel movement. However, some people have less than a bowel movement a week and are not bothered by this at all, while others may find this physically uncomfortable or emotionally distressing. Just as there is no 'magic' number of bowel movements that an individual should have, there is also no magic number that defines when constipation is a medical problem requiring immediate evaluation or intervention.
An important question that should be addressed when deciding whether constipation should be evaluated or even justifies a trip to the emergency room is whether it is acute (of recent onset) or chronic (of long duration). Cases of acute constipation are more worrisome and might indicate a significant underlying medical condition such as bowel obstruction. If constipation is associated with 'alarm symptoms' such as severe, worsening abdominal pain, extreme abdominal swelling, fever, nausea and vomiting, or if new-onset constipation occurs in an older person who is usually regular an immediate medical consultation should be obtained.
Most cases of constipation are chronic, having lasted for years, and are not associated with 'alarm symptoms.' It is usually related to a functional bowel disorder, such as irritable bowel syndrome (IBS). However, there are other possible causes of chronic constipation including medication use, hormonal problems, pelvic floor disorders, neurological disorders like Parkinson’s disease, and other conditions. Thus, if any of these possibilities appears relevant, a non-urgent medical evaluation would be logical.
– Ami D. Sperber, MD and Roy Dekel, MD