Constipation

Constipation is diagnosed and treated by the GI Division of Premier Medical Group.

What is constipation?

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Constipation is a condition of the digestive system and is defined as having a bowel movement fewer than three times per week. The normal time between bowel movements varies with people. For some people, normal is having 3 movements a day, and for others, normal is 2 to 3 times a week. Nevertheless, constipation is defined as “A condition in which bowel movements are infrequent or incomplete”. When a person is constipated, the stools are typically hard, small in size, dry and difficult to eliminate. With constipation you can feel bloated and your bowel movement can be painful when you strain to eliminate. In some cases, severe constipation causes bowel obstruction.

 

It’s important to remember that constipation is a symptom, and not a disease. Most people experience constipation at some point in their life. Your doctor may consider you constipated if you have two of the following symptoms.

  • Your stools are small and hard more than 25% of the time.
  • You have two or fewer bowel movements in a week.
  • You need to strain during a bowel movement more than 25% of the time.
  • Your bowel movements are not complete; you do not get compete evacuation.

Severe constipation symptoms may include all of these, as well as lower abdominal pain.

What are the causes of constipation?

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The most common cause of constipation is inadequate water intake. Food moves through the colon and as it does, the colon absorbs water from the food while it forms waste products. Muscle contractions in the colon work to push the stool closer to the rectum and by the time the stool is there, it should be in solid form. If the colon absorbs too much of the water or if the muscle contractions are sluggish or slow-moving, the stool can become dry and hard resulting in constipation.

Besides poor water intake, other causes of constipation can include:

  • Eating disorders
  • An overabundance of certain foods
  • Irritable bowel syndrome (IBS)
  • Pregnancy
  • Colon cancer
  • Insufficient water intake (less than 64 oz daily)
  • Poor fiber in the diet.
  • Some medications (especially narcotic pain medicines) and iron pills
  • Interruption of routine diet
  • Traveling; disruption of regular routine
  • Stress
  • Inadequate activity or exercise or immobility
  • Any medications which contain calcium or aluminum
  • Ignoring the urge to have a bowel movement (perhaps due to painful hemorrhoids or anal fissures)
  • Dehydration
  • Abuse of laxatives and/or stool softeners
  • Hypothyroidism
  • Neurological conditions such as Parkinson’s disease, pelvic floor dysfunction or multiple sclerosis
  • Lack of physical activity, (particularly in the elderly)

Other problems with the colon and rectum, such as intestinal obstruction and scar tissue (adhesions) caused by diverticular disease, inflammatory diseases and previous abdominal surgeries can also affect bowel motility resulting in constipation, often severe constipation. Other complications which can cause severe constipation are colorectal strictures, colon cancer, diverticulosis, tumors, and congenital or otherwise neurological diseases such as Hirschsprung’s disease, which can squeeze, or constrict the intestine and rectum.

What are the symptoms of constipation?

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The most common symptoms of constipation are infrequent bowel movements and/or difficulty having a bowel movement. A swollen abdomen, abdominal pain, and vomiting can also be symptoms. Bowel movements will generally be dry, hard ribbon-like, beaded and other unusual shapes.

How is constipation diagnosed?

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Most people do not require extensive testing. Tests generally depend on the severity and length of the constipation, age and whether or not there is blood present in the stool. The doctor will also take a full medical history and ask if there has been recent weight loss. Most likely, the doctor will ask about your diet and eating habits. He or she will want to know the frequency and consistency of your bowel movements and whether there was any blood present in the stool. Other helpful information would include physical activity, any medications, herbal remedies, vitamins, nutritional supplements, exercise performance enhancers, caffeine intake or other substances you take and your level of physical activity.

Your doctor may also perform a physical exam which includes a rectal exam, using a gloved, lubricated finger to assess the health and tone of the muscles that close off the anus (internal and external anal sphincters) and to identify blood, obstruction, tenderness or other revealing conditions. Sometimes, blood (generally, these are blood tests as well) tests will also be requested to rule out thyroid, inflammatory, metabolic, serum calcium or other disorders. In the most severe cases, other tests may include: a colorectal transit study (Sitz marker study), anorectal function tests, a defecography, barium enema x-ray, and/or sigmoidoscopy or colonoscopy.

What are the types of constipation?

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There several types of constipation, the most common of which is idiopathic such as functional constipation (also called chronic idiopathic constipation). Irritable bowel syndrome (IBS) with predominant and severe constipation symptoms is categorized separately.

Idiopathic constipation or that of unknown origin (lacks a physical or physiological cause but may have a neurological, psychological or psychosomatic cause) generally does not respond to standard treatment.

Idiopathic and chronic idiopathic constipation (CIC) or “functional constipation” is when the bowel is healthy but not working as expected. This is often the result of diet and lifestyle. Although more commonly present in women, functional constipation does occur in men and children as well. Delayed transit and colonic inertia are types of functional constipation that are caused by a decrease in muscle activity in the colon. Pelvic floor dysfunction is also a type of functional constipation which is caused by a weakness of the muscles in the pelvis surrounding the anus and rectum. Biofeedback training can be a helpful adjunctive treatment with this type of constipation.

Another abnormality is the inability to relax the rectal and anal muscles that allow the stool to exit. People with IBS having predominantly constipation may have pain and bloating as well.

How is constipation treated?

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Treating constipation can sometimes be as simple as diet and lifestyle changes. Among these changes are:

  • Drink at least 2 quarts (64 oz) of water or other fluids daily. Avoid caffeine and in some cases dairy.
  • Eat a well-balanced diet with enough fiber. Include fruits, vegetables, whole grains, bran cereals, and legumes.
  • Exercise.
  • Don’t fight the urge to move your bowels and don’t try to rush.
  • Laxatives can be used when all else fails, but should never be used habitually.
  • Stimulants such as dulcolax, senokot and correctal are some of the more common laxatives recommended.
  • Stool softeners can help moisten the stool.
  • Lubricants can help to grease the stool allowing it to move through the intestine more easily.
  • Always ask your doctor about using any “cleansing” methods such as “colonics” as these can sometimes be dangerous.

Treatments for Severe Constipation

  • The best treatment for severe constipation often depends on accurately identifying the underlying cause. Again, it’s important to pay attention and report to your doctor any abdominal pain and other accompanying symptoms.
  • If your chronic constipation is caused by anorectal dysfunction, biofeedback may be recommended.
  • Discontinuing or changing certain medications or performing surgery to correct an anorectal problem such as rectal prolapse, when the lower portion of the colon turns inside out.
  • If the symptoms from colonic inertia are very severe, the doctor may suggest surgery to remove the colon. This happens in very rare cases.

What are constipation medications?

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Without even counting fiber supplements, there are many over-the-counter constipation medications you might take. You should know they’re not all the same, so some may work better for you than others. Stimulants cause your intestines to contract; osmotic medications increase fluid secretion, lubricants help the stool move more easily, stool softeners draw water from the intestines. There are also suppositories and enema treatments for constipation.

There are three categories of prescription constipation medications: lactulose (Enulose, Kristalose, and generic), linaclotide (Linzess) and lubiprostone (Amitiza). The latter two groups of drugs cause the intestinal lining to secrete chloride, sodium and water which softens the stool.

Keep in mind that many medications used to treat other symptoms may cause constipation as a side effect. If you believe your constipation is a side effect of a medication you’re taking, be sure to talk with your doctor about whether taking an over-the-counter laxative is appropriate with your other medications.

Frequently Asked Questions

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Can constipation be serious?

Only if it leads to complications, such as hemorrhoids and/or tears in the skin around the anus. This can happen when you strain to pass a hard stool and it quickly and inappropriately stretches the external sphincter muscle. Straining to pass a hard stool can also cause a sudden drop in heart rate and blood pressure, known as vasovagal syncope or vagal response. Severe constipation along with the presence of other symptoms can also be an indication of a more serious underlying condition.

What if I see blood in the stool?

Rectal bleeding can occur as a result of a hard stool passing and tearing the skin. You should get checked by your physician if you see any type of rectal bleeding, no matter how small, type of color (bright red or dark) clotted or otherwise. This includes whether you have mild or severe constipation, or no constipation at all.

What do I do about hemorrhoids?

Warmtub baths (Sitz baths), ice packs, and special creams to the affected area can help.

What do I do about the intestinal lining that is pushing out?

This is known as “rectal prolapse”, caused by straining to have a bowel movement. Usually this will fix itself when you stop straining or coughing. If it’s severe or chronic, it may require surgery to repair the prolapsed lining and to strengthen and tighten the anal sphincter muscle.

What should I do if I am constipated?

Try drinking an adequate amount of water unless amount has been restricted by your doctor, warm liquids in the morning instead of caffeinated beverages (coffee, certain teas, some carbonated beverages), add fiber to your diet, eat prunes and bran, wheat or multigrain cereals, and use a stool softener or mild laxative (do not use laxatives for more than 2 weeks, without your doctors’ consent).

What is an impaction?

Fecal impaction is when the stool is so hard (devoid of water) and large it cannot easily pass through the anus. It is so tightly packed that the normal pushing action is unsuccessful in voiding. Mineral oil taken by mouth or in an enema form may help. In severe cases, your doctor may need to perform a manual dis-impaction of the hardened stool.

What is the most common cause of constipation?

Poor diet and lack of exercise.

Should I call the doctor if I am constipated?

You should call your doctor if you have any of the following symptoms:

  • The constipation lasts more than 2 weeks.
  • There is blood in your stool.
  • You are having pain with your bowel movements.
  • You are losing weight unintentionally (not dieting).
  • The constipation is a new change in bowel habits for you.