Do you experience difficulty in evacuating stools? Or are you unable to have regular bowel movements? Do you go for three days or longer without defecating? Have you undergone intermittent treatment for the same but found no relief?

If yes, then you may be suffering from constipation. Constipation is a condition in which a patient has difficulty with bowel movements or is unable to have regular bowel movements. The number of bowel movements per week varies widely from patient to patient. Some people evacuate their bowels several times a day while others only a few times a week. It is unhealthy however for an individual to go three days or longer without defecating. The longer the time between bowel movements, the more likely the stool will become harder and much more difficult and painful to pass.

Constipation is considered to be chronic when you have fewer than two bowel movements a week or an inability to pass stool.

Constipation may seem like an everyday problem. Most people have experienced constipation at some point in their life. But it can be very disruptive, painful and interfere with your day – to day life.

What causes constipation?

Constipation has many causes and many of them can co-exist. They include:

  • Not enough water or fiber in the diet: most common cause.
  • Change in daily routine or diet
  • Not enough exercise or mobility
  • Too much dairy
  • Medications such as narcotic pain medication, some antacids, iron tablets, antihistaminics, certain blood pressure medicines, psychiatric medications such as antidepressants, herbal supplements etc
  • Prolapse: Prolapse is the dropping of the pelvic organs due to the weakness of the pelvic floor. When this weakness leads to bulging of parts of your large bowel (conditions called as sigmoidocele or enterocele) or rectal prolapse in which the rectal mucosa slides out of the anal opening, constipation can result.
  • There may be paradoxical contractions of the pelvic floor or the muscles of the pelvic floor may not relax.
  • Stress and depression
  • Ignoring the urge to have a bowel movement resulting in eventual loss of feeling of the urge.
  • Irritable bowel syndrome
  • Medical disorders like hypothyroidism or diabetes
  • Colon cancer: It may be accompanied by other symptoms including blood in stool and weight loss.
  • Pregnancy
  • Stool softener and laxative abuse: Laxative abuse is most common among older adults who are preoccupied with having a bowel movement.
  • Eating disorders
  • Neurological conditions including spinal cord injury and multiple sclerosis

How is constipation evaluated?

Most people do not need comprehensive testing. However, if you have constipation that has persisted for more than two weeks, you may need further evaluation. Underlying medical problems such as hypothyroidism and diabetes or colorectal cancer need to be detected early and treated.

Most people do not need extensive testing to evaluate constipation. Only a small number of patients with constipation have a serious underlying medical problem (such as a poor function of the thyroid gland, diabetes, or colorectal cancer).

If you have constipation that has persisted for more than two weeks, you should see a doctor determine if you need further evaluation. For a patient who has colorectal cancer, early detection and treatment may be life-saving.
After a thorough history and physical examination, including vaginal and rectal examination, you may be asked to undergo the following tests:

  • Blood tests and colonoscopy particularly in patients older than 50 years.

Colonic transit study which is an x-ray test that measures the time it takes for stools to move through the colon

  • Anal manometry which measures the pressure and function of the rectoanal muscles
  • Defecogram which is a live x-ray imaging study of the evacuation sequence of stools. It helps to determine whether non-relaxing or paradoxically contracting pelvic floor muscles are responsible for the constipation

Most patients, who have serious chronic constipation that cannot be explained by the presence of an underlying medical condition, suffer from either

  • Colonic inertia (lazy colon): It is a condition in which the colon retains stool because it is contracting poorly. This condition can be diagnosed using colon transit studies
  • Obstructed defecation: In this condition, the colon is contracting normally. But the patient is unable to evacuate stool from the rectum. This condition is confirmed by anal manometry.

How is constipation treated?

  • Increased consumption of liquids: It may help to drink two to four extra glasses of water a day. Consumption of warm liquids in the morning might help.

Diet changes:

  • Adding fruits, vegetables, legumes and whole-grain breads to diet is very helpful. Fruits have the most fiber in their skin. Also fruits with seeds that can be eaten like strawberries have the most fiber. High fiber-foods like bran cereal are particularly useful.
  • Prunes and prune juices also help regularize bowel movements.
  • Milk can cause constipation in some patients and should be avoided
  • Caffeinated drinks such as coffee and soft drinks have a dehydrating effect and should be avoided
  • Addition of supplemental fiber to the diet: Metamucil or Citrucel can be prescribed
  • If needed a very mild stool softener or laxative [such as Colace (docusate) or milk of magnesia) can be used, but not for more than two weeks without doctor’s advice.

How can constipation be prevented?

Eating a well-balanced diet with the dietary modifications described above is essential. It is important to drink at 8 big glasses of water a day. Exercising regularly and passing stools when you feel the urge are also important.

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