Constipation

Overview

Constipation is generally described as having less than 3 bowel movements a week. If this persists for several weeks or longer, it is categorized as chronic constipation. 

Occasional constipation is very common and sometimes does not need treatment, though there are options should you need them. Chronic constipation is more serious and some people who experience it find it interferes with their ability to go about their daily life. Chronic constipation can also cause excessive strain in order to have a bowel movement. 

Treatment options available for chronic constipation partially depend on the underlying cause. In some cases however, a cause is never found. 

Signs and Symptoms 

The signs and symptoms of chronic constipation include: 

  • Lumpy or hard stools
  • Passing fewer than 3 stools per week
  • Feeling as though your can’t completely empty your rectum of stool 
  • Needing help to empty your rectum such as using a finger or pressing on your abdomen. 
  • Feeling as though there’s a blockage in your rectum preventing bowel movements
  • Straining to have bowel movements

If you experience two or more of these symptoms over 3 consecutive months, you may have chronic constipation. 

The most common occurrence of constipation is when stool is moving too slowly through the digestive tract or cannot be fully voided from the rectum which can cause it to become dry and hard. There are many potential causes for chronic constipation. 

Blockages in the colon or rectum

Blockages in the rectum or colon can stop or slow down stool movement. Causes include: 

  • Colon cancer
  • Rectal cancer
  • Anal fissure
  • Narrowing of the colon
  • Rectum bulge through the back wall of the vagina
  • Other abdominal cancer that presses on the colon
  • A blockage in the intestines

Problems with the nerves around the colon and rectum

Neurological problems may interfere with the nerves that cause the muscles in the rectum and colon to contract and push stool through the intestines. Causes include: 

  • Multiple sclerosis
  • Stroke 
  • Spinal cord injury
  • Damage to the nerves controlling bodily functions
  • Parkinson’s disease

Difficulty with the muscles involved in elimination

Issues with the pelvic muscles that are involved in bowel movements can cause chronic constipation. These problems can include: 

  • Pelvic muscles that do not coordination contraction and relaxation correctly 
  • Weakened pelvic muscles
  • Not being able to properly relax the pelvic muscles to allow for a bowel movement 

Conditions that affect hormones in the body

There are hormones that help balance bodily fluids. Conditions or diseases that upset hormonal balance can also lead to constipation. These include: 

  • Pregnancy
  • Diabetes
  • Underactive thyroid 
  • Overactive parathyroid gland

Diagnosis and Treatment

In addition to a digital rectal exam and a general physical exam, the following tests and procedures can be used to diagnose and find the cause of chronic constipation: 

  • X-Ray – an x-ray can help to determine whether your intestines are blocked and whether there is stool present throughout the colon. 
  • Evaluation of anal sphincter muscle function – this is a procedure where the doctor inserts a narrow, flexible tube into your anus and rectum, then inflates a small balloon at the tip of the tube. Then the device is pulled back out through the sphincter. This allows your doctor to measure the coordination of the muscles used to move your bowels. 
  • Examination of the rectum and lower colon (sigmoidoscopy) – In this procedure, the doctor will insert a lighted, flexible tube into your anus in order to examin your rectum and the lower portion of your colon. 
  • Evaluation of the anal sphincter muscle speed – This test will measure the amount of time it takes for you to push out a balloon that has been placed in your rectum after being filled with water. 
  • Colonoscopy – Your doctor will examine the entire colon using a flexible, camera-equipped tube. 
  • Colonic Transit Study – You will swallow a capsule that contains a wireless recording device or a radiopaque marker. The progress of the capsule through the colon is recorded over 24-48 hours and will be visible on x-rays. Sometimes you will eat food that has been radiocarbon-activated and a special camera will record its progress. Your doctor will watch for signs of intestinal muscle dysfunction and how food moves through the colon. 
  • An X-ray of the rectum during defecation – Your doctor will insert a soft paste made of barium into your rectum. Then you will pass the barium paste as you would stool. The barium will show up on x-rays and might reveal problems with muscle function or coordination, or a prolapse. 
  • MRI defecography – A doctor will insert contrast gel into your rectum which you will pass as you would stool. The MRI scanner visualizes and assesses the function of the defecation muscles. This test also help diagnose problems such as rectocele or rectal prolapse. 
  • Blood tests – Your doctor will look for a systemic condition like hypothyroidism or high calcium levels. 

There are many avenues of treatment for chronic constipation depending on what is determined to be the root cause. 

Diet and Lifestyle Changes

Your doctor may recommend changing different aspects of your diet or lifestyle. For example, exercising. Physical activity is known to increase muscle activity in your intestines. If you can fit in exercise most days of the week, you are likely to see results. Your doctor may also recommend an increase in fiber intake. Added fiber will increase the weight of your stool and speeds its passage through the intestines. Slowly incorporate more fresh vegetables and fruits every day, and choose whole grain cereals and breads. Your doctor may recommend a specific number of grams so follow their instructions carefully. Finally, do not ignore the urge to have a bowel movement. Take your time in the bathroom and do not rush yourself.

Laxatives

There are many kinds of laxatives. Each works differently to ease the process of having a bowel movement. You can use an over the counter laxative such as: fiber supplements, osmotics, stimulants, enemas and suppositories, lubricants, and stool softners. 

If over the counter products do not work for you, your doctor may prescribe a medication such as: serotonin 5-hydroxytryptamine 4 receptors (Motegrity), medications that draw water into your intestines (Amitiza or Linzess), or peripherally acting mu-opioid receptor antagonists (Relistor).  

Training Your Pelvic Muscles

You can work with a therapist who will use devices to help you learn to tighten and relax your pelvic muscles. Learning how to properly relax your pelvic floor muscles can help you pass stool more easily. 

Surgery

Surgery can be an option if other treatments have not worked or if your chronic constipation is caused by a rectocele, blockage, or stricture. Surgical options involve removing part of the colon, it is rarely necessary to remove the entire colon.