Chronic Constipation Overview
Constipation is infrequent or difficult bowel movements. Normal frequency varies, but fewer than three hard, dry bowel movements per week probably indicates constipation. Most constipation is temporary and easily treated
Chronic Constipation Symptoms
You're likely to have constipation if you've had at least two of these symptoms for at least three of the past six months:
- Fewer than three bowel movements per week
- Hard stools
- Strain during bowel movements
- Sense rectal blockage
- Sense incomplete emptying
- Need to use manual maneuvers to facilitate a bowel movement
Constipation is usually not serious, but chronic constipation may lead to complications or indicate a dangerous underlying problem. See your Wellstar physician if you have an unexplained change in bowel habits, or are constipated for more than a few weeks, or experience any of these symptoms:
- Bowel movements more than three days apart even after palliative changes in diet and exercise
- Intense abdominal pain
- Bloody stool
- Constipation alternating with diarrhea
- Rectal pain
- Thin, pencil-like stools
- Unexplained weight loss
Chronic Constipation Causes and Prevention
The waste products of digestion move from the small to the large intestine, where most of the water and salt is removed and reabsorbed, conserving these vital materials. If there is not enough fluid or fiber in your diet, or the large intestine's muscle contractions are too slow, too much water is removed from the waste, and the stool becomes hard and dry.
Another cause of constipation is lack of coordination of the voluntary pelvic muscles used to move your bowels.
Causes of intestinal slowdown include:
- Lack of fluids
- Lack of fiber
- Delaying bowel movements
- Lack of exercise
- Irritable bowel syndrome
- Lifestyle changes, like pregnancy and aging
- Misuse of laxatives
- Diseases like stroke, diabetes, and thyroid and Parkinson's disease
- Physical problems with the large intestine, like obstruction
- Certain medications
- Hormonal disturbances
- Anal fissure and hemorrhoids (both may also be caused by constipation)
- Spinal cord injury
Constipation is more likely in:
- Females, especially when pregnant
- Children and elderly people
- Sedentary people
- People with low-fiber diets
- People who don't drink enough fluids
- Those taking certain medications
- Patients undergoing chemotherapy
Chronic Constipation Diagnosis
Your Wellstar physician will take a complete medical history, perform a physical examination, and ask about medications that may cause constipation. They may also investigate possible conditions that can cause constipation.
For older patients, or those with severe symptoms, several tests may be used:
- For a barium enema x-ray, your bowel is lined with a barium dye that appears clearly on an x-ray.
- For an x-ray of the rectal area, the lower part of your large intestine is filled with a paste of the same thickness as stool, which appears clearly on x-rays taken as it is expelled.
- Colonoscopy—insertion of a lighted, flexible tube with a camera to examine the lower part of your large intestine.
- Rectal manometry—insertion, inflation, and withdrawal of a small balloon to measure coordination of bowel movement muscles.
- Swallowing a capsule visible to x-rays taken over several days to see how well waste moves through your colon.
Chronic Constipation Treatment
Usually, changes in diet and activity relieve constipation.
- A high-fiber diet (at least 20-35 grams of fiber daily) helps form a soft stool.
- Drinking plenty of water softens stools.
- Exercise stimulates digestive activity.
- Take time for complete bowel movements.
Laxatives may be habit-forming and should only be tried when diet and exercise fail to alleviate symptoms. There are several types of over-the-counter laxative:
- Considered the safest are fiber supplements, like Metamucil® and Citrucel® These must be taken with plenty of water.
- Stimulants, like Correctol® and Dulcolax®, and herbal stimulants like Cascara® and Senna®, increase intestinal contraction. Stimulants, including herbal stimulants, may lead to habituation, overuse, and colon failure, a very serious condition.
- Lubricants, such as mineral oil, help the stool move more easily
- Osmotics, like Miralax®, help fluids move through the large intestine
- Saline laxatives draw water into the colon to soften the stool
Prescription medications for constipation include chloride channel activators, which increase the stool's fluid content. If none of these treatments alleviate your constipation, the impacted stool may be broken up manually, or, in rare cases, part of the colon or anal sphincter or rectum may be removed surgically.