Constipation

Constipation is the infrequent and/or difficult passage of stool. The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.

Common Misconceptions About Constipation
A common misconception is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the life span. These misconceptions have led to a marked overuse and abuse of laxatives. Many are not needed and routine use of some stimulant laxatives can cause dependency.

Is Constipation Serious?
Although it may be extremely bothersome, constipation itself is usually not serious. However, it may be the initial symptom of a serious underlying disorder such as cancer. Constipation can lead to hemorrhoids or fissures (caused by the hard stool stretching the sphincters). Bleeding can occur for either of these reasons and appears as bright red streaks on the surface of the stool. Fissures may be quite painful and can aggravate the constipation that originally caused them. Fecal impactions can occur (especially in young children and older adults) and may be accompanied by a loss of control of stool, with liquid stool flowing around the hard impaction. Chronic constipation may increase the risk for the development of diverticulosis or associated diverticular diseases.

Basics of Constipation

  • Most people experience occasional short bouts of constipation. If a laxative is necessary for longer than three weeks, seek medical advice.
  • Eat a well-balanced diet that includes unprocessed bran, whole-wheat grains, fresh fruits and vegetables.
  • Drink plenty of fluids.
  • Exercise regularly.
  • Set aside time after breakfast or dinner for undisturbed visits to the toilet.
  • Don’t ignore the urge to have a bowel movement.
  • Whenever there is a significant or prolonged change in bowel habits, see your doctor.

Causes of Constipation
Constipation is a symptom, not a disease. Like a fever, constipation can be caused by many different conditions. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:

  • Poor Diet: A main cause of constipation may be a diet high in animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), but low in fiber (vegetables, fruits, whole grains), especially insoluble dietary fiber, which helps move bulk through the intestines and promote bowel movements. Some studies have suggested that high-fiber diets result in larger stools, more frequent bowel movements.
  • Irritable Bowel Syndrome (IBS): Also known as spastic colon, IBS is one of the most common causes of constipation in the U.S. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.
  • Poor Bowel Habits: A person can initiate a cycle of constipation by ignoring the urge to have a bowel movement. Some people do this to avoid using public toilets, others because they are too busy. After a period of time, a person may stop feeling the urge. This leads to progressive constipation.
  • Laxative Abuse: People who habitually take stimulant laxatives become dependent upon them and may require increasing dosages until, finally, the intestine becomes insensitive and fails to work properly.
  • Travel: People often experience constipation when traveling long distances, which may relate to changes in lifestyle, schedule, diet and drinking water.
  • Hormonal Disturbances: Certain hormonal disturbances, such as an under active thyroid gland, can produce constipation.
  • Pregnancy: Pregnancy is another common cause of constipation, which may be partly due to hormonal changes during pregnancy.
  • Fissures and Hemorrhoids: Painful conditions of the anus can produce a spasm of the anal sphincter muscle, which can delay a bowel movement.
  • Specific Diseases: Many diseases that affect the body tissues, such as scleroderma or lupus, and certain neurological or muscular diseases, such as multiple sclerosis, Parkinson’s disease and stroke, can be responsible for constipation.
  • Loss of Body Salts: The loss of body salts through the kidneys or through vomiting or diarrhea is another cause of constipation.
  • Mechanical Compression: Scarring, inflammation around diverticula, tumors and cancer can produce mechanical compression of the intestine and result in constipation.
  • Nerve Damage: Injuries to the spinal cord and tumors pressing on the spinal cord can produce constipation by affecting the nerves that lead to the intestine.
  • Medications: Many medications can cause constipation. These include pain medications (especially narcotics), antacids that contain aluminum or calcium, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, antiparkinsonism drugs and calcium channel blockers for high blood pressure and heart conditions.
  • Colonic Motility Disorders: The peristaltic activity of the intestine may be ineffective resulting in colonic inertia or outlet obstruction.  Please visit the Heartland Center for Motility, within Gastroenterology Consultants, for more information.

Diagnostic Tests
Constipation may be caused by abnormalities or obstructions of the digestive system in some people. A doctor can perform tests to determine if constipation is the symptom of an underlying disorder.

In addition to routine blood, urine and stool tests, a colonoscopy may help detect problems in the rectum and colon.

Anorectal manometry uses highly specialized techniques for measuring pressures and movements within the colon and its sphincter muscles.  Anorectal manometry is available through the Heartland Center for Motility within Gastroenterology Consultants.

Treatment
The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives. For most people, dietary and lifestyle improvements can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.

Bowel habits also are important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored.

If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an under active thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy. In most cases, stimulant laxatives should only be taken under a doctor’s supervision. A doctor is best qualified to determine when a laxative is needed and which type is best. There are various types of oral laxatives and they work in different ways.

Biofeedback is a helpful tool to assist in the improvement of constipation that is due to uncoordinated movement of the muscles of the colon and pelvic floor. Anorectal manometry and biofeedback therapy are now offered at the Heartland Center for Motility, under the supervision of Dr. Ashok Attaluri, within Gastroenterology Consultants.  Dr. Attaluri is an expert in Motility Disorders of the gastrointestinal tract.

Above all, it is necessary to recognize that a successful treatment program requires persistent effort and time. Constipation does not occur overnight and it is not reasonable to expect that constipation can be relieved overnight.