About Chronic Constipation

Overview

Chronic constipation refers to persistent constipation that lasts for 3 months or more and does not have a clearly identifiable underlying cause. It is a common gastrointestinal condition characterized by infrequent bowel movements, difficulty passing stools, or incomplete defecation. The bowel movements may be dry, lumpy, or hard. Chronic constipation can have a negative impact on quality of life, causing symptoms such as:

• Abdominal pain
• Bloating
• Loss of appetite
• Headaches
• Restlessness
• Anxiety
• Depression.

It affects individuals of all ages and can be more prevalent among children and older adults. The prevalence of chronic constipation is increasing due to changes in diet, lifestyle factors, and social and psychological influences. Treatment options for chronic constipation may include:

• Dietary changes
• Increased physical activity
• Over-the-counter medications (ask your doctor)
• Prescription medications if necessary.

Causes and Risk Factors

The root causes of Chronic Constipation include:

• Neurological causes: Dysfunction in the neural connection between the brain and the gut can alter bowel function. Conditions such as impaired mobility, neural dysfunction, and systemic factors can contribute to constipation.
• Endocrine or metabolic disorders: Conditions like diabetes, hypothyroidism, and hypercalcemia can impact gut function and motility, leading to constipation.
• Mechanical bowel obstruction: Obstructions of the bowel, whether acute or gradual in onset, can cause constipation.

The non-modifiable risk factors of Chronic Constipation are:

• Age: Constipation is more common in elderly individuals.
• Female sex: Females are at a higher risk of experiencing constipation due to factors like hormonal changes during pregnancy and pelvic floor injuries during labor.

The modifiable risk factors of Chronic Constipation include:

• Lifestyle factors: Inadequate fiber or fluid intake, sedentary lifestyle, and decreased physical activity can increase the prevalence of chronic constipation.
• Medications: Certain medications like opiates, calcium channel blockers, antidepressants, antipsychotics, and antacids can cause chronic constipation.
• Other health conditions: Pelvic floor dysfunction, neurologic problems (e.g., multiple sclerosis), mental health problems (e.g., depression), bowel diseases (e.g., irritable bowel syndrome), and physical disabilities that lead to immobility can contribute to chronic constipation.

Remember to consult with your healthcare professional for personalized advice. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.

Symptoms

The most common early symptoms of chronic constipation include:

• Difficult passage of stool
• Reduced frequency of bowel movements (less than three times per week)
• Feeling of incomplete defecation

As chronic constipation progresses or becomes more severe, other common symptoms may occur, such as:

• Feeling like you still need to pass stool after you already have
• Feeling like your intestines or rectum are blocked
• Having hard, dry stool that is difficult to pass
• Straining to have a bowel movement
• Belly pain or bloating
• Blood or white mucus in the stool
• Unintentional weight loss

It's important to note that chronic constipation can also lead to complications like anal fissures, stool impaction, hemorrhoids, and rectal prolapse. If you experience any concerning symptoms or if constipation persists despite dietary changes, it is advisable to consult with a healthcare provider for further evaluation and guidance.

Diagnosis

To diagnose chronic constipation, doctors commonly perform the following examinations, tests, and procedures:

• Medical history: The doctor will ask questions about your symptoms and medical history.
• Physical examination: The doctor may check for signs of dehydration, abdominal swelling, pain, or tenderness. They may also perform a rectal exam.
• Blood tests: These tests can help identify any underlying conditions or abnormalities.
• Bowel function tests: These tests evaluate how well your intestines are functioning and how food is moving through them.
• Imaging tests: These include X-rays, ultrasounds, or other imaging techniques to visualize the intestines and check for any abnormalities.
• Endoscopies: Colonoscopy and flexible sigmoidoscopy are procedures that allow the doctor to examine the colon and rectum using a flexible tube with a camera.

To determine the stage or severity of chronic constipation, additional examinations, tests, and procedures may include:

• Marker study (colorectal transit study): This test involves ingesting a pill containing markers visible on an X-ray to assess how food moves through your intestines.
• Anorectal manometry: This test measures the muscle tightness around the anus and evaluates rectal function.
• Fecal occult blood test: This test checks stool samples for hidden blood that can indicate underlying conditions.
• Proctoscopy: A procedure to visually examine the rectum and anus for any abnormal areas using a proctoscope.

Remember that these are general descriptions of common diagnostic procedures. Your doctor will advise you on which specific tests are necessary based on your individual situation.

Treatment Options

The goals of treatment for chronic constipation are:

• Reduce symptoms: The first goal is to alleviate symptoms like abdominal pain and bloating.
• Establish regular bowel movements: The second goal is to have regular, soft bowel movements at least three times per week without straining.

Treatment options for chronic constipation include:

• Diet and lifestyle changes: Increasing fiber intake by adding fruits, vegetables, and whole grains to the diet can help add bulk to the stool, making it easier to pass. Staying hydrated and increasing physical activity also promote regular bowel movements.
• Over-the-counter medications (OTC): If diet and lifestyle changes are not effective, OTC medications may be recommended. These medications can help soften the stool or increase bowel movements. However, it is important to consult with a healthcare professional before using OTC medications.
• Behavioral modification: Defecation training can help establish regular bowel habits. Going to the bathroom when the urge arises and taking advantage of the gastrocolic reflex after eating can facilitate defecation.
• Therapeutic procedures: In cases of fecal impaction, an enema or manual disimpaction may be necessary to resolve the impaction. However, manual disimpaction should only be performed by a healthcare professional due to associated risks.

It is important to note that treatment approaches may vary depending on the severity and underlying cause of chronic constipation. Consulting with a healthcare professional is crucial for personalized treatment recommendations.