About Constipation

Overview

Constipation is a condition in which you may have fewer than three bowel movements a week. It is characterized by stools that are hard, dry, or lumpy, making them difficult or painful to pass. You may also experience a feeling that not all stool has passed. Constipation is not a disease itself but can be a symptom of an underlying medical problem. It can cause discomfort and may be accompanied by stomach cramps, bloating, and nausea. While everyone's bowel movement patterns can vary, chronic constipation occurs when these symptoms persist over time. It is estimated that about 16% of adults experience chronic constipation, with the prevalence increasing among older adults and those in nursing homes. Taking preventive measures and seeking relief are important steps in managing constipation.

Causes and Risk Factors

The root causes of constipation include:

• Nerve Problems: When the link between the brain and the gut doesn’t work properly, it can change how the bowels function.
• Body-Wide Issues: Health problems like trouble moving around, diabetes, low thyroid levels, or too much calcium in the blood can affect how the gut works and moves.
• Blocked Bowel: Any kind of blockage in the intestines can lead to constipation.

The non-modifiable risk factors of constipation, which are factors that cannot be changed to reduce the risk of developing the condition, include:

• Increasing age: The older you get, the more you are at risk for constipation.
• Gender: Women tend to be more likely than men to develop constipation.
• Pregnancy: Constipation commonly occurs during pregnancy.
• Medical conditions: Parkinson's disease, multiple sclerosis, weakened pelvic muscles are some medical conditions that increase the risk.

The modifiable risk factors of constipation, which are lifestyle and environmental factors that can be changed to reduce the risk of developing the condition, include:

• Poor diet: Not getting enough fiber in your diet can contribute to constipation.
• Dehydration: Being dehydrated can affect bowel movements.
• Lack of exercise: Not being physically active can slow down the digestive system.

Remember, these are general risk factors and causes. It is important to consult with your healthcare professional for an accurate diagnosis and personalized advice.

Symptoms

Common early symptoms of constipation include:

• Feeling a blockage or like something is lodged in your rectum
• Straining during bowel movements
• Having less than three bowel movements a week
• Excessive straining or pain during bowel movements

As constipation progresses or becomes more severe, other common symptoms that may occur include:

• Passing lumpy, hard stools
• Stooling fewer than three times a week
• Bloating and gas
• Blood in stool
• Physical pain while using the bathroom
• Swollen abdomen or bloating
• Stool that appears large or resembles small pellets

It is important to note that symptoms can vary from person to person, and tracking your symptoms can help you report them to your healthcare provider accurately. If you experience any concerning symptoms or if constipation is new or unusual for you, it is recommended to consult with your healthcare provider for further evaluation and guidance.

Diagnosis

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

• Medical history: The doctor will ask questions about symptoms and medical history.
• Physical examination: This may include checking for signs of dehydration, abdominal swelling, pain, or tenderness, and performing a rectal exam.
• Stool tests: Doctors may test stools for hidden blood to rule out other diagnoses.
• Blood tests: These can help identify any underlying conditions or imbalances.
• Urine tests: These can provide additional information about kidney function and hydration levels.

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

• Colonoscopy: This procedure allows the doctor to examine the entire colon for any abnormalities.
• Sigmoidoscopy: This procedure examines the lower part of the colon for signs of inflammation or blockages.
• Ultrasounds or X-rays: These imaging tests can help identify any structural abnormalities in the digestive system.
• Colorectal transit studies: These tests measure how long it takes for food to move through the digestive tract.
• Balloon expulsion test: This test assesses the ability to expel a balloon filled with water from the rectum.

It is important to note that these additional tests are not always necessary and will depend on the individual's symptoms and medical history. Consult with a healthcare professional for personalized advice.

Treatment Options

The goals of treatment for constipation are to reduce symptoms like abdominal pain and bloating, and to have regular, soft bowel movements at least three times each week. Here are the recommended treatments and how they work to achieve these goals:

• Medication types:
• Fiber supplements: These help increase the bulk and softness of stool, making it easier to pass.
• Stool softeners: These medications add moisture to the stool, making it easier to pass.
• Prescription medications: Medications like lubiprostone can increase fluid in the digestive tract, promoting bowel movements.
• Therapies:
• Osteopathic treatment: This therapy aims to restore the movement of abdominal organs and improve tissue function.
• Abdominal massage: Massaging the abdomen can stimulate bowel movements and relieve constipation.
• Transcutaneous Electrical Nerve Stimulation (TENS): TENS therapy uses electrical stimulation to promote muscle contractions in the intestines, aiding in bowel movements.
• Acupuncture: Acupuncture has shown positive effects on functional constipation by stimulating nerve pathways.
• Therapeutic procedures:
• Enema: Used for fecal impaction, an enema helps soften and remove impacted stool.
• Manual disimpaction: This procedure is performed by a healthcare professional to manually remove impacted stool.
• Lifestyle changes:
• Increased fiber intake: Consuming more fiber-rich foods can add bulk to the stool, facilitating regular bowel movements.
• Hydration: Drinking plenty of water and other liquids helps soften the stool.
• Regular exercise: Exercise promotes healthy digestion and bowel movements.

It is important to note that medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Other side effects can occur. Check with your healthcare professional or read the information provided with your medication for additional side effect information.