Track 10: Chronic Constipation

Chronic constipation is a condition characterized by infrequent, difficult, or painful bowel movements that persist for at least 3 months. It can be a long-term issue affecting a person’s quality of life. While constipation is common and often temporary, chronic constipation requires attention to understand and manage the underlying causes effectively.

Symptoms of Chronic Constipation

Infrequent bowel movements: Fewer than three bowel movements per week.

Difficulty passing stools: Straining or feeling incomplete evacuation.

Hard or lumpy stools: Stools that are dry and difficult to pass.

Abdominal discomfort: Bloating, cramps, or a feeling of fullness.

Feeling of obstruction or blockage in the rectum.

Rectal discomfort or pain during bowel movements.

Causes of Chronic Constipation

Chronic constipation can be caused by a variety of factors, which can often overlap. The primary causes include:

Dietary Factors:

Low fiber intake: Fiber helps in absorbing water and forming stools, so a low-fiber diet can lead to hard stools.

Inadequate fluid intake: Dehydration can cause the colon to absorb too much water from waste, resulting in hard, dry stools.

Lifestyle Factors:

Inactivity or lack of exercise: Physical activity stimulates digestion and bowel movements. Lack of movement can slow down bowel function.

Ignoring the urge to go: Regularly ignoring the body's signals to defecate can lead to the weakening of the urge over time.

Medical Conditions:

Irritable Bowel Syndrome (IBS): A condition that often leads to either constipation or diarrhea.

Hypothyroidism: Low thyroid function can slow down metabolism and bowel movements.

Diabetes: High blood sugar levels can damage nerves controlling the intestines, leading to constipation.

Neurological Disorders: Conditions like Parkinson's disease, multiple sclerosis, or spinal cord injuries can affect the nerves that control the intestines.

Pelvic floor dysfunction: Dysfunction of the muscles and nerves controlling the pelvic floor can lead to difficulty with bowel movements.

Medications:

Opioid pain medications: These can slow bowel movement and are a common cause of constipation.

Antidepressants and antipsychotics: Some medications that affect serotonin levels can lead to constipation.

Iron supplements: Iron can cause stools to become hard and difficult to pass.

Antacids containing aluminum or calcium: These can reduce bowel motility and cause constipation.

Structural Problems:

Colonic stricture or obstruction: Narrowing or blockage of the colon can prevent stool from passing.

Rectal prolapse or other anorectal disorders: Conditions affecting the rectum or anus can make defecation difficult.

Psychological Factors:

Stress and anxiety: Can lead to changes in bowel habits and digestion.

Depression: May affect the autonomic nervous system that controls bowel movements.

Age and Hormonal Changes:

Aging: Aging can slow the digestive process and lead to a slower transit time through the colon.

Pregnancy: Hormonal changes during pregnancy can slow bowel movements and cause constipation.

Diagnosis of Chronic Constipation

To diagnose chronic constipation, a healthcare provider will usually perform a physical examination, review the patient's medical history, and ask about their diet, lifestyle, and medication use. Additional tests might include:

Blood tests: To check for thyroid function, diabetes, and other conditions.

Colonoscopy or sigmoidoscopy: To rule out structural abnormalities like colon cancer, polyps, or diverticulosis.

Rectal manometry: A test to assess the function of the rectum and anal sphincter.

X-rays or imaging studies: To evaluate for obstruction or colonic motility issues.

Treatment for Chronic Constipation

Managing chronic constipation often requires a multifaceted approach, combining lifestyle changes, medications, and sometimes, therapies to address any underlying conditions.

1. Dietary and Lifestyle Changes

Increase fiber intake: Aim for 25-30 grams of fiber per day from fruits, vegetables, whole grains, and legumes.

Increase fluid intake: Drink plenty of water to keep the stool soft and facilitate passage.

Exercise regularly: Physical activity helps stimulate bowel function and prevent constipation.

Establish regular bowel habits: Try to go to the bathroom at the same time each day and respond promptly to urges.

2. Medications

Depending on the severity of the condition, several medications may be used:

Fiber supplements: Products like psyllium (Metamucil) or methylcellulose (Citrucel) can help add bulk to stool.

Stool softeners: Medications like docusate (Colace) help soften stool and make it easier to pass.

Laxatives: Available in various forms (e.g., stimulant, osmotic), these can help promote bowel movements.

Osmotic laxatives (e.g., polyethylene glycol or lactulose) draw water into the colon, softening stool.

Stimulant laxatives (e.g., senna, bisacodyl) stimulate bowel muscles to contract.

Prokinetic agents: These drugs increase the motility of the intestines (e.g., prucalopride).

Lubiprostone and linaclotide: Medications specifically designed to treat chronic constipation by increasing fluid secretion in the intestines.

Biofeedback therapy: If pelvic floor dysfunction is suspected, biofeedback can help train the pelvic floor muscles to work properly.

3. Biofeedback and Pelvic Floor Therapy

For people with pelvic floor dysfunction, working with a trained pelvic floor therapist can help improve muscle coordination and reduce straining during bowel movements.

4. Surgery (Rare cases)

Surgery may be considered if there are anatomical issues causing the constipation, like a colonic obstruction, rectal prolapse, or other structural problems that don't respond to more conservative treatments.

When to Seek Medical Help

If you experience:

Severe or persistent abdominal pain.

Unexplained weight loss.

Blood in the stool.

Symptoms that are not responding to over-the-counter treatments.

Prevention of Chronic Constipation

Maintain a healthy, balanced diet rich in fiber.

Drink adequate fluids daily.

Exercise regularly to stimulate normal bowel movement.

Avoid delaying bowel movements and respond promptly to urges.

Conclusion

Chronic constipation can significantly affect a person’s daily life, but with the right approach, it is often manageable. Lifestyle modifications are often the first step, followed by medical therapies for more persistent cases. If you're experiencing chronic constipation, a healthcare provider can help identify its cause and recommend the appropriate treatment.