Constipation: Symptoms, Causes, Diagnosis, Treatment and Prevention

If you have difficulty passing stools, or you don’t pass a stool very often, or your stools are very hard, then you are probably experiencing constipation.

What is Constipation?

Constipation is a condition characterized by infrequent or irregular bowel movements, resulting in hard, dry stool, which are difficult to pass.

This happens when stool passes through the colon too slowly. The slower the stool moves through the large intestine, the more water is absorbed by the colon. As a result, the stools become hard and dry, making them difficult to pass.

The severity of constipation can vary greatly. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that may lead to health complications, such as hemorrhoids, tears in the skin around the anus (called anal fissures), and fecal impaction.

Constipation is one of the most common digestive complaints in the United States, affecting about 42 million people, according to the National Institutes of Health (NIH). It can affect people of all ages but it is more common in women, especially over the age of 65.

What are the Symptoms of Constipation?

A normal bowel movement can vary from person to person. Some people may pass stools more than once a day, while others may pass them a few times a week. However, you may be constipated if you experience the following symptoms:

  • Passing fewer than three stools a week
  • Passing hard, dry stools
  • Straining or pain during bowel movements
  • Feeling as though there’s a blockage in your rectum that prevents bowel movements
  • Feeling like you have not fully emptied your bowels after a movement

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

What Causes Constipation?

Constipation can be caused by a number of factors, such as unhealthy lifestyles, medications, and medical conditions.

Common unhealthy lifestyles that cause constipation include:

  • Not eating enough fiber
  • Not drinking enough water (dehydration)
  • Not getting enough exercise
  • Stress
  • Ignoring the urge to have a bowel movement

Certain medications that can cause constipation include:

  • Diuretics, such as hydrochlorothiazide (Hydrodiuril) and furosemide (Lasix)
  • Opioid pain relief drugs, such as codeine (Paracodol, Syndol), hydrocodone (Hysingla, Zohydro ER), methadone (Dolophine, Methadose) and meperidine (Demerol)
  • Psychiatric medications, like clozapine (Clozaril) and olanzapine (Zyprexa)
  • Some antidepressants, like amitriptyline (Elavil) and imipramine (Tofranil)
  • Certain anticonvulsants, including phenytoin (Dilantin) and carbamazepine (Tegretol)
  • Antacids containing calcium, such as Tums, Maalox, and Mylanta
  • Iron supplements that are used to treat iron-deficiency anemia, including ferrous gluconate and ferrous sulphate

Health and medical conditions that cause constipation include:

  • Colorectal problems, like a hernia, colorectal cancer, diverticulitis and inflammatory bowel disease (IBD)
  • Endocrine problems, such as diabetes, uremia, hypercalcemia, and underactive thyroid gland (hypothyroidism)
  • Neurologic disorders, including spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke
  • Irritable bowel syndrome (IBS)
  • Intestinal obstruction
  • Pregnancy

How is Constipation Diagnosed?

Your doctor will ask questions about your medical history, bowel movements, and your lifestyle habits.

Your doctor will also perform a physical examination, which includes a check of your pulse or temperature. He or she will touch your abdomen to check for pain, swelling, and lumps. The doctor then carries out a rectal examination which involves inserting his or her finger inside your anus (he or she will wear a glove and use lubrication). It’s a quick check for any problems that can be felt by finger.

If you’re experiencing severe symptoms, your doctor may order additional tests to diagnose or rule out other conditions. The tests may include the following:

  • Lab tests. In this test, the doctor will try to detect if there is a systemic condition, such as low thyroid (hypothyroidism) or high calcium levels.
  • An abdominal X-ray. It used to produce images of the inside of your abdomen. This can help your doctor determine whether your intestines are blocked and whether there is stool present throughout the colon.
  • Anorectal manometry. A test used to evaluate the strength of the rectal and anal muscles. In this procedure, your doctor will insert a thin, flexible tube with a balloon tip into your anus. The device is then pulled back through the sphincter muscle. This test allows your doctor to measure your anal sphincter’s muscle strength and see if your muscles are contracting.
  • Colonoscopy. In this test, your doctor will examine your colon using a colonoscope, which is a long, flexible tube that’s equipped with a tiny camera and light source. He or she will use the colonoscope to look closely for any polyps or other problems and any found polyps will be removed during this procedure.

How is Constipation Treated?

Treatment for constipation depends on the cause, the severity, and how long the condition has been present. The treatment options for constipation include:

Dietary and lifestyle changes

In most cases, constipation can be relieved and treated by making small changes to your diet and lifestyle.

  • Increase your fiber intake
    Adding fiber to your diet can help keep your stools bulky and soft, making it easier to move through your intestines. However, increasing your fiber intake too quickly can cause bloating and cramping. So, start slowly and work your way to your daily fiber goal over the course of a few weeks.

    It is recommended that women should aim to consume 20-25 grams of fiber per day, while men should target 30-38 grams of fiber. High fibre foods include oats, prunes, broccoli, pulses, nuts and seeds.

    Read also: top 10 foods that relieve constipation

  • Exercise regularly
    This can helps increase muscle activity in your intestines. Aim for about 150 minutes of moderate aerobic physical activity every week, with a goal of 30 minutes per day at least five times per week. Examples of aerobic exercises include running, jogging, swimming, cycling, dancing, and hiking.
  • Don’t delay if you feel the urge to have a bowel movement
    The longer you wait, the harder your stools become and more difficult to pass.
  • Drink plenty of water
    Since constipation is related to dehydration in the colon, you need to drink a lot of water to stay hydrated. When your body is properly hydrated, less water will be withdrawn from the colon. This will keep your stool soft and easy to pass.
  • Elevate your feet while sitting on the toilet
    When you are on the toilet, try raising your feet with a step stool, so that your knees are above your hips. This can make passing stools more easier.

Use laxatives

Your doctor may recommend using a laxative for a short time to help you pass stools if diet and lifestyle changes don’t help. Some laxatives are available over the counter, while others are available with a prescription.

As different laxatives work in different ways, your doctor will pick the drug that might work best for you based on the results of your tests. The following are some laxatives that can help ease constipation:

  • Fiber supplements (Citrucel, FiberCon, Benefiber)
  • Osmotic laxatives (Milk of Magnesia, Constilac, Miralax)
  • Stimulant laxatives (Correctol, Dulcolax, Senokot)
  • Stool softeners (Colace, Surfak)

Never use laxatives for more than two weeks without talking to your doctor. Long-term or inappropriate use of laxatives may result in laxative dependence and may cause electrolyte imbalances, which can be dangerous.

Surgery

Surgery may be an option if you have tried other treatments without success or your chronic constipation is caused by a structural problem in the colon.

Examples of these problems include a blockage in the colon (intestinal obstruction), a narrowing in a portion of the intestine (intestinal stricture), tear in the anus (anal fissure) or the collapse of part of the rectum into the vagina (rectal prolapse). Some causes of outlet dysfunction constipation may be treated with surgery.

How Can I Prevent Constipation?

You can prevent constipation by doing some of the same things that treat constipation. These include:

  • Get enough fiber in your diet
  • Drink plenty of water each day
  • Get regular exercise
  • Manage stress
  • Try to have a bowel movement at the same time every day
  • Don’t ignore the urge to pass stool
  • If medication you’re taking could be causing constipation, change the dose or switch to another drug. Never stop taking your medications or supplements before talking with your doctor first.

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