Chronic Constipation

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The Hoag Digestive Health Institute is one of the top programs in the nation, committed to understanding, diagnosing and treating conditions of the GI tract. That includes constipation issues that may have become chronic. From the latest diagnostic imaging to dietary advice and next-generation treatments, we’ve got the tools and techniques you need to get you on the road to better digestive health. Contact Hoag today.

What Is Constipation?

Constipation is a common digestive issue in which people have infrequent bowel movements, dry or lumpy stools or difficulty passing stool over a prolonged period of time.

While most people experience constipation at some point, it becomes chronic when it lasts for several weeks or longer.

It’s also important to understand that what constitutes “regular bowel movements” varies from person to person, including the consistency and frequency of bowel movements. For some, having bowel movements twice a day is normal, while for others, four times a week is the norm.

What Are The Symptoms Of Chronic Constipation?

The symptoms of constipation can vary from patient to patient, and can change over time. However, symptoms of chronic constipation include:

  • Moving the bowels less than three times a week for a long period of time
  • Difficulty passing stool
  • Abdominal pain due to straining during bowel movements
  • Lumpy or hard stools
  • A feeling of being “blocked” or not having fully emptied your bowels
What Causes Constipation? 

Sometimes, it can be hard to pin down the causes of constipation. However, there are certain factors which are known or believed to cause constipation and dry stool in adults. Factors that may contribute to constipation include: 

  • Not eating enough high fiber foods in your daily diet, including fruits, vegetables and grains
  • Dehydration and not drinking enough fluids, which can make the stool dry and hard to pass. Not drinking enough water is one of the most common causes of constipation
  • Consuming too much caffeine, which can contribute to dehydration
  • Lifestyle factors, including diet changes and not getting enough exercise
  • Having a family history of constipation
  • Certain medications, including opioid pain relievers
  • Having a fever
  • Hormonal changes, including during pregnancy or prior to menstruation 
  • Certain gastrointestinal conditions, including IBS and Crohn’s disease
  • Certain mental issues, including depression and anxiety
  • Eating too many processed foods or dairy products
  • Having weak pelvic floor muscles
What Medical Issues Can Contribute To Constipation

Several medical conditions can cause constipation or make symptoms worse. Factors that can cause constipation include: 

  • Disorders that affect the muscles or nerves used during normal bowel movements, including stroke or Parkinson’s disease.
  • Conditions affecting hormones or metabolism, like diabetes. 
  • Diet and lifestyle changes, including if you don’t exercise regularly or have a diet with not enough fluids or fiber
  • Tumors
  • Pelvic floor disorders
  • Gastrointestinal disorders, including irritable bowel syndrome, intestinal blockage or stricture, which is a narrowing of the GI tract

How Is Chronic Constipation Diagnosed?

Constipation is usually considered chronic when a patient has fewer than three bowel movements per week for a long period of time, bowel movements that are dry and difficult to pass or reports attempting bowel movements repeatedly without result.

Diagnosing constipation involves reviewing the patient’s medical history, a thorough physical examination and possibly diagnostic tests. During the exam, your healthcare provider is likely to ask about your bowel habits, diet, any medications you may be taking, how much caffeine you consume every day, your level of physical activity and other factors.

What Medical Exams Or Tests Are Used To Diagnose Constipation?

Apart from a physical examination and reviewing the patient’s medical history, doctors might recommend certain imaging tests to diagnose constipation that’s believed to be chronic. These may include:

  • Anorectal manometry, which is used to evaluate the strength and coordination of the muscles in the anus and rectum
  • Balloon Expulsion Test, which involves asking the patient to push out a special balloon that has been inserted into the rectum and inflated, simulating a bowel movement.
  • MRI Defecography, a procedure in which a barium paste introduced into the rectum, helping enhance the detail of MRI images produced during the test. During this procedure, the patient is sometimes asked to simulate a bowel movement.
  • Colorectal Transit Study, which is usually performed by having patients swallow small capsules containing a substance that can be seen in X-rays. This allows doctors to view these capsules as they travel through the GI tract and evaluate how long food takes to move through the body.
Can Constipation Be Fixed By Changing My Diet?

Sometimes. Though constipation can result from a variety of factors including medications you may be taking or medical conditions you might have, eating a healthy diet plays a crucial role in managing and preventing constipation for most people. 

Consuming a high fiber diet that includes lots of fresh fruits, vegetables and whole grains can help. Drinking enough water is also important to preventing constipation as it helps soften the feces and makes stools easier to pass.

On the other hand, consuming too many processed foods, high-fat meats, caffeinated drinks or dairy products might make constipation worse.

Are There Any Serious Complications That Can Be Caused Or Made Worse By Constipation?

Sometimes, not moving the bowels over a long period of time or excessive straining to pass stool can lead to serious medical complications. These may include: 

  • Hemorrhoids (AKA piles), which can result from too much straining while constipated 
  • Weight loss
  • Rectal prolapse, a condition in which a small amount of the rectum’s lining pushes out from the anal opening 
  • Anal fissures, which are small tears in the anus 
  • Fecal impaction, in which the stool hardens in the rectum and often cannot be expelled without medical intervention
Is Constipation Dangerous?

While constipation can be uncomfortable and distressing, it’s not usually dangerous unless it continues a long time without a bowel movement. However, if left untreated, it can lead to complications like rectal prolapse or anal fissure, which is a tear in the lining of the rectum. In some cases, being unable to have a bowel movement might also be a symptom of a more severe illness, including colon cancer.

Are There Any Medications That Can Cause Constipation? 

Yes, several over-the-counter and prescription medications can cause constipation or make it worse. Some of these medications include:

  • Antidepressants: certain types of antidepressants, especially tricyclic antidepressants, can lead to constipation.
  • Antacids, particularly those containing aluminum or calcium can cause constipation.
  • Opioids: Opioid-based pain medications are well-known for causing constipation.
  • Diuretics: by reducing the amount of water in your system, diuretics can increase the risk of constipation.
  • Calcium channel blockers, which are used for treating high blood pressure, certain heart conditions and other medical conditions.
  • Iron supplements
  • Anesthesia used during surgeries and medical procedures can sometimes lead to constipation after surgery

How Is Constipation Treated?

Treatment for constipation varies based on its cause and severity. Dietary and lifestyle changes, like consuming a high fiber diet and staying active, can help. Over-the-counter laxatives, fiber supplements and stool softeners might also be recommended.

Some people can also benefit from adopting a knees-up squatting position when defecating, with their feet resting on an elevated toilet stool. In severe cases, doctors might prescribe enemas to help flush stool out the lower digestive tract, or prescription medications.

Can Drinking More Water Help Fix Constipation?

Yes, drinking enough fluids, especially water, can often help prevent constipation and alleviate symptoms. Fluids help fiber in your diet work more effectively, making stool softer and easier to pass through the digestive system.

How much water you should drink depends on several factors, including how much physical activity you’re doing, your gender, body weight, how hot it is where you are and more. However, according to information from the National Academies of Medicine, it’s recommended that women should drink between 6 to 9 cups of water per day, while men need about 8 to 12 cups, with one cup equalling 8 fluid ounces.

Which Medications Are Safe To Treat Constipation?

There are several over-the-counter and prescription medications to treat constipation. These include fiber supplements, stool softeners and laxatives. There are also time-tested methods like advising patients to eat prunes, or to adopt a high-fiber diet. However, be sure to consult with your healthcare provider about the issues you’re experiencing before starting any new diet or medication.

Who Is Most At Risk To Develop Constipation?

Older adults are more likely to experience chronic constipation, and medical conditions that are often experienced by older people like stroke, Parkinson’s disease, diabetes and Alzheimer’s disease can increase the risk. Additionally, certain medications, a diet low in fiber and high in processed food, reduced physical activity and other can also contribute to constipation for people of all ages.

Are There Any Ways To Reduce My Risk Of Developing Constipation?
  • Consume a diet that’s high in fiber, including fresh fruits, vegetables and whole grains like bran cereal
  • Eat prunes, which are delicious, natural and one of the most fiber-dense foods
  • Drink enough fluids, which can keep your stool soft
  • Stay active and engage in daily physical activity
  • If possible, avoid medications that can cause constipation
  • Maintain a regular bowel movement routine, and avoid skipping bowel movements when you feel the urge to go.



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