Constipation

Dr. Ken D. Nguyen is the president and co-founder of Pacifica Digestive Health. His clinical interests include screening and management of gastric cancer in Asian patients, viral hepatitis (including hepatitis B and hepatitis C), advanced liver disease and cirrhosis, colon cancer screening, and international medicine.

What is Constipation?

By definition, constipation if the difficult passage of stools that tends to be persistent for several weeks or even longer. Generally, someone with constipation may have fewer than two to three bowel movements a week. For some people, this condition may end up being painful to the extent that they may effect their quality of life.

What Are the Symptoms of Constipation?

Some signs and symptoms that are associated with constipation may include:

• Hard/lumpy stool

• Passing less than three stools in a week

• Having the feeling that you are not able to fully empty stool from their rectum

• Straining while having bowel movements

• Having the feeling that there is a blockage that is preventing you from having a normal bowel movement

• Feeling the need to help empty your rectum such as pressing against the abdomen and the use of a finger to remove stool from your rectum

What Are the Causes of Constipation?

There are various reasons which may lead to development of constipation and these include:

1. Blockages in the colon or the rectum: Any form of blockages in your rectum or colon may cause difficulty with emptying your bowel or having regular bowel movements. Some reasons for blockage may include:

• Bowel obstruction

• Colon or rectal cancer

• Anal fissure

• Bowel stricture or narrowing

• Rectum prolapse, or bulge of the rectum out of the anus or through the posterior wall of the vagina

2. Nerve problems around the rectum and colon region: Neurological conditions may cause the muscles in the rectum, or colon to lack the ability to contract and allow forward movement of stool. This may lead to a condition called "neurogenic bowel". Some causes by include:

• Stroke

• Multiple sclerosis

• Autonomic neuropathy

• Parkinson’s disease

• Spinal cord injury

3. Pelvic floor disorder: Any issues associated with pelvic muscles may end up affecting bowel movements and cause chronic constipation. Some reason why pelvic floor disorder may result in constipation include:

• Weakened pelvic muscles

• Being unable to relax the pelvic muscles to allow for bowel movement

• Lack of coordination in the pelvic muscles

4. Various conditions that affect hormones: Hormones are very essential as they help in balancing body fluids but some diseases and conditions may end up upsetting the balance and these may include:

• Pregnancy

• Diabetes

• Underactive thyroids

• Over reactive parathyroid gland

Constipation may also be a symptom of irritable bowel syndrome (IBS), especially if you have associated abdominal pain, cramps, bloating, and gas. IBS with more predominant symptoms of constipation is called IBS-C.

What Are Risk Factors Associated With Constipation?

Some factors that may increasing your risk of constipation may include:

• Eating a low fiber diet

• Being a woman

• Aging

• Dehydration

• Various medications such as sedative, antidepressants, narcotics and medication for lowering blood pressure

• Lack of physical activity

• Various psychiatric conditions such as eating disorders and depression

What Are Complications That May Arise From Constipation?

1. Hemorrhoids: If you strain when having their bowel movements, you may end up having hemorrhoids, which are veins in and around the anus may become swollen or bleed.

2. Anal fissure: Having large or hard stool may cause to develop nears in your anal canal which may be painful when you have a bowel movement and can sometimes be difficult to heal.

3. Fecal impaction: Having prolonged and severe constipation may result in stool getting stuck in your rectum, which may require removal by a healthcare provider.

4. Rectal prolapse: Having constipation may cause your rectum to bulge and protruding out from your rectum.

How Can Constipation Be Prevented?

Eating a high fiber diet will help with constipation

Constipation can be prevented and avoided by lifestyle modifications.

• Eating fiber foods such as vegetables, fruits, bran and even whole grain

• Drink as much fluids as possible and at least 8-10 glasses of water daily

• Eat lesser processed foods, meat products and dairy as these are very low in fiber

• Be as active as possible

• Find a healthy way of managing stress

• Do not ignore the urge to passing stool

• Try creating a regular schedule for bowel movements especially after having a meal

How Can Constipation Be Treated?

Constipation can be treated with both over-the-counter and prescription medications if lifestyle modifications alone does not improve your symptoms.

Common over-the-counter medications that can be used to treat constipation include:

• Bulking Agent (Fiber): Bulking agents work by simply pulling fluid into the GI tract, making stool bulkier and softer. Bulking agents must be taking with large amount of water or else they may cause backup and blockage of your bowel. Examples of bulking agent include Metamucil (psyllium), Benefiber, methylcellulose, and polycarbophil.

• Osmotic Agents: Osmotic agents work by keep fluids within the stool and making the stool softer. However, they can cause dehydration if not taken with enough water. Examples of osmotic agents include Miralax, Milk of Magnesia, and magnesium citrate.

• Stool Softeners: Stool softeners work by bring fluid into the stool, making the stool softeners, and help with straining. Examples of stool softeners include Colace and Surfak.

• Stimulant Laxatives: Stimulant laxatives work by stimulating the bowel to contract and move stool foward. Examples of stimulant laxatives include Doculax and Senokot.

• Lubricants: Lubricants help with bowel movement by coating the outside of stool and making it easier to pass. Example of lubricant include Fleet mineral oil enemas.

If over-the-counter medications alone does not improve your constipation, your doctor may recommend prescription-strength medications. These medication may include:

• Lubiprostone is chloride channel activator that works by opening chloride channels and drawing more fluid into the GI tract. It is used for both patients with IBS-C as well as constipation where there is no clear cause (chronic idiopathic constipation). It improves constipation by softening the stool, decreasing the need to strain during a bowel movement, and increase the amount of bowel movements that you have.

• Linaclotide and plecanitide are guanylate cyclase-C agonists that work by promoting chloride and bicarbonate excretion into the GI tract which then draws water, which improves constipation by leading to softer stool, more frequent stools, less straining, and less abdominal pain. It is also indicated for both IBS-C and chronic idiopathic constipation.

Conclusion

There are many causes of constipation. The symptoms of constipation may be very bothersome if not well controlled. Lifestyles changes can help avoid or alleviate some symptoms. However, there are also multiple over-the-counter medications as well as prescription medications that may help with your symptoms.