Overview
Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.
Constipation is generally described as having fewer than three bowel movements a week.
Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms.
Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found.
Symptoms
Passing fewer than three stools a week.
Having lumpy or hard stools.
Straining to have bowel movements.
Feeling as though there’s a blockage in your rectum that prevents bowel movements.
Feeling as though you can’t completely empty the stool from your rectum.
Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum.
Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.
When to see a doctor
Causes
lockages in the colon or rectum
Blockages in the colon or rectum may slow or stop stool movement. Causes include:
Blockages in the colon or rectum may slow or stop stool movement. Causes include:
- Anal fissure
- Bowel obstruction
- Colon cancer
- Narrowing of the colon (bowel stricture)
- Other abdominal cancer that presses on the colon
- Rectal cancer
- Rectum bulge through the back wall of the vagina (rectocele)
- When to see a doctor
Problems with the nerves around the colon and rectum
Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:
- Autonomic neuropathy
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
- Stroke
Difficulty with the muscles involved in elimination
Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:
- Inability to relax the pelvic muscles to allow for a bowel movement (anismus)
- Pelvic muscles don’t coordinate relaxation and contraction correctly (dyssynergia)
- Weakened pelvic muscles
Conditions that affect hormones in the body
Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:
- Diabetes
- Overactive parathyroid gland (hyperparathyroidism)
- Pregnancy
- Underactive thyroid (hypothyroidism)
Risk factors
Being an older adult
Being a woman
Being dehydrated
Eating a diet that’s low in fiber
Getting little or no physical activity
Taking certain medications, including sedatives, narcotics, some antidepressants or medications to lower blood pressure
Having a mental health condition such as depression or an eating disorder
Complications
- Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
- Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
- Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
- Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.
Prevention
- Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
- Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
- Drink plenty of fluids.
- Stay as active as possible and try to get regular exercise.
- Try to manage stress.
- Don’t ignore the urge to pass stool.
- Try to create a regular schedule for bowel movements, especially after a meal.
- Make sure children who begin to eat solid foods get plenty of fiber in their diets.
Diagnosis
- Blood tests. Your doctor will lookfor a systemic condition such as low thyroid (hypothyroidism).
- Examination of the rectum and lower, or sigmoid, colon (sigmoidoscopy). In this procedure, your doctor inserts a lighted, flexible tube into your anus to examine your rectum and the lower portion of your colon.
- Examination of the rectum and entire colon (colonoscopy). This diagnostic procedure allows your doctor to examine the entire colon with a flexible, camera-equipped tube.
- Evaluation of anal sphincter muscle function (anorectal manometry). In this procedure, your doctor inserts a narrow, flexible tube into your anus and rectum and then inflates a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows your doctor to measure the coordination of the muscles you use to move your bowels.
- Evaluation of anal sphincter muscle speed (balloon expulsion test). Often used along with anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.
- Evaluation of how well food moves through the colon (colonic transit study). In this procedure, you may swallow a capsule that contains either a radiopaque marker or a wireless recording device. The progress of the capsule through your colon will be recorded over several days and be visible on X-rays.In some cases, you may eat radiocarbon-activated food and a special camera will record its progress (scintigraphy). Your doctor will look for signs of intestinal muscle dysfunction and how well food moves through your colon.
- An X-ray of the rectum during defecation (defecography). During this procedure, your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.
- MRI defecography. During this procedure, as in barium defecography, a doctor will insert contrast gel into your rectum. You then pass the gel. The MRI scanner can visualize and assess the function of the defecation muscles. This test also can diagnose problems that can cause constipation, such as rectocele or rectal prolapse.
Treatment
Diet and lifestyle changes
Your doctor may recommend the following changes to relieve your constipation:
- Increase your fiber intake. Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.
- Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.
- Don’t ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.
Laxatives
Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement. The following are available over th counter:
- Fiber supplements. Fiber supplements add bulk to your stool. These include psyllium, calcium polycarbophil and methylcellulose fiber.
- Stimulants. Stimulants including Correctol, bisacodyl and senna-sennosides oral cause your intestines to contract.
- Osmotics. Osmotic laxatives help fluids move through the colon. Examples include oral magnesium hydroxide, magnesium citrate, lactulose, polyethylene glycol.
- Lubricants. Lubricants such as mineral oil enable stool to move through your colon more easily.
- Stool softeners. Stool softeners such as docusate sodium and docusate calcium moisten the stool by drawing water from the intestines.
- Enemas and suppositories. Sodium phosphate, soapsuds or tap water enemas can be useful to soften stool and produce a bowel movement. Glycerine or bisacodyl suppositories also can soften stool.
Training your pelvic muscles
Biofeedback training involves working with a therapist who uses devices to help you learn to relax and tighten the muscles in your pelvis. Relaxing your pelvic floor muscles at the right time during defecation can help you pass stool more easily.
During a biofeedback session, a special tube (catheter) to measure muscle tension is inserted into your rectum. The therapist guides you through exercises to alternately relax and tighten your pelvic muscles. A machine will gauge your muscle tension and use sounds or lights to help you understand when you’ve relaxed your muscles.
Surgery
Surgery may be an option if you have tried other treatments and your chronic constipation is caused by a blockage, rectocele, anal fissure or stricture.
For people who have tried other treatments without success and who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option. Surgery to remove the entire colon is rarely necessary.
Lifestyle and home remedies
- Increase your fiber intake. Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.
- Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.
- Don’t ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.
Preparing for your appointment
Because appointments can be brief, and because there’s often a lot of information to cover, it’s a good idea to be well-prepared. Here’s some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions.At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restricting your diet or eating certain high-fiber foods to prepare for diagnostic testing.
- Write down any symptoms you’re experiencing.
- Write down key personal information,including any major stresses or recent life changes, such as traveling or becoming pregnant.
- Make a list of all medications,vitamins, supplements or herbal medications you’re taking.
- Take a family member or friend along.Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questionsto ask your doctor.
For constipation, some questions you might want to ask your doctor include:
- What’s the most likely cause of my symptoms?
- What kinds of tests do I need, and how do I need to prepare for them?
- Am I at risk of complications related to this condition?
- What treatment do you recommend?
- If the initial treatment doesn’t work, what will you recommend next?
- Are there any dietary restrictions that I need to follow?
- I have other medical problems. How can I manage these along with constipation?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.
What to expect from your doctor
- When did you begin experiencing symptoms of constipation?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do your symptoms include abdominal pain?
- Do your symptoms include vomiting?
- Have you recently lost weight without trying?
- How many meals do you eat a day?
- How much liquid, including water, do you drink a day?
- Do you see blood with your bowel movements mixed in with the stool, in the toilet water or on the toilet paper?
- Do you strain with your bowel movements?
- Do you have any family history of digestive problems or colon cancer?
- Have you been diagnosed with any other medical conditions?
Have you started any new medications or recently changed the dosage of your current medications?
