Constipation is something that everyone suffers at some point. Most of the time, it’s caused by a problem with your diet, including too much dairy and not enough fiber.
But the condition may be worse than mere infrequent bowel movements or difficulty in passing stools. In fact, it may be a sign of a serious health issue, including a stroke, spinal cord injury or cancer.
Constipation is clinically defined as having fewer than three bowel movements in a week, and the condition becomes chronic if it's present for three months or longer. Although an occasional bout with constipation, the people with chronic issues may find it interferes with normal living and enjoyment of the daily routine, as the system is taxed with excessive straining and other issues.
Symptoms of constipation include having lumpy or hard stools; passing fewer than three stools a week; straining during bowel movements; a feeling that there is blockage in the rectum area; and the need to help bowels completely evacuate by using a finger to remove stool or pressing on the abdomen.
While chronic constipation has many causes, it primarily occurs with a lack of moisture in the intestinal tract. This causes stools to become hard and dry, making movement difficult.
But blockages and difficulty can also be a sign of a bowel obstruction; an anal fissure; colon cancer; a narrowing of the colon; abdominal cancer that compresses the colon; rectal cancer, or, in women, a condition known as rectocele, which is a compression of the front wall of the rectum into the back wall of the vagina.
Constipation issues can also be associated with problems in the rectum and the nerves around the colon, causing the muscles to contract and make passage of stools difficult. These conditions can include autonomic neuropathy, multiple sclerosis, Parkinson’s disease, a spinal cord injury or a stroke. Muscle issues can include a condition called anismus, which is an inability to relax the pelvic muscles; dyssynergia, where pelvic muscles don’t coordinate contraction and relaxation in the pelvic muscles; and weakened pelvic muscles.
Finally, your constipation problem could be a hormonal issue. Diseases and conditions that disturb the body’s hormonal balance may cause constipation, including an overactive parathyroid gland (a condition known as hyperparathyroidism); diabetes; pregnancy; or an underactive thyroid (hypothyroidism).
WHO GETS IT?
Your chances of getting constipation on a frequent or chronic basis are enhanced by several factors. They include gender (women are more prone to constipation); age (older isn’t better); being dehydrated (more common than you think – most people don’t drink nearly enough water); eating a low-fiber diet (again, more common in the United States than it should be); leading a sedentary lifestyle; and taking certain medications, including narcotics, sedatives or blood pressure medications.
If constipation becomes chronic, it can exacerbate existing conditions or create new problems in the body.
Some of the most likely issues include hemorrhoids, created by swelling in the veins in and around the anus; an anal fissure, which is torn skin in the anus caused by a hard or larger than normal stool; fecal impaction, which is an accumulation of hardened stool that is stuck in the intestines; and rectal prolapse, where a bit of intestine protrudes from the anus because of the constant straining and stretching.
DIAGNOSIS AND TREATMENT
Doctors will conduct a complete physical examination and patient history to determine the origin of constipation issues.
Beyond that, the following procedures may be performed to contend with constipation:
1. Sigmoidoscopy – The doctor inserts a lighted, flexible tube into the anus to take a look at the lower portion of the colon and rectum. This is usually done under light sedation.
2. Colonoscopy – This is an examination of the entire colon using a flexible tube with camera. This is done under complete sedation and requires the patient to prepare with a cleansing procedure the day before the examination.
3. Anal manometry – This is yet another insertion of a flexible tube into the anus and rectum. Only this time, a small balloon at the tip of the tube is inflated, then slowly withdrawn through the sphincter. This determines how much coordination is present in the muscles that are actively assisting in the elimination process.
4. Colonic transit study – The patient swallows a capsule containing dye markers that will be visible on a series of X-rays taken over several days. This is a way for doctors to track intestinal workings and determine whether anything is impeding food and waste material as it makes its way through the intestines.
5. Defecography – A barium-infused paste is inserted into the rectum during this test, and is later passed as though it were a stool. The barium will show up on X-rays and help the doctor to determine whether there are problems with muscle function or coordination, or potentially a rectal prolapse.
Once the cause of constipation is determined, there are a number of effective treatments. The most basic is a change in lifestyle and diet. More fiber, more water, more exercise and better choices in the overall diet can help increase the speed of eliminations as they move through the intestinal channel.
Certainly just adding more fruits, vegetables and whole grain breads and cereals should make a world of difference. Generally, most adults should try to ingest about 14 grams of fiber for each 1,000 calories consumed daily. Of course, a crash diet of fiber may cause bloating and gas -- so don’t become an overnight vegetarian. Instead, work up to the goal. Even little changes can make a big difference.
Along with dietary changes, just a little physical activity can stimulate long-dormant muscles in the intestines.
In some cases, doctors may recommend fiber supplements to add bulk to the stool. These include psyllium, methylcellulose, polycarbophil and guar gum, sold under such names as Metamucil, Konsyl, FiberCon and Citrucel.
Osmotic laxatives like milk of magnesia are also helpful to create fluids that will ease stool passage in the intestines. Commercial brands include MiraLax and Fleet Enema. There are also lubricants that can help passage, including mineral oil.
Finally, stool softeners are used to draw water and help stools soften on the way out the door. Commercial brands include Surfak and Colace, but there are prescription strength medications like Amitiza and Linzess that work if over-the-counter medications are not strong enough to help.
If none of those methods work, surgery may be an option, particularly if the constipation is caused by an anal fissure or stricture. In some severe cases, removal of parts of the colon may be required, although that is rarely done because of the complications of the surgery.