Constipation: Causes, Complications and Treatment

Constipation is not a disease itself but maybe a symptom of another medical problem. The term constipation is defined variably, but people generally complain of change in their bowel habits such as passing hard stools, excessive straining during defecation, feeling of fullness, decreased frequency, etc. Since every person has different bowel habits, so the criteria of constipation is not standard but the above features can provide you some help. Constipation is common in all age groups but women and older adults are more susceptible. About 16% of adults and 33% of older adults present to the clinic with the symptoms of constipation.

Signs and Symptoms

These are the various symptoms associated with constipation:

• Stools that are hard, lumpy, and difficult to pass.
• Straining during defecation
• Feeling of fullness that all stools have not passed.
• The decrease in the frequency of passing stools (less than 3 bowel movements in a week)

Constipation can easily be treated by home remedies but if you have the following problems associated with it then consult to your doctor as soon as possible

• Blood on the toilet paper or stools
• Pain in abdomen
• Unintentional weight loss
• Fever
• Vomiting

 Because these features indicate some underlying disease that needs to be treated.

Causes of constipation

Constipation is generally due to slow movements of stool through your colon, more time in transit means more water is absorbed and ultimately it becomes hard. It can be due to several reasons. It is easy to determine the cause if the time of onset is known and there are different causes for the constipation of recent onset (acute) and long-standing (chronic)

Recent onset:

• Obstruction – can be due to the colon or rectal cancer, bowel stricture(narrowing)
• Anal sphincter problem– like anal fissure, painful hemorrhoids
• Medications – certain medications present constipation as a side effect

Long-standing constipation (chronic):

• Medications – Certain medications slowly cause constipation for e.g. Calcium channel blocker for hypertension, antidepressants.
• Neurologic disorders – They affect the nerves that cause muscles of the colon to contract and relax like multiple sclerosis, spinal cord injury, autonomic neuropathy, stroke, parkinsonism
• Generalized muscular disorders – Systemic sclerosis can affect the muscles of the colon.
• Hormonal changes – medical conditions that cause a hormonal change in the body like pregnancy, diabetes, hypothyroidism
• Celiac disease
• Irritable bowel syndrome

Risk factors FOR Constipation

Some people have higher chances of having constipation due to the following risk factors

• Age – Older adults
• Gender – women have more chances than men
• Physical inactivity
• Low fiber diet
• Taking certain medications and dietary supplements
• Depression

Complications of Constipation

People having a recent onset of constipation generally do not show any complications but chronic constipation can cause

• Anal fissure – tear in the tissue of the anal canal due to friction and straining
• Hemorrhoids – veins present in the anus get dilated and can rupture.
• Rectal prolapse – Constipation can cause excessive straining in the colon. The buildup pressure can cause part of the rectum to protrude from the anus.
• Fecal impaction – Stool becomes so hard and dry that the colon is not able to expel them and they get stuck in the intestine.

Diagnosis of Constipation

Your doctor will ask you some question related to your medical history, conduct a physical exam and medical test to find the cause of your constipation

• Medical history: Your doctor will ask you many questions related to your bowel habits – frequency, the color of stools, consistency, time of onset of the problem, blood in the stool, pain during passing stools.
• Physical examination: Rectal exam – here your doctor will insert a lubricated gloved finger or proctoscope in the anus to look for anal fissure, hemorrhoids, or any other thing
• Laboratory tests: These are not needed if the constipation is treated by the home remedies but if still persists then your doctor can order
• Blood test: To look for signs of inflammation, infection, or systemic illness like hypothyroidism, diabetes
• Stool test: To look for the presence of blood, infection
• Endoscopy: Endoscopy is a non-surgical procedure that uses the camera and light to see the inside of your digestive tract. Two types of endoscopy are done
• Colonoscopy– to examine the rectum and entire colon
• Sigmoidoscopy– to examine the rectum and lower end of the colon
• Colorectal transit studies: these tests are used to assess the movement of stools through your intestines.

Treatment of Constipation

• Changing diet and lifestyle
• Increasing intake of fiber: By increasing the intake of fiber in your diet, it may help your stool to become bulky, soften and increase the passage time through your intestines. An adult should take 25 to 31 grams of fiber per day
• Take more and more fluids
• Exercise daily: Regular exercise improves the functioning of the intestinal muscles
• Training your bowel movements: You should train yourself to have bowel movements at the same time every day by spending adequate time without any rush
• Change medication – If you are thinking that certain medications are causing your constipation to consult your doctor regarding it.
• Laxatives – The doctor will prescribe a suitable laxative like.
• Bulk-forming agents – Citrucel
• Stool softeners – docusate
• Osmotic agents – milk of magnesia
• Lubricants – mineral oil
• Prescription medication –  Above were over-the-counter drugs but if symptoms still persist then doctors may prescribe certain prescription medications such as lubiprostone.
• Surgery is recommended at extreme cases when constipation is caused by some blockage, fissure, stricture.

Treating underlying cause: Medications only provide relief for a small period of time, if the symptoms still persist. It indicates some other underlying disease. So, specific treatment is required.

Reference:

• American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211–217.
• A Practical Approach to Diagnosis and Treatment. New York, NY: Springer Science and Business Media; 2014.
• U.S. Department of Agriculture and the U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020 (PDF, 10.3 MB). 8th ed. Published December 2015.