Constipation is defined as infrequent or hard pellet stools, or difficulty in evacuating stool. If you go one day without a bowel movement it does not necessarily mean you are constipated. In fact, everyone has a slightly different bowel habit (which varies in and of itself depending on the day, what you eat, and age), so what is routine for one person may very well be different compared to someone else. Constipation typically involves multiple days without a bowel movement, great difficulty during bowel movements, and it is often a chronic problem. When this occurs, medical attention should be sought to find the cause of constipation.
By the time food reaches the large intestine (colon), it has been mostly digested. One of the colon’s main jobs is to withdraw water from the remains of food (now stool), so by the time it reaches the rectum there is a soft, formed stool that can pass as a bowel movement. However, if the transit in the colon is slow, meaning the colon doesn’t contract properly and stool spends a long time in the colon, too much water can be extracted from the stool. This causes the stool to become hard and difficult to expel, causing constipation. Slow transit can also be caused by:
Constipation is not always caused by slow transit. Additional causes of constipation include:
Additionally, irritable bowel syndrome (IBS) is often associated with symptoms of constipation. More information on IBS here.
If you experience regular constipation, you should be evaluated for the presence of a digestive disorder or disease that could be causing these symptoms. During your evaluation, you'll be asked about your symptoms, how often they occur, and if they're accompanied by pain or other symptoms. You'll also be asked to provide a medical history to look for clues. A physical exam and blood tests are most often additional helpful first steps. In some instances, no further testing is needed and lifestyle modification or medication is tried.
If warranted, there is a variety of testing available to diagnose the cause of constipation. An in-office visual and tactile exam of the anus (called an anoscopy, or rectal exam) can check for suspected hemorrhoids, anal fissure, and problems with rectal muscles. A sigmoidoscopy uses a sigmoidoscope (a light, flexible endoscope) to visualize the sigmoid colon and rule out mechanical blockages, such as tumors. Colonoscopy is not often indicated for constipation only, but can rule out advanced diverticulosis or diverticulitis and colorectal cancer. In severe circumstances, anorectal manometry or defecography are used to rule out muscular and structural causes of constipation.
Treatment for constipation depends on the underlying cause of the constipation. For those with mild to moderate chronic constipation, dietary changes and/or medication are often helpful. A high fiber diet is recommended for those with chronic constipation (fruits, vegetables, whole grain breads, bran cereals). If dietary modification is not adequate and constipation persists, laxatives and/or stool softeners may be tried. Some people with more severe symptoms use enemas or medication used to stimulate secretion of water in the colon periodically.
For those with severe constipation caused by a less common underlying cause, treatment may differ. Medication may still be prescribed, but additional treatments or therapies may also be tried. For example, patients with severe constipation caused by problems with the muscles that promote normal bowel function are sometimes prescribed anorectal biofeedback therapy, where they learn neuromuscular conditioning to re-train their muscles to behave more normally.
Here is a list of just some of the plans we accept, please contact our office if you have any questions.
