What is Constipation?
Constipation is a very common condition that affects millions of Americans. Hundreds of millions of dollars are spent each year on laxatives, doctor visits and testing in patients who suffer from constipation.
Some people think that you should have a bowel movement every day, but that is wrong. Constipation is generally described as having fewer than 3 bowel movements in a week. Patients feel constipated if they strain to have a bowel movement, have small pellet like bowel movements, or have a feeling of incomplete evacuation after a bowel movement. So, the American College of Gastroenterology uses either infrequent bowel movements or difficult to pass bowel movements in their definition of constipation.
What causes constipation?
Anything that slows transit through the digestive tract can cause constipation.
- Changes to your diet especially a diet lacking in fiber
- Dehydration or not drinking enough water
- Lack of physical activity
- Medications especially opioids or pain medications
- Colon cancer
- Colon obstruction from scar tissue or pelvic floor issues
- Chronic use of laxatives
- Hormonal conditions like hypothyroidism
- Chronic illnesses like diabetes, Parkinson’s disease, and kidney failure
When should I see a doctor?
A brief episode of constipation is usually nothing to worry about, but you should be concerned:
- When constipation lingers for 3 or more weeks
- If you have recurrent bouts of constipation over several months
- You have abdominal pain with the constipation
- You see blood in your stool
- Your symptoms are disabling
- You have unexplained weight loss
What kind of testing will be done to evaluate my constipation?
As a gastroenterologist, my approach to the patient with constipation is first to obtain a careful history including a complete list of medications that the patient is taking. The history alone often gives the diagnosis.
Next I examine the patient, focusing on any areas of abdominal tenderness or palpable masses. A digital rectal exam is part of the physical in most patients. I check for masses, hemorrhoids and fissures. I test the stool for occult (hidden blood).
Laboratory tests are ordered looking for electrolyte imbalances and thyroid dysfunction.
Diagnostic tests sometimes include a plain abdominal x-ray looking for bowel obstruction. Marker studies are sometimes performed to determine the transit time through the colon and look for areas of hang up. A direct examination of the colon such as colonoscopy is often recommended. This is the best test to exclude colon cancer as a cause for constipation. Other more specialized tests such as rectal manometry may also be required.
What treatments are available?
If the constipation is due to inadequate water intake, inactivity or not enough fiber in the diet, it is pretty easy to treat. Likewise if it is due to medications such as pain pills (opioids), avoiding these medications will help.
Chronic constipation often requires something stronger. Osmotic laxatives like milk of magnesia, polyethylene glycol, or magnesium oxide are safe and effective (patients with kidney disease need to use caution with the magnesium containing laxatives). Stimulant laxatives such as senna and bisacodyl work well, but are best if only used for acute constipation. They can cause problems if used frequently.
Several new prescription laxatives are available for chronic constipation and for irritable bowel with constipation. There are new medications available for opioid induced constipation as well.
Finally, enemas (either tap water or pre mixed) can be useful in fecal impactions and acute constipation.
Can constipation be prevented?
Fortunately there are lifestyle changes that you can adopt to help you avoid constipation.
- Stay active. Walking is especially important
- Avoid opioid pain medicines
- Drink plenty of water
- Eat a diet high in fiber and consider a fiber supplement daily
- Ask your doctor about constipation as a side effect of new medicines he/she prescribes for you
Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your healthcare provider to determine what is right for you. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition.
This website is owned and managed by Brian Cooley, MD. Any information, offers or instruction as written, inferred or implied is the sole responsibility of Brian Cooley, MD and does not warrant claim or representation, inherent, or implied of DHAT, its subsidiaries or employees.