Chronic constipation refers to a long-term condition where a person experiences infrequent, difficult, or painful bowel movements. It can be accompanied by the sensation of incomplete evacuation, bloating, and discomfort. Unlike occasional constipation, chronic constipation persists for several weeks or even longer, and it can significantly impact a person’s quality of life.
What is Chronic Constipation?
Chronic constipation is defined as having fewer than three bowel movements per week for at least three months. However, it's not just about frequency — it can also involve other symptoms like straining, a feeling of incomplete evacuation, hard or lumpy stools, or the need for manual assistance to pass stools.
Causes of Chronic Constipation:
There are many potential causes of chronic constipation, including:
1. Functional Causes (most common):
- Slow Transit Constipation: The muscles of the colon work too slowly, causing stool to move through the digestive system too slowly.
- Pelvic Floor Dysfunction: Difficulty with the muscles involved in bowel movements can cause problems with stool elimination.
- Irritable Bowel Syndrome (IBS): Some people with IBS experience constipation (IBS-C) as a primary symptom.
2. Medical Conditions:
- Hypothyroidism: Low thyroid hormone levels can slow down the digestive process.
- Diabetes: Nerve damage (neuropathy) can affect bowel function, leading to constipation.
- Parkinson’s Disease: A neurological condition that can affect the digestive system.
- Multiple Sclerosis (MS): Another neurological disorder that may lead to chronic constipation.
- Stroke: Damage to the nervous system can disrupt bowel movements.
- Chronic kidney disease: Reduced kidney function can affect gastrointestinal motility.
3. Medications:
Certain medications are known to cause constipation as a side effect, including:
- Opioids (e.g., morphine, codeine)
- Antacids containing aluminum or calcium
- Iron supplements
- Antidepressants (especially tricyclic antidepressants)
- Antihistamines
- Diuretics (water pills)
- Blood pressure medications (calcium channel blockers)
4. Lifestyle Factors:
- Low-fiber diet: Fiber helps add bulk to stool and promotes bowel movement regularity.
- Inadequate fluid intake: Dehydration can lead to hard stools that are difficult to pass.
- Lack of physical activity: A sedentary lifestyle can reduce the movement of the intestines.
- Ignoring the urge to go: Habitually delaying bowel movements can lead to constipation over time.
5. Structural Issues:
- Colorectal cancer: A tumor or obstruction in the colon or rectum can prevent normal bowel movements.
- Rectal prolapse: A condition where part of the rectum protrudes outside the anus, causing difficulty in stool passage.
- Anal fissures or hemorrhoids: Pain during bowel movements can make people avoid going to the toilet, worsening constipation.
Symptoms of Chronic Constipation:
Common symptoms of chronic constipation include:
- Infrequent bowel movements (fewer than three per week)
- Straining during bowel movements
- Hard, lumpy stools that are difficult to pass
- Feeling of incomplete evacuation, where it feels like you haven’t fully emptied your bowels
- Bloating, abdominal discomfort, or pain
- Flatulence (excessive gas) or feeling of fullness in the abdomen
- Rectal pain or discomfort during bowel movements
Diagnosis of Chronic Constipation:
To diagnose chronic constipation, a doctor will often:
- Take a detailed medical history and ask about symptoms, diet, and lifestyle.
- Perform a physical exam, which may include a digital rectal exam.
- Recommend blood tests to check for underlying conditions like hypothyroidism, diabetes, or electrolyte imbalances.
- Perform colonoscopy or sigmoidoscopy to rule out structural issues or diseases in the colon or rectum.
- Conduct a stool test to evaluate stool consistency and any hidden blood.
- Use barium X-ray or manometry (to assess how well the colon and rectum are working).
Treatment of Chronic Constipation:
Treatment for chronic constipation depends on its cause and severity but often includes a combination of lifestyle changes, medications, and, in some cases, medical procedures.
1. Dietary Changes:
- Increase fiber intake: Aim for 25-30 grams of fiber per day from fruits, vegetables, whole grains, and legumes. Fiber adds bulk to stool and helps it move through the digestive tract.
- Increase fluid intake: Drinking plenty of water helps soften stool and makes it easier to pass.
- Probiotics: These may help improve gut health and regularity for some individuals.
2. Physical Activity:
- Regular exercise: Physical activity, especially aerobic exercise, can stimulate bowel movement by improving gastrointestinal motility.
3. Bowel Habits:
- Don’t ignore the urge to go: Delaying bowel movements can worsen constipation.
- Establish a regular bathroom routine: Try to go at the same time each day, especially after meals when bowel movements are more likely.
4. Medications:
- Laxatives: These can be used to treat constipation temporarily, but they should be used sparingly and under medical supervision.
- Bulk-forming laxatives (e.g., psyllium) help add fiber to stool.
- Stool softeners (e.g., docusate) can help make stool easier to pass.
- Osmotic laxatives (e.g., polyethylene glycol, lactulose) help pull water into the stool.
- Stimulant laxatives (e.g., bisacodyl, senna) promote muscle contractions in the intestines but should be used with caution to avoid dependency.
- Prescription medications for more severe cases include:
- Chloride channel activators (e.g., lubiprostone)
- Guanylate cyclase-C agonists (e.g., linaclotide)
- Serotonin agonists (e.g., prucalopride)
5. Biofeedback Therapy:
For people with pelvic floor dysfunction or difficulty coordinating the muscles involved in bowel movements, biofeedback therapy may help. This therapy trains the muscles to work more efficiently.
6. Surgery:
In rare cases, surgery may be needed if constipation is due to structural problems like rectal prolapse or obstructive lesions. Surgical options are typically considered only when other treatments fail.
Complications of Chronic Constipation:
Chronic constipation, if left untreated, can lead to several complications, including:
- Hemorrhoids: Swollen veins in the anus or rectum due to prolonged straining.
- Anal fissures: Small tears in the skin around the anus caused by hard, dry stools.
- Fecal impaction: A large, hard mass of stool becomes stuck in the rectum, requiring medical intervention.
- Bowel obstruction: In severe cases, the colon can become blocked, leading to pain, nausea, and vomiting.
When to See a Doctor:
If you experience chronic constipation, especially with symptoms like significant abdominal pain, rectal bleeding, unexplained weight loss, or a family history of colon cancer, it’s important to see a doctor for a thorough evaluation.
