Description

Constipation is a problem with the passage of stool. Constipation usually means spending less than three bowel movements per week or have a difficult time having a bowel movement.

Constipation is quite common. A lack of fiber in the diet, fluids, and exercise can lead to constipation. But other medical conditions or certain medications can be the cause.

Constipation is usually treated with changes in diet and exercise, or with over the counter medications. Constipation may require the use of medications, changes in your medications or other treatments prescribed by a healthcare professional.

Long-term constipation, also called chronic constipation, may require the treatment of another disease or condition that may cause or worsen constipation.

Symptoms

Symptoms of constipation include:

  • Less than three bowel movements per week.
  • Hard, dry, or lumpy stools.
  • Effort or pain with bowel movements.
  • A feeling that not all stool has passed.
  • A feeling that the rectum is locked.
  • The need to use one finger to pass stools.

Chronic constipation is to have two or more of these symptoms for three months or more.

When to see a doctor

Make an appointment with your health care professional if you have constipation with any of the following conditions:

  • Symptoms that last for more than three weeks.
  • The symptoms that make it difficult to do everyday activities.
  • Bleeding from the rectum or blood in the toilet paper.
  • Blood in the stool, or black stool.
  • Other unusual changes in the shape or the color of the stool.
  • Stomach pain that does not stop.
  • The loss of weight without trying.

Causes

The patterns of bowel movements vary from person to person. The typical range is three times a day to three times a week. So it is important to know what is typical for you.

In general, constipation occurs when the stool moves too slowly through the large intestine, also called the colon. If the stool is moved slowly, the body absorbs the excess water from the stool. The feces can become hard, dry and difficult to pass.

The style of life of the causes

Slow movement of stool can happen when a person does not:

  • Drink sufficient amount of liquid.
  • Eat enough dietary fiber.
  • Exercise regularly.
  • Use the toilet when there is an urgency to have a bowel movement.

Medications

Constipation can be a side effect of some medications, especially opioid analgesics. Other medications that may cause constipation include some that treat the following conditions:

  • Pain.
  • The high blood pressure.
  • Seizures.
  • Depression.
  • Disorders of the nervous system.
  • Allergies.

Problems with the pelvic floor muscles

The muscles that support the organs in the lower part of the torso are called the pelvic floor muscles. The ability of both to relax these muscles and bid are required to pass stool through the rectum. Problems with the weakness or the coordination of these muscles can cause chronic constipation.

Blockages in the colon or in the rectum

Damage or changes in the tissues of the colon or rectum can block the passage of stool. In addition, tumors in the colon, rectum, or tissues nearby, can cause an obstruction.

Other factors

A number of conditions that can affect the work of the muscles, nerves or hormones that are involved in the passage of stool. Chronic constipation can be linked to any number of things, including:

  • The Irritable bowel syndrome.
  • Diabetes.
  • Multiple sclerosis.
  • Nerve dysfunction or damage.
  • The hyperactivity of the thyroid gland, also referred to as hyperthyroidism.
  • Parkinson's disease.
  • Pregnancy.

Sometimes, the cause of chronic constipation can't be found.

Risk factors

Factors that may increase the risk of chronic constipation include:

  • Being an older adult
  • To be a woman
  • Getting little or no physical activity
  • Have a mental health condition such as depression or an eating disorder

Complications

Complications of chronic constipation include:

  • Swelling of the tissues around the anus, which is also called hemorrhoids.
  • Tearing of the tissues of the anus, also called anal fissures.
  • Hard stools backup in the colon, also called fecal impaction.
  • Exposed tissues of the rectum that have come out of the anal opening, also called rectal prolapse.

Prevention

The following tips can help prevent the development of constipation.

  • Eat plenty of fiber-rich foods, including vegetables, fruits, legumes and whole-grain foods.
  • Eat fewer foods with a low amount of fiber, such as processed foods, dairy, and meats.
  • Drink plenty of fluids.
  • Stay active and exercise regularly.
  • Do not ignore the urge to have a bowel movement.
  • Create a regular schedule for the passage of stool, especially after a meal.

Diagnosis

In addition to a general physical exam, your health care professional is likely that you do the following during your appointment:

  • Press gently on the abdomen to check for pain, tenderness, or irregular pieces.
  • Look at the tissue of the anus and the surrounding skin.
  • The use of a gloved finger to check the status of the rectum and the anal muscles.

You will also be asked questions about your medical history, diet, exercise habits, and feces. For some people, the information of this event can be sufficient for a diagnosis and treatment plan.

For other people, one or more additional tests may be needed to help the health care team to understand the nature or cause of the constipation.

Laboratory tests

Your health care professional may send blood samples to a laboratory for diseases or conditions that can cause constipation.

Endoscopy

Your health care professional may order a procedure called an endoscopy. A small tube with a camera is guided into the colon. This can reveal the condition of the colon or of the presence of irregularities in the tissues. Before this procedure, you can have a limited diet, the use of an enema or drink solutions that cleanse your colon. Generally, there are two types of tests:

  • A colonoscopy is an exam of the rectum and entire colon.
  • A sigmoidoscopy is an examination of the rectum and the lower part of the colon, also called the sigmoid or descending colon.

Imaging tests

Depending on your symptoms, your doctor may order an x-ray. A chest x-ray may show where the stool is present in the colon and, if the colon is blocked. Imaging tests such as a ct scan or an mri may be needed to diagnose conditions that may be causing constipation.

Tests of stool movement

The doctor may order a test that records the movement of the stool through the colon. This is called a colorectal transit study. These studies include:

  • Bookmark radiopaque study. This X-ray procedure shows how tiny pellets of a pill that you have moved through the colon over a period of time.
  • The scan. This study involves the consumption of a meal with tiny radioactive substances, which are tracked with a special technology as they move through the colon.

Evidence of the rectum and the anus

Other tests may be used to measure the degree in the rectum and the anus of work and how a person can move the stool.

  • The anorectal manometry. A narrow, flexible tube that is inserted into the anus and rectum. After a small balloonlike device is inflated, it retracts the anus. The procedure of coordination of the muscles that are used to pass the stool.
  • Balloon expulsion test. This test measures the amount of time that it takes to push out a small water-filled balloon in the rectum. This provides information about how well the muscles of or are controlled.
  • Defecography. This test is designed to mimic the passage of stool. A thick substance that can be controlled with the technology of image is placed in the rectum. X-rays or magnetic resonance imaging may reveal information about how well the rectum and the anus of work, when the substance is passed as feces.

Treatment

Treatment for constipation usually begins with diet and lifestyle changes intended to increase the speed at which stool moves through the colon. Also, your health care professional may change medications that you are taking if that may be causing or worsening constipation. If those changes don't help, other treatments may be necessary.

Diet and lifestyle changes

Your doctor may recommend the following changes to relieve your constipation:

  • Eating a diet high in fiber. Fiber adds bulk to stool and helps the stool to hold fluids. These factors give the feces of the correct shape and weight to move through the colon. Foods rich in fiber include fruits, vegetables, beans and whole-grain bread, cereals, and rice. Increase the fiber in your diet slowly to avoid bloating and gas. The dietary Guidelines for Americans recommend 25 to 34 grams of fiber per day, depending on recommended daily calories.
  • Drink lots of water. Drink water and other drinks without caffeine. This keeps the stool soft and prevents bloating and gas that can happen with the increase of fiber in the diet.
  • Exercise most days of the week. Regular physical activity helps to improve the movement of the stool through the colon. Try to exercise most days of the week. If you do not already exercise, talk with your healthcare provider about safe ways to start.
  • The use of good bowel habits. Do not avoid the urge to have a bowel movement. Maintain a schedule for the passage of stool. For example, try to pass stools from 15 to 45 minutes after a meal, because the digestion, helps move the stool through the colon.

Prunes, also called dried plums (prunes), have been used to treat or prevent constipation. Prunes are a good source of fiber, but they also have this natural agents that remove the liquid in the colon.

Laxatives

Laxatives are medicines that help to move the stool through the colon. Each laxative works slightly differently. The following are available without a prescription:

  • Fiber supplements. Fiber supplements help the stool to retain liquids. The stool is then softer and easier to pass. Fiber supplements include psyllium (Metamucil, Konsyl, others), calcium polycarbophil (FiberCon, Equalactin, others) and methylcellulose (Citrucel).
  • Osmotics. Osmotic laxatives help the movement of the stool through the colon by increasing the amount of fluids that are released in the intestine. Examples include oral magnesium hydroxide (Phillips' Milk of Magnesia, Dulcolax Liquid, others), magnesium citrate, lactulose (Generlac) and polyethylene glycol (Miralax).
  • Stimulants. Stimulants cause the walls of the intestine to tighten, forcing the movement of the stool. These include bisacodyl (Correctol, Dulcolax Laxative, others) and sennosides (Senokot, Ex-Lax, Perdiem).
  • Lubricants. Lubricants such as mineral oil to allow the stool to move through your colon more easily.
  • Stool softeners. Stool softeners such as docusate sodium (Colace) and docusate calcium to allow more liquid to be mixed in the stool.

Enemas and suppositories

An enema is a liquid gently pumped into the rectum to help pass the stool. An enema may be used when other treatments do not work. Your health care professional may use one of these if your rectum is blocked with feces. Some are also available without a prescription. The fluid may be:

  • The water from the faucet.
  • The tap water with a mild soap.
  • The Mineral oil.

A suppository is a small tube-shaped object placed in the rectum to deliver a drug. The suppository will melt at body temperature and releases the medication. Suppositories for constipation can be one of the following:

  • Laxative osmotic.
  • Stimulant laxative.
  • Lubricant laxative.

Prescription medications

Your health care professional may prescribe other medications if other treatments do not work. These include:

  • Lubiprostone (Amitiza).
  • Linaclotide (Linzess).
  • Plecanatide (Trulance).
  • Prucalopride (Motegrity).

If constipation is caused by the opioid pain medication, you may take a drug that blocks the effect of opioids on the movement of the stool through the colon. These include:

  • Methylnaltrexone (Relistor).
  • Naldemedine (Symproic).
  • Naloxegol (Movantik).

Training of the pelvic muscles

Biofeedback training involves working with a therapist who uses devices to help you learn to relax the muscles and to coordinate the use of the muscles of the pelvis, the rectum and the anus. These exercises can correct problems with chronic constipation.

The sensors in the rectum and the skin, providing comments such as sound or light in a device such as the therapist helps you to go through various exercises. These signals help to train the control of the muscles needed to pass stools.

Surgery

Surgery may be necessary to correct the damage or irregularities in the tissues or nerves of the colon or rectum. The surgery is usually done only when other treatments for chronic constipation have not worked.

Alternative medicine

Researcher in the study of the use of probiotics and acupuncture to treat constipation. More research is needed to understand these options.

Preparing for your appointment

It is likely to first see your doctor or other health care professional. You may be referred to a specialist in digestive disorders, called a gastroenterologist.

Because appointments can be brief, and because there is often a large amount of information to cover, it is a good idea to be well prepared. Here's some information to help you prepare, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as the restriction of the diet.
  • Write down any symptoms you are experiencing.
  • Write down key personal information, including any major stresses or recent life changes, such as travel or be coming pregnant.
  • Make a list of all the medications, vitamins, herbal supplements, or medications you are taking.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

For constipation, some questions that you can ask your doctor include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need, and how do I prepare for them?
  • Am I at risk of complications related to this disease?
  • What treatment do you recommend it?
  • If the first treatment does not work, what are we going to do next?
  • Are there restrictions in the diet should I follow?
  • I have other medical problems. How can I manage these along with the constipation?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor may ask you several questions. Your doctor may ask:

  • When was the first you have symptoms of constipation?
  • The symptoms been constant or on and off?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do your symptoms include stomach pain?
  • Do your symptoms include vomiting?
  • You've lost weight recently without trying?
  • How many meals do you eat in a day?
  • The amount of liquid, including water, do drink a day?
  • Do you see the blood mixed with the stool, in the toilet water or on the toilet paper?
  • What strain when having a bowel movement?
  • Do you have any family history of digestive problems or cancer of the colon?
  • Have you been diagnosed with any other medical condition?
  • Have you started any new medication or recently changed the dose of your current medication?
Symptoms and treatment of Constipation