Constipation

Constipation Overview

Constipation is a condition in which a person has uncomfortable or infrequent bowel movements that is hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Constipation is generally described as having fewer than three bowel movements a week.

The normal frequency between bowel movements varies widely from person to person. Some people have bowel movements several times a day while others have them only two to three times a week. Whatever your bowel movement pattern is, it’s unique and normal for you, as long as you don’t stray too far from your pattern. Most people have their own routine and go to the bathroom the same number of times per day and at around the same time. What is normal for one person may be abnormal for another.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause people to strain excessively in order to have a bowel movement.

Signs and Symptoms Constipation

Constipation is a symptom, not a disease. Most commonly, constipation is thought of as infrequent bowel movements, usually less than 3 stools per week. However, people may have other complaints as well including:

Signs and symptoms of chronic constipation include:

• Abdominal Pain
• Abdominal Bloating
• Excessive time needed to pass a bowel movement
• Straining to have bowel movements
• Pain with bowel movements secondary to straining
• The sensation of incomplete bowel evacuation
• Small stools
• Passing fewer than three stools a week
• Having lumpy or hard stools
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Constipation may be considered chronic if you’ve experienced two or more of these symptoms in the last three months.

Causes of Constipation

Constipation generally occurs when stool moves too slowly through the digestive tract and cannot be removed effectively from the rectum, which may cause the stool to become hard and dry. Constipation occurs because the colon absorbs too much water from waste or stool, which dries out the stool making it hard in consistency and difficult to push out of the body. Chronic constipation has many possible causes.

Rectum/Colon Blockages

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

• Abdominal cancer that presses on the colon
• Colon cancer
• Rectal cancer
• Tears in the skin around the anus (anal fissure)
• Intestinal blockage (bowel obstruction)
• Narrowing of the colon (colon stricture)
• Rectum bulge through the back wall of the vagina (rectocele)

Autonomic nervous system disorders in the digestive system (colorectal)

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

• Damage to the nerves that control bodily functions (autonomic neuropathy)
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Stroke

Pelvic Muscle Disorders

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
• Pelvic muscles that don’t coordinate relaxation and contraction correctly, lead to difficult defecation (dyssynergia)
• Weakened pelvic muscles

Hormonal Issues

Hormones help balance fluids in the body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes
• Overactive parathyroid gland (hyperparathyroidism), PTH hormone imbalance
• Pregnancy- Increased levels of estrogen and progesterone can lead to constipation
•  Underactive thyroid (hypothyroidism) slows the metabolism and digestion making the bowel sluggish and leading to longer transit time of stools and weaker muscle contractions

Risk Factors of Constipation

Factors that may increase the risk of chronic constipation include:

• Low fiber diet intake
• Dairy products
• Dehydration or low water intake
• Hormones
• Pregnancy
• Health conditions and diseases
• Stress
• Age (slow metabolism)
• Activity (little or no exercise)
• Medications (side effects)
• Overuse of laxatives
• Depression (psychological issues)

Complications of Constipation

Complications of chronic constipation include:

• Hemorrhoids- Straining to have a bowel movement may cause swelling in the veins in and around the anus.
• Anal Fissure- A large or hard stool can cause tiny tears in the anus.
• Fecal Impaction- Chronic constipation may cause an accumulation of hardened stool that gets stuck in the intestines.
• Rectal Prolapse- Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude out from the anus.

Constipation Diagnosis

In addition to the patients medical history, bowel movement patterns and physical exams the following diagnostic tests are performed to investigate the causes of constipation:

Lab tests: Blood and urine tests reveal signs of anemia, diabetes and hypothyroidism. Stool sample tests are conducted to check for signs of infection, inflammation, and cancer.

Imaging tests: MRI, CT scans of lower gastrointestinal tract (GIT) are conducted to identify other problems that could be causing the constipation.

Colonoscopy: To get an internal view of the colon, a colonoscopy or sigmoidoscopy procedure may be performed. During this procedure, a small sample of colon tissue (biopsy) may be taken to test for cancer or other problems and any found polyps will be removed.

Colorectal transit studies: CTS tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through the intestines.

Bowel function tests: Additional tests may be performed to check how well the anus and rectum hold and release stool. These tests include a certain type of MRI scan tests (defecography) are performed to rule out causes of outlet dysfunction constipation, and the insertion of a small balloon into the rectum (balloon expulsion test and complete anorectal manometry) may be performed.

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