Treating Constipation

Constipation is generally described as having fewer than 2 bowel movements a week. Chronic constipation is infrequent bowel movements or difficulty passing stools. Chronic constipation can persist for several weeks or longer. 

Though occasional constipation is extremely common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms that we'll discuss below. 

Treatment for chronic constipation depends partly on the underlying cause, However, in some cases, a cause is never actually found. 

Symptoms of Chronic Constipation

Signs and symptoms of chronic constipation include the following:

• Passing fewer than 3 stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there's a blockage in the rectum that prevents bowel movements
• Feeling as though you can't completely empty the stool from the rectum
• Needing help to empty your rectum

Constipation may be considered chronic if you've experienced 2 or more of these symptoms for the last 3 months. 

When to see a doctor:

You should make an appointment with your doctor if you experience unexplained and persistent changes in your bowel habits. 

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

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

• Anal fissure
• Bowel obstruction
• Colon cancer
• Narrowing of the colon
• Other abdominal cancer that presses on the colon
• Rectal cancer
• Rectum bulge through the back wall of the rectocele

Problems with the nerves around the colon and rectum

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

• Autonomic neuropathy
• Multiple sclerosis
• Parkinson's Disease
• Spinal cord injury
• Stroke

Difficulty with the muscles involved in elimination

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

• Inability to relax the pelvic muscles to allow for a bowel movement
• Pelvic muscles don't coordinate relaxation and contraction correctly
• Weakened pelvic muscles

Conditions that affect hormones in the body

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

• Diabetes
• Hyperparathyroidism
• Pregnancy
• Hypothyroidism

Risk Factors

Factors that may increase your risk of chronic constipation include the following:

• Being an older adult
• Being a woman
• Dehydration
• Not enough fiber in your diet
• Getting little to no physical activity
• Taking certain medications, including sedatives, narcotics, antidepressants, or medications to lower blood pressure
• Having a mental health condition, such as depression or an eating disorder

Complications

• Hemorrhoids
• Anal fissure
• Fecal impaction - when an accumulation of hardened stool gets stuck in your intestines
• Rectal prolapse

Prevention

• Include plenty of high fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals, and bran
• Eat fewer foods with low amounts of fiber such as processed foods, dairy, and meat products
• Incorporate fiber supplements into your daily life, or as part of your daily vitamins
• Drink plenty of fluids
• Stay as active as possible and try to get regular exercise
• Try to manage stress
• Don't ignore the urge for a bowel movement
• Make sure children who begin to eat solid foods get plenty of fiber in their diets

Diagnosis & Treatment

In addition to a general physical exam and a digital rectal exam, doctors use the following tests and procedures to diagnose chronic constipation and try to find the cause:

Blood tests: Your doctor will look for a systemic condition, such as low thyroid, or hypothyroidism.

Sigmoidoscopy: In this procedure, your doctor inserts a lighted, flexible tube into the anus to examine the rectum and lower portion of the colon.

Colonoscopy: This diagnostic procedure allows your doctor to examine the entire colon with a flexible, camera equipped tube.

Anorectal Manometry: Your doctor inserts a narrow, flexible tube into the anus and rectum, then inflates a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows your doctor to measure the coordination of the muscles you use to move your bowels.

Balloon Expulsion Test: Often used along with an anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in the rectum.

Colonic Transit Study: In this procedure, you may swallow a capsule that contains either a radiopaque marker or a wireless recording device. The progress of the capsule through your colon will be recorded over several days and be visible on X-rays. In some cases, you may eat radiocarbon activated food and a special camera will record its progress. Your doctor will look for signs of intestinal muscle dysfunction and how well food moves through your colon.

Defecography: During this procedure, the doctor inserts a soft paste made of barium into the rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.

MRI Defecography: As with the barium defecography, a doctor will insert contrast gel into the rectum and allow you to pass the gel. The MRI scanner can visualize and assess the function of the defecation muscles. This test also can diagnose problems that cause constipation, such as rectocele or rectal prolapse.

Treatment

Treatment for chronic constipation usually begins with diet and lifestyle changes meant to increase the speed at which waste moves through your intestines. If those changes don't help, your doctor may recommend medications or surgery.

Diet and Lifestyle Changes

Increase Fiber Intake: Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables daily. Choose whole grain breads and cereals. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.

Exercise: Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week.

Don't Ignore Urges: Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions or feeling rushed.

Laxatives

Several types of laxatives exist on the market today, and each works differently to make it easier to have a bowel movement. The following are available here at Mountainside Medical Equipment or over the counter:

Fiber Supplements: Fiber supplements add bulk to your stool. They include Metamucil, Konsyl, Fiber Con, and Citrucel. 

Stimulants: Includes products, such as Correctol, Ducodyl, Dulcolax, and Senokot, all of which cause your intestines to contract. 

Osmotics: Osmotic laxatives help fluids move through the colon. Examples include: Phillips Milk of Magnesia, Magnesium Citrate, Kristalose, and Miralax.

Lubricants: Lubricants, such as mineral oil enable the stool to move through the colon more easily.

Stool Softeners: Such as: Colace and Surfak, moisten the stool by drawing water from the intestines.

Enemas & Suppositories: Sodium phosphate, soapsuds, or tap water enemas can be useful to soften stool and produce a bowel movement. Glycerin or Bisacodyl suppositories also can soften stool.

Other Medications

If over the counter medications don't help your chronic constipation, your doctor may recommend a prescription medication, especially if you have irritable bowel syndrome.

There are a number of prescription medications available to treat chronic constipation. Amitiza and Linzess, for instance, work by drawing water into your intestines and speeding up the movement of stool.

Training your pelvic muscles

Biofeedback training involves working with a therapist who uses devices to help you learn to relax and tighten the muscles in your pelvis. Relaxing your pelvic floor muscles at the right time during defecation can help you pass stool more easily. During this session, a catheter is inserted into the rectum. The therapist guides you through exercises to alternately relax and tighten your pelvic muscles. A machine will gauge your muscle tension and use sounds or lights to help you understand when you've relaxed your muscles.

Surgery

Surgery may be an option if you've tried other treatments and your chronic constipation is caused by a blockage, rectocele, anal fissure or stricture. For people who have tried other treatments without success and who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option. 

To view a full list of our products to relieve constipation, please visit www.mountainside-medical.com!