Patient Education

Constipation and Defecation Problems

What is chronic constipation?

Chronic constipation is when symptoms last several weeks or more. This may cause daily tasks to become more difficult.

Symptoms

Symptoms and signs of chronic constipation include:

• Fewer than three bowel movements each week
• Stools that are lumpy, dry, or hard.
• Straining during bowel movements
• A blocked feeling in your rectum
• A feeling of incomplete emptying during bowel movements

You should see a doctor about constipation if:

• Constipation is a new problem for you
• There is blood in your stool
• You have unintentional weight loss
• You experience severe pain during bowel movements
• Your constipation lasts three weeks or longer
• Schedule an appointment

 Causes

The most common causes of constipation are inadequate fiber in the diet, dehydration, and certain medications.  All of these can cause the stool to pass too slowly in the digestive tract. Slow movement causes the stool to lose moisture and become hard and dry.  Reasons include:

• Not enough fiber in diet
• Not drinking enough water
• Lack of physical activity
• Consuming lots of dairy
• Ignoring the urge to have a bowel movement
• Change in routine
  • Traveling
  • Becoming pregnant
  • New diet or exercise routines
• Medications
  • Strong pain medications (e.g. narcotics)
  • Antidepressants
  • Antacids containing calcium
• Other medical conditions
  • Diabetes
  • Neurologic conditions like Parkinson’s, MS, or a spinal cord injury
  • Pelvic floor disorders
  • Irritable bowel syndrome

Diagnosis

In addition to a general physical exam and review of the patient history, your doctor may use the following techniques to help diagnose constipation and find the root cause.

• Digital rectal exam – Using a gloved finger, your doctor will inspect the rectum.  If  stool is present, they will evaluate the amount and consistency. The stool may also be tested for occult (hidden) blood. In most cases, this is the extent of testing needed to diagnose chronic constipation.
• Sigmoidoscopy – This is an imaging test when the doctor uses a thin flexible tube with a camera to examine the lower part of the large intestine.
• Colonoscopy – In a colonoscopy, the entire large intestine is examined by the doctor using a thin, flexible tube with a viewing camera.
• Imaging tests – such as X-Rays, MRI, or CT-scan.

Treatment – how do you fix constipation?

Providing constipation relief is important for your health and wellbeing.  Treatment for constipation will depend on the underlying cause, which may or may not be determined.

Treatment usually begins with lifestyle changes to diet and exercise.  Often, patients can get relief through these steps:

• Increasing Fiber in Diet – Slowly increase your fiber intake.  A sudden increase in fiber can cause gas, bloating, and can even make constipation worse.
• Drink more water – Drink an additional 2 to 4 glasses of water each day.
• Exercise most days – Try to fit in physical activity most days every week.  This will help increase muscle activity in your intestines.
• Don’t ignore the urge to go – take your time in the bathroom.  Allow yourself enough time for a bowel movement without feeling rushed.

Enemas can be useful to soften impacted stools and create a bowel movement. The most common types are sodium phosphate (Fleet), soapsuds or tap water.

Laxatives for Constipation

If diet and exercise aren’t enough, your doctor may recommend laxatives. They will help you decide which type of laxative is right for you.

• Fiber Supplements – These add bulk to your stool, and include brands like Citrucel and FiberCon.
• Osmotics – These help fluid to move through the colon. Brands include Phillips Milk of Magnesia and Miralax.
• Stimulants – These cause your intestines to contract and include brands like Correctol and Dulcolax.
• Lubricants – Lubricants like mineral oil enable your stool to move more easily.
• Stool Softeners –  Stool softeners help pull water from the intestine to moisten the stool.

Medications, Physical Therapy, and Surgery for Constipation

There are several prescription medication options your doctor may prescribe. If your doctor finds that your constipation is caused by muscle issues, they may recommend pelvic floor physical therapy.  This specific type of muscle therapy helps retrain and strengthen the muscles in your pelvic area.

Your doctor may recommend surgery if other options haven’t worked, and your constipation is caused by a rectocele, blockage, stricture, or anal fissure. Surgery to remove part of the colon may also be an option.

Constipation Prevention 

The best ways to prevent constipation include adequate water intake, exercise, and a high-fiber diet.  Laxatives can be helpful, but shouldn’t be taken for extended periods of time. Discuss with your doctor the best way to use laxatives to prevent constipation.