Chronic Constipation

Chronic Constipation

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for more than several weeks. This means having fewer than three bowel movements per week, for several consecutive weeks.


Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily life.


Symptoms


Signs and symptoms of chronic constipation include:

  • Passing fewer than three stools a week
  • Having lumpy or hard stools
  • Straining more to have bowel movements
  • Feeling as though there's a blockage in your rectum that prevents any 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 the remaining stool from your rectum).

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


Causes


Chronic constipation has many possible causes:


- Blockages in the colon or rectum


Blockages in the colon or rectum area can slow or stop stool movements from occurring. This can be caused by a number of factors:

  • Tiny tears in the skin around the anus (anal fissure)
  • A blockage in the intestines (bowel obstruction)
  • Narrowing of the colon (bowel stricture)
  • Bowel cancer
  • Abdominal cancers that press on the colon
  • Rectal cancer
  • Rectum bulge through the back wall of the vagina (rectocele) 

- Difficulty with the muscles involved


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

  • Weakened pelvic muscles
  • The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
  • Pelvic muscles that don't relax and contract correctly (dyssynergia)

- Problems with the nerves


Neurological problems can affect the nerves that cause muscles to contract and move stool through the intestines. The causes include:

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

- Conditions that affect hormones in the body


There are conditions that upset the balance of hormones that may lead to chronic constipation, these can include:

  • Pregnancy
  • Diabetes
  • Hyperparathyroidism
  • Hypothyroidism

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Diagnosis & Treatment

Diagnosis


Initially, to diagnose constipation, your doctor will carry out a general physical exam and a digital rectal exam. But for  doctors to diagnose chronic constipation, they will use the following tests and procedures:


  • Blood tests - your doctor will look for a systemic condition such as low thyroid (hypothyroidism) or high calcium levels.
  • An X-ray - this scan can help your doctor determine whether our intestines are blocked and whether there is stool present.
  • Examination of the rectum and lower colon (sigmoidoscopy) - in this procedure, your doctor inserts a lighted, flexible tube into your anus to see signs of chronic constipation.
  • Examination of the rectum and entire colon (colonoscopy) - your doctor will examine the entire colon with a flexible, camera-equipped tube.
  • Evaluation of anal sphincter muscle function (anorectal manometry) - your doctor inserts a narrow, flexible tube into your anus and rectum and 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.
  • Evaluation of anal sphincter muscle speed (balloon expulsion test) - 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 your rectum.
  • Evaluation of how well food moves through the colon (colonic transit study) - you will be asked to swallow a capsule that contains a recording device. The progress of the capsule through your system will be recorded over 24 to 48 hours and will be visible on X-rays.
  • An X-ray of the rectum during defecation (defecography) - your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would normally your stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.
  • MRI defecography - this is where a doctor will insert contrast gel into your rectum. You then pass the gel, as you would normally stool. The MRI scanner can visualise and assess the function of the muscles used for defecation. 

Treatment


Treatment for chronic constipation usually begins with changes made to diet and lifestyle. If those changes don't help, your doctor may recommend medications or an operation.


- Diet and lifestyle changes


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


  • Increase your fibre intake - adding more fibre to your diet increases the weight of your stool and speeds its passage through your intestines. You will be instructed to eat more fresh fruits and vegetables each day and choose whole-grain bread and cereal.
  • Exercise most days of the week - physical activity increases the muscle activity in your intestines. So your doctor will often suggest trying to fit in some form of exercise most days of the week.
  • Don't ignore the urge to go to the toilet - take your time in the bathroom and allow yourself enough time to have a bowel movement without being rushed.

- Laxatives


There are several different types of laxatives. Each works somewhat differently to make it easier to have a bowel movement.  Your doctor will prescribe the right medication for your needs.


- Operation


Having an operation may be an option for you if you have tried other forms of treatment that haven't worked for you.


For people who have tried other treatments without success and who have abnormally slow movement of stool, surgical removal of part of the colon may be an option. 

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