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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Chronic constipation

Chronic constipation

Constipation occurs when bowel movements become difficult or less frequent. Constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week.

 

It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumors of the colon).

Clinical criteria

  • Straining during the bowel movement (passing stools) more than 25% of time
  • Hard (pellet like) stools more than 25% of time
  • Incomplete evacuation more than 25% of time

  • Bowel movements fewer than three per week

Common causes

  • Inadequate fluid intake
  • Inadequate fiber in diet
  • Inadequate activity or mobility
  • Frequent use and abuse of laxatives
  • Inattention to bowel habits or ignoring the urge to have a bowel movement
  • Hemorrhoids and anal fissure
  • Hypothyroidism
  • Depression

  • Neurological conditions like Parkinson’s, multiple sclerosis, and injury to spinal cord

Drugs causing constipation

  • Strong pain medicines (narcotics) – morphine, codeine
  • Iron and calcium supplements
  • Antacids containing calcium or aluminum
  • Antidepressants
  • Anticonvulsants

  • Anti Parkinson medications

Clinical features

  • Less than 3 stools per week
  • Hard stools
  • Excessive straining during bowel movements
  • Feeling of incomplete evacuation after having a bowel movement
  • Finger evacuation or manipulation of your lower abdomen
  • The discomforts of chronic constipation can go way beyond having infrequent bowel movements.

  • This motility problem can also lead to bloating, abdominal pain and an increased sensation of intestinal gas.

Risk factor

  • Older adults
  • Sedentary life styles or confined to bed
  • Inadequate fluids and fiber rich foods
  • Undergoing chemotherapy

  • Women and pregnancy

Complications

Hemorrhoids – due to spasm of the anal sphincter muscle and engorgement of blood vessels

Anal fissure- as a result of hard stool stretches the sphincter muscle

Fecal impaction

Rectal prolapsed

Lazy bowel syndrome- due to abuse and over abuse of laxatives

Warning about constipation

  • Constipation lasted for more than 2 weeks
  • Blood in the stools
  • Unexplained weight loss

  • Severe abdominal pain with bowel movements

Tests and diagnosis

  • Barium enema X-ray
  • Flexible sigmoidoscopy
  • Colonoscopy

  • Thyroid profile

Preventive measures

  • Need to consume 8- 10 glasses of water every day
  • Choose fiber rich foods- green leafy veg, carrot, beans, sprouts, and lady’s finger. Whole grain cereals and pulses. Fruits like banana, watermelon, papaya, guava, and others
  • Reduce low fiber foods- fatty foods, refined foods, junk foods, carbonated beverages, and others
  • Regular exercises like brisk walking, leg raising exercises, biking or swimming
  • Don't ignore the urge to have a bowel movement. The longer you delay, the more water is absorbed from your stool and the harder it becomes.
  • Avoid overuse of laxatives/ stool softener like dulcolax or docusates.

  • For occasional relief try a saline laxative such as milk of magnesia, this draws water into the colon to lubricate the stool.

Treatment

Laxatives

These over-the-counter medications should be considered as a last resort because they can become habit-forming.

There are several different types of laxatives:

  • Stimulant laxatives – castor oil, bisacodyl, sennakot
  • Stool softeners- docusates. It’s also used in hemorrhoids and anal fissure
  • Saline laxatives- magnesium citrate (milk of magnesia), magnesium hydroxide, and sodium phosphate
  • Hyperosmolar laxatives-  lactulose, sorbitol and polyethylene glycol

  • Lubricant laxatives- mineral oil and fleet

Fiber supplements

  • Also called bulk laxatives, generally considered the safest laxative.
  • Ex- Psyllium husk, ispaghula husk.
  • These agents must be taken with plenty of water.
  • This medication is generally well tolerated. Bloating, gas, and a feeling of fullness may occur.

  • They are also used in IBS, spastic colon, hemorrhoids and to reduce the cholesterol levels

5 –HT- 4 agonists

Ex- Tegaserod

Used in chronic idiopathic constipation and irritable bowel syndrome

Chloride channel activators

The agent lubiprostone (Amitiza) is available by prescription and increases fluid content of stool.