Chronic Constipation Can Be Treated
What is Chronic Constipation?

Constipation is infrequent bowel movements or difficult passage of stools. Constipation is a common gastrointestinal problem.

What's considered normal frequency for bowel movements varies widely. In general, however, you're probably experiencing constipation if you pass fewer than three stools a week, and your stools are hard and dry.

Fortunately, most cases of constipation are temporary. Simple lifestyle changes, such as getting more exercise, drinking more fluids and eating a high-fiber diet, can go a long way toward alleviating constipation. Constipation may also be treated with over-
the-counter laxatives.

Symptoms

Not having a bowel movement every day doesn't necessarily mean you're constipated. You likely have constipation, however, if you've had at least two of the following signs and symptoms for at least three of the past six months:

1) Pass fewer than three stools a week
2) Experience hard stools
3) Strain excessively during bowel movements
4) Experience a sense of rectal blockage
5) Have a feeling of incomplete evacuation after having a bowel movement
6) Need to use manual maneuvers to have a bowel movement, such as finger evacuation or manipulation of your lower abdomen

Although constipation may be bothersome, it is usually not serious. Most people who have constipation don't seek a doctor's care. However, chronic constipation may lead to complications or be a sign of a serious underlying disorder.

See your doctor if you experience an unexplained onset of constipation or change in bowel habits, or if symptoms are severe and last longer than three weeks. Also seek medical care if you experience any of the following signs or symptoms, which might indicate a more serious health problem:

1) Bowel movements occurring more than three days apart, despite corrective changes in diet or exercise
2) Intense abdominal pain
3) Blood in your stool
4) Constipation that alternates with diarrhea
5) Rectal pain
6) Thin, pencil-like stools
7) Unexplained weight loss

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract, causing it to become hard and dry.

Normally, the waste products of digestion (stool) are propelled through your intestines by muscle contractions. In the large intestine (colon), most of the water and salt in this waste mixture are reabsorbed because they are essential for many of your bodily functions.

However, when there is not enough fluid or fiber-rich food in your diet — or if the colon's muscle contractions are slow — the stool hardens, dries and passes through your colon too slowly. This is the root cause of constipation.

You may also experience constipation if the muscles you use to move your bowels aren't properly coordinated. This problem is called pelvic floor dysfunction (anismus), and it causes you to strain with most bowel movements — even soft ones.

A number of factors can cause an intestinal slowdown, including:

1) Inadequate fluid intake or dehydration
2) Inadequate amounts of fiber in your diet
3) Ignoring the urge to have a bowel movement or delaying until later
4) Lack of physical activity (especially in older adults)
5) Irritable bowel syndrome
6) Changes in lifestyle or routine, including pregnancy, aging and travel
7) Illness
8) Frequent use or misuse of laxatives
9) Specific diseases, such as stroke, diabetes, thyroid disease and 10) Parkinsons disease
11) Problems with the colon and rectum, such as intestinal obstruction or diverticulosis
12) Certain medications, including pain medications, diuretics and those used to treat Parkinsons disease, high blood pressure and depression
13) Hormonal disturbances, such as an underactive thyroid gland
14) Anal fissures and hemorrhoids, which can produce a spasm of the anal sphincter muscle
15) Loss of body salts through vomiting or diarrhea
16) Injuries to the spinal cord, which can affect the nerves that lead to and from the intestine

In rare cases, constipation may signal more-serious medical conditions, such as colorectal cancer, hormonal disturbances or autoimmune diseases. In children, constipation might indicate Hirschsprung's disease, a congenital condition that results from missing nerve cells in the colon.

Children may also become constipated if they are afraid of or unwilling to use the toilet. Older children may ignore or forget to attend to bowel movements.

In most cases, simple changes in your diet and lifestyle can help relieve symptoms and manage constipation. Less often, you may need medical treatment. Above all, recognize that a successful treatment program can take time and effort.

Diet and lifestyle changes

The following simple changes can go a long way toward reducing constipation:

A high-fiber diet. A diet with at least 20 to 35 grams of fiber each day helps your body form soft, bulky stool. High-fiber foods include beans, whole grains, and fresh fruits and vegetables. Limit foods that have little to no fiber, such as cheese, meat and processed foods.

Regular exercise. Physical activity can help stimulate intestinal activity.

Adequate fluid intake. Drinking plenty of water and other fluids will help soften your stool.

Take the time for bowel movements. Set aside sufficient time to allow undisturbed visits to the toilet. And don't ignore the
urge to have a bowel movement.

Laxatives

These over-the-counter medications should be considered only when diet and lifestyle changes aren't effective. Some can become habit-forming.

There are several different types of laxatives:

Fiber supplements, or bulk laxatives, are generally considered the safest of laxatives. Examples include FiberCon, Metamucil, Konsyl, Serutan and Citrucel. These agents must be taken with plenty of water.

Stimulants cause rhythmic contractions in the intestines. Examples include Correctol, Dulcolax and Senokot.

Lubricants enable stool to move through your colon more easily. Examples include mineral oil and Fleet.

Stool softeners moisten the stool and help prevent dehydration. Examples include Colace and Surfak.

Osmotics help fluids to move through the colon. Examples include Cephulac, Sorbitol and Miralax.

Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Examples include milk of magnesia and Haleys M O.

Other medications

If lifestyle changes and over-the-counter medications do not improve your symptoms, your doctor may recommend prescription medications, such as:

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

5-HT-4 agonists. These agents stimulate release of compounds in your body that increase fluid secretion in the intestines and decrease colonic transit time. Prucalopride is one such 5-HT-4 agonist. These drugs are not available in the U.S., and there have been some concerns about the safety of their use.

Procedures

If your constipation doesn't respond to changes in lifestyle or medical treatment, your doctor may recommend in-office or, rarely,
surgical procedures.


Manual procedures. To help clear your colon of retained, impacted stool if laxatives are not effective, your doctor may first gently insert a gloved finger and manually break up the impacted stool (disimpaction). Next, you'll be given a laxative enema to soften the stool and provide lubrication for a bowel movement.

Surgical procedures. If you have chronic, severe constipation and other treatments haven't helped, surgical removal of part of your colon may be recommended. In this procedure, the problem segment or segments of the anal sphincter or rectum are removed.

Treating underlying causes

If an underlying disorder is causing your constipation, treatment will be aimed at the specific cause. If pelvic floor dysfunction is
the cause of your constipation, your doctor may suggest biofeedback as a treatment. This retraining technique may help you learn to better coordinate the muscles you use to have a bowel movement.

If you're pregnant and have constipation, try eating lots of high-fiber foods, such as fruits, vegetables and whole grains. Drink plenty of fluids and get as much exercise as you can. Discuss with your doctor any plan, including exercise, to treat your constipation. Swimming and walking may be good choices.

Adopted from mayoclinic.com