Chronic Constipation
Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. Constipation is generally described as having fewer than three bowel movements a week.
Though occasional constipation is common, some people experience chronic constipation that can interfere with daily tasks. Chronic constipation may also cause people to strain excessively to have a bowel movement.
Treatment depends in part on the underlying cause. In some cases, a cause is never found.
Symptoms
Signs and symptoms include:
- Passing fewer than three stools a week
- Having lumpy or hard stools
- Straining to have bowel movements
- Feeling a blockage in your rectum
- Feeling you can't completely empty the stool
- Needing help to empty your rectum, such as using a hand or finger
Constipation may be considered chronic if two or more of these symptoms persist for the last three months.
When to see a doctor
See a doctor if you experience unexplained and persistent changes in bowel habits.
Causes
Constipation occurs when stool moves too slowly through the digestive tract or cannot be eliminated effectively. Causes include:
Blockages in the colon or rectum:
- Tiny tears around the anus (anal fissure)
- Bowel obstruction
- Colon cancer
- Narrowing of the colon (bowel stricture)
- Other abdominal cancer pressing on the colon
- Rectal cancer
- Rectocele (rectum bulge through back wall of the vagina)
Problems with nerves around colon and rectum:
- Autonomic neuropathy (nerve damage)
- Multiple sclerosis
- Parkinson's disease
- Spinal cord injury
- Stroke
Difficulty with muscles involved in elimination:
- Anismus (inability to relax pelvic muscles)
- Dyssynergia (uncoordinated pelvic muscles)
- Weakened pelvic muscles
Conditions that affect hormones:
- Diabetes
- Overactive parathyroid gland (hyperparathyroidism)
- Pregnancy
- Underactive thyroid (hypothyroidism)
Risk factors
- Being an older adult
- Being a woman
- Dehydration
- Low-fiber diet
- Low physical activity
- Certain medications (sedatives, opioids, some antidepressants, blood pressure meds)
- Mental health conditions (depression, eating disorder)
Complications
- Hemorrhoids (swollen veins in anus)
- Anal fissures (small tears)
- Fecal impaction (hardened stool stuck in intestines)
- Rectal prolapse (rectum protruding from anus)
Prevention
- Eat high-fiber foods (beans, vegetables, fruits, whole grains)
- Reduce low-fiber foods (processed foods, dairy, meat products)
- Drink plenty of fluids
- Stay active and exercise regularly
- Manage stress
- Respond to the urge to pass stool
- Create a regular bowel schedule, especially after meals
- Ensure children get enough fiber when starting solids
Diagnosis
Tests to diagnose chronic constipation include:
- Blood tests (thyroid, calcium levels)
- X-ray of intestines
- Sigmoidoscopy (examine rectum and lower colon)
- Colonoscopy (examine entire colon)
- Anorectal manometry (measure sphincter muscle coordination)
- Balloon expulsion test (muscle speed during bowel movement)
- Colonic transit study (track movement of food through colon)
- Defecography (X-ray of rectum during defecation)
- MRI defecography (visualize defecation muscles and diagnose prolapse/rectocele)
Treatment
Begins with diet and lifestyle changes. If ineffective, medications or surgery may be recommended.
Diet and lifestyle changes
- Increase fiber intake (fruits, vegetables, whole grains)
- Exercise most days
- Respond promptly to the urge to have a bowel movement
Laxatives
- Fiber supplements (psyllium, calcium polycarbophil, methylcellulose)
- Stimulants (bisacodyl, sennosides)
- Osmotic laxatives (magnesium hydroxide/citrate, lactulose, polyethylene glycol)
- Lubricants (mineral oil)
- Stool softeners (docusate sodium/calcium)
- Enemas and suppositories (tap water, glycerin, bisacodyl)
Other medications
- Lubiprostone, linaclotide, plecanatide (draw water into intestines)
- Prucalopride (stimulates colon movement)
- PAMORAs (reverse opioid-induced constipation)
Training your pelvic muscles
Biofeedback therapy helps relax and tighten pelvic muscles during defecation for easier stool passage.
Surgery
Considered if other treatments fail and chronic constipation is caused by a blockage, rectocele, stricture, or extremely slow stool movement. Rarely, full colon removal is needed.
Alternative medicine
Some use acupuncture or complementary therapies, but these are not well-studied.