What is constipation?
Constipation means different things to different people. Constipation is a symptom, not a disease. Constipation usually refers to having three or fewer bowel movements in a week or if stool is hard, dry, painful, or difficult to pass. Some people with constipation lack energy and feel full or bloated. Some people think they have constipation if they don’t have a bowel movement every day. However, bowel habits are different for everyone. Diet, exercise and medications in addition to other factors can all affect bowel habits. At one time or another, almost everyone gets constipated. In most cases, it lasts for only a short time and is not serious. When people understand what causes constipation, they can take steps to prevent it.
What causes constipation?
To understand what causes constipation, it helps to know how the large intestine (colon) works. The large intestine removes most of the water from stool and changes it to a solid waste. The large intestine then moves the stool through the rectum and anus as a bowel movement. Constipation occurs when stool passes through the large intestine too slowly. When stool stays in the large intestine too long, the intestine removes too much water, and the stool becomes hard and dry.
The two types of constipation are idiopathic constipation and functional constipation. Idiopathic (of unknown origin) constipation does not respond to standard treatment. Functional constipation means that the bowel is healthy but not working properly. Functional constipation is often the result of poor dietary habits and lifestyle. It occurs in both children and adults and is most common in women. Colonic inertia, delayed transit, and pelvic floor dysfunction are three types of functional constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower, or sigmoid, colon. Pelvic floor dysfunction is caused by a weakness of the muscles in the pelvis surrounding the anus and rectum. However, because this group of muscles is voluntarily controlled to some extent, biofeedback training is somewhat successful in retraining the muscles to function normally and improving the ability to have a bowel movement. Functional constipation that stems from problems in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.
Some lifestyle habits that may cause constipation include:
- Changing normal diet, exercise, or travel habits
- Ignoring the urge to have a bowel movement
- Feeling a lot of stress
- Eating a low-fiber diet
- Not drinking enough liquids
- Taking calcium or iron supplements
- Taking medicines such as painkillers with codeine, diuretics (water pills), antidepressants, certain blood pressure medications (calcium channel blockers), antiparkinson drugs and antispasmodics
Some medical conditions that may cause constipation include:
- Pregnancy or having given birth
- Problems with the muscles and nerves in the intestine, rectum, or anus
- Irritable Bowel Syndrome (IBS): please refer to the section titled Irritable Bowel Syndrome (IBS) for more information about this condition
- Diabetes, a condition in which a person has high blood sugar, also called hyperglycemia, because the body cannot use blood glucose, or blood sugar, for energy
- Hypothyroidism, a condition in which the thyroid gland does not produce enough hormone to meet the body’s needs and many of the body’s functions slow down
- Chronic idiopathic constipation: problems with intestinal function
What tests are done to find the causes of constipation?
The tests performed depend on the duration and severity of the constipation, the person’s age, and whether blood in stools, recent changes in bowel habits, or weight loss have occurred. Most people with constipation do not need extensive testing and can be treated with stool softeners in addition to changes in diet and exercise. In addition to a physical examination, Dr. Makhani may also order one or more tests if a serious problem is suspected as the cause of constipation after failing standard medical therapy.
- Colonoscopy: Please refer to the title Colonoscopy under Services section for more information.
- Colorectal transit study: For this test, small capsules are swallowed that can be seen on an x ray as they move through the large intestine and anus.
- Anorectal function test (manometry): used to evaluate anal sphincter muscle function. For this test, a catheter or air-filled balloon is inserted into the anus and slowly pulled back through the sphincter muscle to measure muscle tone and contractions. This test is followed by a balloon expulsion tests which consists of filling a balloon with varying amounts of water after it has been rectally inserted to determine sensation and the ability to expel the balloon.
- Defecography test: A soft paste is placed into the rectum and the patient pushes out the paste while an x-ray machine takes pictures of the rectum and anus.
How is constipation treated?
Constipation is usually treated with a combination of diet, exercise and medications.
High fiber diet: Fiber helps form soft, bulky stools and is found in many vegetables, fruits, and grains. The most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats. People who eat a high-fiber diet are less likely to become constipated. Fiber, both soluble and insoluble, is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass. Limitation of foods that have little or no fiber include pizza, ice cream, cheese, meat, snacks like chips, and processed foods such as instant mashed potatoes or frozen dinners.
Americans eat an average of 5 to 14 grams of fiber daily, which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed. A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy, such as fast foods, or prepared foods, both of which are usually low in fiber. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and low in fiber. Fiber should be added to the diet in a step-wise fashion to avoid excessive bloating and gas.
High-fiber Foods
| Fruits | Vegetables | Breads, Cereals, and Beans |
|---|---|---|
| applespeachesraspberries | acornsquashbroccoli | black-eyed peaskidney beanslima beans |
| tangerines | brussels sprouts | cold whole-grain cereal (All-Bran, Total, Bran Flakes) |
| oranges | cabbage | hot whole-grain cereal (oatmeal, Wheatena) |
| pears | carrots | wheat or 7-grain bread |
| prunes | cauliflower | |
| spinach | ||
| zucchini |
Dr. Makhani may suggest fiber pills or powder to help soften and bulk up the stool. Fiber products can be purchased in a pharmacy or grocery store without a prescription. Some fiber products are flavored while others are not. The fiber should be taken with plenty of water as directed.
Increased fluid intake: This includes water and other liquids such as fruit and vegetable juices and clear soups. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day because dehydration can cause constipation. However, liquids that contain caffeine and alcoholic beverages will worsen one’s symptoms by causing dehydration. It is best to avoid liquids that contain caffeine or alcohol when feeling thirsty or dehydrated.
Getting enough exercise: Regular exercise helps the digestive system stay active and healthy. Exercising 20 to 30 minutes every day may help.
Visiting the restroom during the urge to have a bowel movement: Sometimes people feel so hurried that they don’t pay attention to their body’s needs. Sometimes people usually have a bowel movement at a certain time of day and they should try to visit the restroom around that time. Reading a book or magazine in the restroom can help people relax. However it is important not to sit in the bathroom for more than a few minutes and to avoid straining to have a bowel movements. These actions can cause hemorrhoids and bleeding.
Using laxatives as needed: Laxatives are medicines that help pass stool. Most people who are mildly constipated do not need laxatives. However, if the above therapies are not effective, then Dr. Makhani may recommend a laxative for a limited time. Please consult with Dr. Makhani for more information about the types of laxatives available
Biofeedback: This treatment is recommended in a select subset of people who have problems with the muscles and nerves that control bowel movements. Biofeedback is a painless process that uses sensors in the rectal area to help feel the stool and move it out of the rectum. Biofeedback with a trained therapist has been shown to help some people with this subset of constipation.