Constipation Latest Facts: Causes, Diagnosis and Treatments

Constipation is a condition where an individual has less frequent bowel movements and the stools that he/she passes are hard.  In addition, the constipated person may also have difficulty relieving themselves and also may be left with the sensation that the stools have not been passed completely.

Toilet

Toilet

In general, an individual is diagnosed with constipation if they have been passing hard and dry stools for one whole week and had less than three bowel movements during that period.

It must be noted that there are huge variations from individual to individual. While one individual may have three bowel movements per day another may only have 3 bowel movements for the whole week.

How common is constipation?

In the US, constipation occurs in individuals of all ages, ethnicities, and backgrounds. Roughly, 16 out of 100 adults have symptoms of constipation in the US. And this number goes up to 33 out of 100 in adults aged 60 years or older.

The probability of having constipation increases in certain individuals due to various factors. Individuals who are at an increased risk of having constipation are:

  • Pregnant women
  • Individuals who are 60 or above
  • Individuals who eat diets with very little fiber content
  • Individuals who are taking dietary supplements and medications which are known to cause constipation.
  • Individuals who don’t drink enough fluids and are not physically active.
  • Individuals who have various medical conditions.

Common causes of constipation

Constipation can happen due to various factors involving lifestyle and dietary factors, sudden changes in life or daily routine, certain medications, and many medical conditions.

A diet deficient in fiber-containing foods and rich in high fat-containing foods can be a possible reason for constipation. Similarly, a sedentary lifestyle that lacks physical activity can also cause constipation.

Medications and dietary supplements which can cause or make constipation worse are:

  • Medications used to treat acidity like antacids.
  • Medication for depression.
  • Narcotic medication (opioids) used to relieve pain.
  • Medications to treat spasms.
  • Calcium channel blockers.

Changes in daily routine or life that can cause constipation:

  • Pregnancy
  • Traveling for long hours.
  • Old age
  • Ignoring the urge to go to the bathroom.
  • Changing dietary intake in terms of quantity or changing the type of foods.

Medical conditions which cause constipation:

  • Celiac disease.
  • Brain or spinal cord injuries.
  • Disorders of metabolism like diabetes.
  • Hormonal disorders like hypothyroidism.
  • Intestinal obstructions like an anorectal blockage.

When to consult a doctor?

If common methods of treatment like increasing liquid intake, eating fiber content-rich foods, and integrating physical activity in one’s daily routine do not help improve your condition, it is recommended to see a healthcare professional as it may be chronic constipation.

It is recommended to see a doctor right away if one has any of the below-mentioned symptoms along with constipation:

  • Unexplained weight Loss without any effort and obvious cause
  • Having bloody stools.
  • Lack of ability to pass gas.
  • Constant abdominal pain
  • Vomiting
  • Lower back pain

Diagnosis

A doctor will inquire about one’s dietary habits, lifestyle, medical history and may do a physical exam to conclude if one has constipation.

The doctor will ask about the following issues:

  • Eating habits.
  • Level of physical activity.
  • Color and consistency of stools and presence or absence of blood streaks in them.
  • Frequency of bowel movements.
  • Current medications and dietary supplements one is taking.

The doctor may also inquire if you have had surgery or gastrointestinal issues in the past or if you suffer from any medical conditions like structural problems in the GIT, intestinal obstruction, and colon or rectal cancer.

Physical exam

The doctor may check one’s blood pressure, temperature, and heart rate.
He/she may check for dehydration, check the abdomen for masses, swelling, and tenderness and listen to one’s abdominal sounds using a stethoscope. The doctor may also perform a rectal exam.

Lab tests

Blood tests to see if one has anemia, hypothyroidism, and celiac disease.

Stool tests to check for the presence of blood in stools.

Urine tests to see if one has diabetes.

The doctor may use endoscopy, colorectal transit studies, bowel function tests, and few imaging tests to look for a cause of constipation.

Treatment options

In general, most patients struggling with constipation can improve their condition by changing their diet and lifestyle habits, regulating their bathroom schedule, and taking over-the-counter medications.

Dietary changes

  • Eating fiber-rich foods. Common foods which have high fiber content are vegetables, fruits, nuts, and whole grains. One should also focus on eating fewer foods that have high-fat content like cheese, eggs, and meats.
  • Drinking plenty of fluids daily and avoiding caffeine-rich foods and alcohol.

Lifestyle changes

As it is understood that a sedentary lifestyle can be a cause of constipation so one strategy to relieve constipation is to integrate exercise into the daily routine. It helps to regulate bowel movements. Generally, it is recommended to get at least 150 minutes of physical activity every week.

Regulating bowel movements

It is also recommended to regulate one’s bowel movements to a similar time each day. And one should not ignore the urge to defecate and go to the toilet as soon as one feels the urge and one should allow sufficient time without any stress.

Over the counter medications

If the above methods do not result in improving the condition, one can take many over-the-counter medications like laxatives. Many types of laxatives are available, and it is recommended to talk to a medical professional before taking them and they are recommended only in severe cases of constipation.

Prescription medication, biofeedback therapy, and surgery

If the above methods fail, the doctor may prescribe a few medications like lubiprostone and linaclotide which act through different mechanisms to relieve constipation. Biofeedback therapy can also be recommended which is used to retrain muscles involved in bowel movements. Many surgical procedures are used in specific situations like an anorectal blockage.

How can constipation be prevented?

Constipation can easily be prevented by doing the following:

  • Regulation of one’s bowel habits.
  • Doing more physical activity daily.
  • Eating foods rich in fibers.
  • Not ignoring the urge to go to the bathroom.
  • Drinking enough water and other liquids.

References

1. Cleveland Clinic 2019, Constipation, Accessed 15 March 2021, https://my.clevelandclinic.org/health/diseases/4059-constipationr/
3. NHS 2020, Constipation, Accessed 15 March 2021, https://www.nhs.uk/conditions/constipation/
4. National Institute of Diabetes and Digestive and Kidney diseases 2018, Constipation, Accessed 15 March 2021, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation
5. John Hopkins Medicine, Constipation, Accessed 15 March 2021, https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation

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