Constipation

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 16, 2015
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Constipation is a common condition that occurs when waste or stool has difficulty moving through the gastrointestinal tract. Depending on the cause, constipation is usually highly preventable, and most treatments for constipation are usually noninvasive and can be used prophylactically.

Contents

Definition & Facts

Constipation is a condition associated with complications in moving and emptying the bowels. It becomes medically significant when an individual has less than three bowel movements per week. Constipation is considered to be severe when individuals are unable to have more than one bowel movement per week.

Causes

Constipation usually is caused by stool moving too slowly through the colon. Sometimes the stool is too large to pass or there is not enough water in the large intestine. Other times, the walls of the large intestine are unable to contract and relax properly. Constipation can often be attributed to a diet low in fiber, a high level of stress, or a lack of exercise.

Constipation may also be caused by certain medications, such as opioids and narcotic pain relieves. It can even occur from abuse of laxatives. Hormonal disorders such as hypothyroidism, hyperparathyroidism, diabetes, or high levels of estrogen and progesterone during pregnancy may contribute to constipation. Sometimes constipation may be caused by a blockage in the colon or rectum that inhibits the movement of stool through the gastrointestinal tract.

Blockages in the gastrointestinal tract may include anal fissures, bowel obstructions, a narrowing of the colon, colon polyps or tumors, rectal cancer, rectocele, or other abdominal structures that compress the large intestine. Constipation may be caused by pelvic muscles that are weak or are unable to relax and contract properly. Constipation may also be caused by problems with the nerves surrounding the rectum and the colon.

Malfunctioning nerves can creature problems in the contraction and relaxation of muscles in the rectum and colon, inhibiting the proper movement of stool through the intestines. Certain neurological conditions and disorders responsible for constipation may include autonomic neuropathy, Parkinson's disease, stroke, spinal cord injury, spinal stenosis, or multiple sclerosis.

When to see a doctor

Most episodes of constipation can usually be treated with natural, at-home remedies. However, medical treatment for constipation should be sought when the onset is acute and severe, and when there is less then one bowel movement per week. Constipation should also be treated medically when it accompanies other symptoms such as unexplained weight loss, or unresponsiveness to conventional treatments.

Treatment & Therapy

Treatment of constipation is depends on the cause and on the severity. Most treatments are non-invasive and involve simple life-style modifications. Treatments such as adding dietary fiber, increasing water consumption, having good bowel habits, gentle exercises that compress the abdomen, biofeedback therapy, acupuncture, massage therapy, and chiropractic care should be tried first.

Eating more fresh fruits and vegetables will provide fiber content to the diet, increasing the weight of the stool and facilitating the natural intestinal peristalsis. Typically, 14 grams of fiber should be eaten for every 1,000 calories consumed. Drinking plenty of water not only helps the body to stay hydrated, it also provides the large intestine and colon with more water to help pass stool more easily. Any urges to have a bowel movement should be heeded.

Individuals suffering from constipation should allow themselves enough time to use the bathroom without distractions. It is also helpful to simply sit on the toilet seat, even if a bowel movement does not feel eminent. Proper exercise compresses the abdomen and regulates muscle activity in the intestines. Squatting exercises are ideal for treating constipation because they strengthen the legs and compress the abdomen. Biofeedback therapy involves working with a qualified therapist who uses specialized devices to teach individuals suffering from constipation to relax and contract pelvic floor muscles. The purpose is to help the body direct itself to pass stool more easily.

In a typical biofeedback session for constipation, a catheter is inserted into the rectum to measure muscle tension. The therapist guides patients through exercises for the pelvic muscles. A machine will gauge the muscle tension and use sounds or lights to display when muscles are relaxed. Acupuncture for constipation involves the insertion of sterilized needles into different areas on the body. By working with the body's energy, acupuncture is able to have a direct impact on the nervous, circulatory, and endocrine systems. Both massage therapy and chiropractic care will relax and realign the muscles and joints of the body.

When the muscles and joints are fluid and in proper alignment, the body is better able to pass stool. Stronger treatments may include both non-stimulant and stimulant laxatives, enemas, suppositories, prescription medications, and in some cases surgery. Many different laxatives are available. Fiber supplements add bulk to the stool. Osmotic laxatives help fluids move through the colon. Lubricants, such as mineral oils, assist the stool in moving through the colon more easily. Stool softeners moisten the stool by drawing water from the intestines.

Certain medications may be prescribed to treat severe cases of constipation. Medications such as lubiprostone and linaclotide draw water into the intestines and speed the movement of the stool. These medications may be recommended if using over-the-counter laxatives have been unsuccessful. Surgery may be necessary for constipation caused by rectocele, anal fissures, or strictures. Surgical removal of part of the colon may be an option for individuals who have exhausted other less less invasive alternatives.

Prevention & Prophylaxis

Constipation is a very preventable and manageable condition. Many of the treatments for constipation can be used as preventative measures. Regular exercise (jogging) and eating a high-fiber diet with fresh fruits and vegetables are key components in preventing constipation. Drinking plenty of water and having good bowel habits are easy methods for preventing constipation.

Regular acupuncture, massage, or chiropractic treatments can keep the body functioning properly, allowing stool to more easily pass through the colon. Laxatives, especially stimulant laxatives should not be used for preventing constipation. Chronic use of laxatives can create physical dependence by altering the large intestines and actually predispose individuals to episodes of constipation.

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