Constipation

What is Constipation?

Constipation is generally defined as having three or less bowel movements a week. However, a person’s bowel movement varies widely, and this may be normal for you. Some people move their bowels several times a day while others once or twice a week. In general, though, the longer you wait, the more difficult it becomes to pass a bowel movement. Constipation has a significant impact on quality of life and some people may require regular laxatives, enemas or suppositories in order to maintain regularity.

SYMPTOMS of CONSTIPATION

Some common constipation symptoms to look out for include:

  • Passing fewer than three bowel movements a week.
  • Having overly hard stools.
  • Fecal impaction in the rectum
  • Straining to pass a bowel movement.
  • A feeling of blockage in your rectum that is hindering a bowel movement.
  • A feeling of incomplete emptying of stool from your rectum.
WHEN to See a Doctor for CONSTIPATION

Many people can get temporary constipation in their lifetime that goes away. We recommend that you see us or any constipation clinic if you have a persistent change in bowel habit (more than 3 weeks) of experience any warning signs.

  • Any persistent change (more than 3 weeks) in bowel movement
    • Increased frequency
    • Decreased frequency
    • Increased stool size    
    • Decreased stool size
    • Increased difficulty in evacuating stool
  • Warning signs
    • Blood in stools
    • Loss of weight
    • Loss of appetite
    • Severe abdominal pain
CAUSES of CONSTIPATION

Constipation has many causes and is often multi-factorial. These include:

  • Anatomic/Structural causes
    • Colorectal Cancer
    • Stricture (Narrowing)
    • Intestinal obstruction due to volvulus, intussusception, imperforate anus, malrotation or adhesions
  • Functional causes
    • Irritable bowel syndrome
    • Slow transit constipation
    • Pelvic outlet dysfunction
  • Medications
    • Pain medicines, containing codeine or morphine derivatives
    • Nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen
    • Antidepressants, such as the selective serotonin reuptake inhibitors (e.g. fluoxetine) or tricyclic antidepressants (e.g. amitriptyline)
    • Antacids
    • Iron tablets or supplements.
    • Allergy medications, such as antihistamines (e.g.diphenhydramine)
    • Blood pressure medication, including calcium channel blockers (like verapamil, diltiazem and nifedipine and beta-blockers (like atenolol)
    • Psychiatric medications, like clozapine and olanzapine.
    • Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
    • Antinausea medications, like ondansetron.
  • Disorders of nervous system
    • Parkinson’s disease, Multiple sclerosis
    • Stroke
    • Spinal cord injuries
  • Disorders of endocrine system
    • Thyroid disease
  • Multi-organ systemic diseases
    • Amyloidosis
    • Systemic lupus erythematosus
    • Scleroderma.
RISK FACTORS of CONSTIPATION

Many lifestyle factors can contribute to constipation. These include:

  • Insufficient dietary fiber and water intake
  • Change in diet
  • Sedentary lifestyle
  • Environmental changes that may result in dehydration for instance
  • Travel
  • Pregnancy
  • Habitually ignoring the urge to have a bowel movement
DIAGNOSIS of CONSTIPATION

The various methods of diagnosis are available at most constipation clinic:

  • Through medical history and physical examination.
  • Blood Tests
  • Colonoscopy – It is important to exclude worrisome causes of constipation, such as cancer (especially if you are older than 45 years of age).
  • Colon Transit – After excluding any mechanical cause of obstruction, your constipation doctor may want to assess you for functional constipation including slow colon transit.
  • Anorectal manometry and balloon expulsion studies- Your doctor may want to assess for pelvic floor dysfunction (discoordination of your pelvic floor and defection muscles).
TREATMENT of CONSTIPATION

Examples of constipation treatment administered by most doctors will include:

Lifestyle Measures

  • Increasing the fiber in your diet, 
  • Drinking more water. 
  • Exercise is good as it stimulates the colon.


Medication

There are several medications that are available to treat constipation. These include lubiprostone, prucalopride, senna, lactulose, amongst others.  Your doctor will discuss each medication with you and help you decide what’s best for you.


Surgery

Surgery is rarely needed to treat constipation. Surgery may be indicated if a structural problem in the colon exists. Examples of these problems include

  • Intestinal obstruction
  • Intestinal stricture), 
  • Anal fissure (Anal tear)
  • Rectal Prolapse (collapse of part of the rectum into the vagina)


Physiotherapy

  • If your doctor finds that you have incoordination of your pelvic floor muscles (pelvic floor dyssynergia), a physiotherapist can teach you exercises to re-train the muscles.