Chronic Constipation

Chronic constipation is constipation that lasts for more than 6 months. The patient suffers from difficulty and sometimes painful defecation of hard, dry stool as well as infrequent bowel movements, defined as fewer than three bowel movements per week and in severe cases, lesser than one bowel movement per week. Chronic constipation may not require immediate attention especially if previous measures are able to bring significant relief.

Causes

The causes for acute and chronic constipation may be the same, although acute constipation may have more severe causes, like a malignant growth blocking in the intestine or a serious GI disease. The most common causes for chronic constipation are the following:

• Diet low in fiber and fluids
• Medications (narcotics, antidepressants, anticonvulsants, iron supplements, calcium channel blocking drugs, antacids )
• Frequent suppression of bowel movements, which can lead to disappearance of urges
• Over-use of stimulant laxatives
• Disease that affect the colon
• Hormonal disorders

Symptoms

As said previously, chronic constipation is the difficulty in passing stool, which are hard and dry. Defecation may be so difficult that it leads to straining and in some cases may be accompanied by pain.

Diagnosis

The patient is first examined and a medical history is obtained to obtain information to allow the doctor to determine the type of constipation present. This in turn will determine what kind of diagnostic tool or treatment to use. For example, if it is discovered that a certain medication is causing the problem, that medication could be replaced and the disease is treated.

A physical examination may be able to determine diseases which can cause constipation. For example, it may reveal a tight anal sphincter or the presence of hemorrhoids. Simple palpation of the abdomen will be able to suggest a stool-filled colon.

Blood tests may also be able to show some of the possible causes of constipation. For example, it can reveal hypothyroidism, a condition which also causes constipation. A barium enema, on the other hand, may be able to show tumors or stricture on the colon, which may be causing the obstruction. Endoscopic tests to visualize the colon (colonoscopy or sigmoidoscopy) will often reveal tumors, inflammation, or bleeding.

Newer technology to determine the causes of the problem include a defecating proctogram, which is an x-ray imaging procedure which looks at how the sigmoid colon and the rectum empty stool, scintigraphy, which determines the rate at which a radioactive isotope travels down the GI tract and a colonic motility test, which utilizes a balloon which is expanded inside the colon, and a machine that measures the colon’s response to the pressure.

Treatment

The easiest way to treat constipation is to add more fiber and fluids to the diet. Fiber adds more bulk to the stool and absorbs water, which makes the stool formed and soft and easy to pass. Eating fiber-rich foods like cereals, vegetables and fruits is one way to add more fiber to the diet. If this is not possible, another way is to take fiber supplements. People on fiber supplements should be aware that increased flatulence is a side effect of increasing intake of fiber-rich foods. Water intake should also be increased to prevent the fiber from “hardening” and causing a blockage in the intestines.

Lubricant laxatives, which may be mineral oil or plain oil emulsions, may help in keeping the stool soft and moist and easy to pass. The oil coats the stool and prevents water from being reabsorbed by the body.
Stool softeners are products that contain docusate, which apparently imporves the ability of water in the colon to penetrate the stool, making the stool soft and wet. It is often prescribed for long-term treatment of constipation and for individuals with anal fissures and hemorrhoids.

Laxatives like Senocot, Dulcolax or Castor oil, which are stimulant laxatives, work to make defecation easier by stimulating the muscles of the colon to expel their contents more rapidly. They also increase the water content in the stool by reducing water absorption by the colon or increasing the amount of water excreted by the small intestine. However, laxatives are not advisable for long-term use since they may lead to dependence and could eventually make the problem worse.