Constipation

Constipation is a very common symptom in the general community. It is often wrongly put down to not having enough fluids, lack of fibre or lack of exercise. Some doctors attribute constipation to Irritable Bowel Syndrome (IBS), but all other fairly common causes should be carefully considered before an IBS label is given. By getting proper advice from appropriately qualified medical practitioners who have an interest in this particular area, patients can avoid long term suffering and the endless cycles of medications and frequent visits to multiple doctors.

CONSTIPATION FACTS

  • Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week.
  • Some of the symptoms of constipation include lower abdominal discomfort, infrequent bowel movements, straining to have a bowel movement, hard or small stools, rectal bleeding and/or anal fissures caused by hard stools, and physiological distress and/or obsession with having bowel movements.
  • Constipation usually is caused by the slow movement of stool through the colon.
  • There are many causes of constipation including medications, poor bowel habits, abuse of laxatives, hormonal disorders, previous obstetrics complications, previous anal surgery including haemorrhoidectomy, rectal prolapse, and diseases primarily of other parts of the body that also affect the colon (such as thyroid dysfunction).
  • Pelvic floor dysfunction can effectively be treated by bio-feedback training (ask your gastroenterologist about it).
  • Medical evaluation of constipation should be done when constipation is of sudden onset, severe, worsening, associated with other worrisome symptoms such as loss of weight, or is not responding to simple measures. It is particularly important if you are above the age of 50, as bowel cancer needs to be excluded.

Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these symptoms of constipation vary, so the approach to each should be tailored to each specific person.

The number of bowel movements generally decreases with age. Most adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than half the people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.

Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, although it can be a source of mental distress for some people. Contrary to popular belief, there is no evidence that “toxins” accumulate when bowel movements are infrequent or that constipation leads to cancer.

It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumours of the colon). Constipation also requires an immediate assessment if it is accompanied by worrisome symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary loss of weight.

The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life.

SYMPTOMS OF CONSTIPATION

  • Infrequent bowel movements
  • Straining to have bowel movements
  • Hard and/or small stools
  • Sense of incomplete evacuation after bowel movements
  • Lower abdominal discomfort
  • Abdominal bloating, occasionally distension
  • Anal bleeding or fissures from the trauma caused by hard stools
  • Occasionally diarrhoea due to obstruction of the colon by hard stool
  • Psychological distress and/or obsession with having bowel movements
  • Hard, compacted stools that are difficult or painful to pass
  • Straining during bowel movements
  • No bowel movements in three days
  • Stomachaches that are relieved by bowel movements
  • Bloody stoolsdue to haemorrhoids
  • Leaks of wet, almost diarrhoea-like stool between regular bowel movements.

PELVIC FLOOR DYSFUNCTION

Pelvic floor dysfunction (also known as outlet obstruction or outlet delay) deserves attention if you have chronic constipation. It refers to a condition in which the muscles of the lower pelvis that surround the rectum (the pelvic floor muscles) do not work normally. These muscles are critical for defecation (bowel movement). It is not known why these muscles fail to work properly in some people, but they can make the passage of stools difficult even when everything else is normal. Your Gastroenterologist should be able to discuss pelvic floor dysfunction in more detail with you, and ways to improve it.

Most of the muscles of the pelvis surrounding the anus and rectum are under some degree of voluntary control. A training method called “bio-feedback” provided by dedicated ano-rectal physiotherapists can teach patients with pelvic floor dysfunction how to make their muscles work more normally and improve their ability to defaecate. During ano-rectal bio-feedback training, a pressure-sensing catheter is placed through the anus and into the rectum. Each time a patient contracts the muscles, the muscles generate a pressure that is sensed by the catheter and recorded on a screen. By watching the pressures on the screen and attempting to modify them, patients learn how to relax and contract the muscles more normally. Ask your Gastroenterologist if a referral for bio-feedback training is beneficial.

MEDICATIONS THAT CAUSE CONSTIPATION

A frequently over-looked cause of constipation is medications. The most common offending medications include:

  • Narcotic pain medications (eg. Endone, Morphine, or Codeine based medicines)
  • Anti-depressants such as amitriptyline
  • Anti-convulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)
  • Iron supplements (tablets or liquid formulations).
  • Some blood pressure tablets such as Diltiazem (Cardizem)
  • Aluminium-containing antacids such as Aluminium hydroxide suspension

The above list is not meant to be exhaustive, and you should ask your doctor if you suspect one or more medications you are taking is contributing to your symptom.

LIFESTYLES

Our busy, modern lifestyles may be responsible for most cases of constipation, particularly the lack of regular routines, and not taking the time to respond to an unmistakable urge to go to the toilet. Your Gastroenterologist should be able to go through with you in detail about how simple this can be corrected, without any medications.

FOR MORE INFORMATION

One of our Gastroenterologists would be happy to go through your symptoms in more detail during formal consultation. A detailed medical history will need to be obtained, and initial simple investigations are often recommended including an Abdominal X-Ray and blood tests. Depending on the results, you may or may not be recommended to have other more specific training strategies or investigations.

For further advice and information, you can request an appointment, or call one of our receptionist team on .