Common Causes of Chronic Constipation
Having fewer than three bowel movements a week is, technically, the definition of constipation. However, how often you “go” varies widely from person to person. Some people have bowel movements several times a day while others have them only one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you – as long as you don’t stray too far from your pattern.
Regardless of your bowel pattern, one fact is certain: the longer you go before you “go,” the more difficult it becomes for stool/poop to pass. Other key features that usually define constipation include:
- Your stools are dry and hard.
- Your bowel movement is painful and stools are difficult to pass.
- You have a feeling that you have not fully emptied your bowels.
Common Causes of Chronic Constipation
If you or a loved one has chronic constipation, much of the anxiety and distress may result from a lack of knowledge about this problem. Not only are there magnified fears about what might be causing the problem, the discomfort of chronic constipation itself can be debilitating. Constipation may slow your performance at work and even cause you to miss recreational activities. That’s why it’s important to know the facts about chronic constipation and talk to your doctor about your personal situation.
Let’s look at common causes of chronic constipation:
There are many causes of constipation – lifestyle choices, medications, medical conditions, and pregnancy.
Common lifestyle causes of constipation include:
- Eating foods low in fiber.
- Not drinking enough water (dehydration).
- Not getting enough exercise.
- Changes in your regular routine, such as traveling or eating or going to bed at different times.
- Eating large amounts of milk or cheese.
- Stress.
- Resisting the urge to have a bowel movement.
Medications that can cause constipation include:
- Strong pain medicines
- Nonsteroidal anti-inflammatory drugs
- Antidepressants
- Antacids containing calcium or aluminum
- Allergy medications, such as antihistamines
- Certain blood pressure medicines, including calcium channel blockers
- Psychiatric medications, like clozapine and olanzapine
- Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
- Antinausea medications, like ondansetron
Medical and health conditions that can cause constipation include:
- Endocrine conditions, like underactive thyroid gland (hypothyroidism), diabetes, uremia and hypercalcemia.
- Outlet dysfunction constipation. (A defect in the coordination of pelvic floor muscles. These muscles support the organs within the pelvis and lower abdomen. They are needed to help release stool.)
- Neurologic disorders, including spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke.
- Lazy bowel syndrome. The colon contracts poorly and retains stool.
- Structural defects in the digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus or malrotation.)
- Multiple organ diseases, such as amyloidosis, lupusand scleroderma.
What are the symptoms of constipation?
Symptoms of constipation include:
- You have fewer than three bowel movements a week.
- Your stools are dry, hard and/or lumpy.
- Your stools are difficult or painful to pass.
- You have a stomach ache or cramps.
- You feel bloated and nauseous.
You feel that you haven’t completely emptied your bowels after a movement
What should I expect when I talk to my doctor about my constipation?
Talking to your doctor – or anyone – about your bowel movements (or lack of them) is not the most pleasant of topics. Know that your doctor is there for you.
We at Aayushman clinic will first ask you questions about your medical history, bowel movements, and your lifestyle and routines.
Medical history
These questions may include:
- What are your current and past diseases/health conditions?
- Have you lost or gained any weight recently?
- Have you had any previous digestive tract surgeries?
- What medications and supplements do you take for other disorders and for the relief of constipation?
- Does anyone in your family have constipation or diseases of the digestive tract or a history of colon cancer?
- Have you had a colonoscopy?
Bowel movement history
These questions may include:
- How often do you have a bowel movement?
- What do your stools look like?
- Have you noticed any blood or red streaks in your stool?
- Have you ever seen blood in the toilet bowl or on the toilet paper after you wipe?
Lifestyle habits and routines
- What food and beverages do you eat and drink?
- What is your exercise routine?
Your doctor will also perform a physical exam, which includes a check of your vital signs (temperature, pulse, blood pressure). He or she will use a stethoscope to listen to the sounds in your abdomen. Your abdomen will also be touched to check for pain, tenderness, swelling, and lumps.
Be aware that your doctor will also perform a rectal exam. This is a finger exam of the inside of your rectum. It’s a quick check for any masses or problems that can be felt by finger.
What lab tests and other medical tests may be done to find the cause of my constipation?
Your doctor can order no tests or many types of tests and procedures. The decision of which ones your doctor might order for you depends on your symptoms, medical history, and overall health.
Lab tests: Blood and urine tests reveal signs of hypothyroidism, anemia, and diabetes. A stool sample checks for signs of infection, inflammation, and cancer.
Imaging tests: Computed tomography (CT), magnetic resonance imaging (MRI) or lower gastrointestinal tract series may be ordered to identify other problems that could be causing your constipation.
Colonoscopy: A colonoscopy or sigmoidoscopy– an internal view of your colon with a scope – may be performed. During this procedure, a small sample of tissue (biopsy) may be taken to test for cancer or other problems and any found polyps will be removed.
Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines.
Other bowel function tests: Your doctor may order tests that check how well your anus and rectum hold and release stool. These tests include a certain type of x-ray (defecography), done to rule out causes of outlet dysfunction constipation, and the insertion of a small balloon into the rectum (balloon expulsion test and anorectal manometry).
How is constipation treated?
Self-care
Most cases of mild to moderate constipation can be managed by you at home. Self-care starts by taking an inventory of what you eat and drink and then making changes.
Some recommendations to help relieve your constipation include:
- Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration.
- Add fruits, vegetables whole grains and other high-fiber foods to your diet. Eat fewer high-fat foods, like meat, eggs and cheese.
- Eat prunes and/or bran cereal.
- Keep a food diary and single out foods that constipate you.
- Get moving, exercise.
- Check how you sit on the toilet. Raising your feet, leaning back or squatting may make having a bowel movement easier.
- Add an over-the-counter supplemental fiber to your diet
- If needed, take a very mild over-the-counter stool softener or laxative (There are many laxative choices). Ask your pharmacist or doctor for help in making a choice. Do not use laxatives for more than two weeks without calling your doctor. Overuse of laxatives can worsen your symptoms.
- Do not read, use your phone or other devices while trying to move your bowels.
Medication/supplement review
In addition to self-care methods, your doctor will review your medications and supplements (if you take any). Some of these products can cause constipation. If they do, your doctor may change the dose, switch to another drug and/or ask that you stop taking the supplement. Never stop taking your medications or supplements before talking with your doctor first.
Prescription medications
A few prescription drugs are available to treat constipation. These include lubiprostone , prucalopride,, plecanatide , lactulose and linaclotide .
Your doctor will pick the drug that might work best for you based on the results of your tests.
Surgery
Surgery is rarely needed to treat constipation. Your doctor may, however, recommend surgery if constipation is caused by a structural problem in the colon. Examples of these problems include a blockage in the colon (intestinal obstruction), a narrowing in a portion of the intestine (intestinal stricture), tear in the anus (anal fissure) or the collapse of part of the rectum into the vagina (rectal prolapse). Some causes of outlet dysfunction constipation may be treated with surgery. This is best discussed after testing. You may also need surgery if cancer was found in your colon, rectum or anus.
How can I prevent constipation?
Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem:
- Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber. Eat bran cereal or add bran cereal to other foods, like soup and yogurt. People with constipation should eat between 18 and 30 grams of fiber every day.
- Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, can dehydrate you. You may need to stop drinking these products until your bowel habits return to normal.
- Exercise regularly.
- Treat mild constipation with a dietary supplement like magnesium. (Not everyone should take magnesium. Check with your doctor before taking.)
- Move your bowels when you feel the urge. Do not wait.
When should I call my doctor?
Call your healthcare provider if:
- Constipation is a new problem for you.
- You see blood in your stool.
- You are losing weight unintentionally.
- You have severe pain with bowel movements.
- Your constipation has lasted more than three weeks.
- You have symptoms of outlet dysfunction constipation.
Remember, talk openly and honestly with your doctor about your bowel movements and any questions or concerns you may have. Pooping is something we all should be doing. Constipation may be a temporary situation, a long-term problem or a sign of a more serious condition. Be safe. See your doctor, especially if you’ve noticed a change in your bowel pattern or if your life is being ruled by your bowels.
Important Reminder:
The information provided above is meant to be used as an informative guide for patients. For precise and individualized recommendations, please consult with one of our board certified gastroenterologists to discuss your symptoms.
For additional information or to book an appointment at the Aayushman clinic Gastroenterology Center, please feel free to reach out to our dedicated team by calling us at 8860291508. You can also schedule online or reach out to us via the Contact Us form.