Constipation: Causes, Diagnosis, and Treatment

Having constipation means that you strain while passing stool, or passing out too infrequently or at too long intervals. Constipation is not a normal, but it is so common that almost everyone experiences it at least occasionally. Constipation can also occur with other digestive symptoms such as bloating, gas, or loss of appetite.

Constipation often occurs when the solid waste left from food digestion passes too slowly in the large intestine. The large intestine absorbs water and serves as storage for the solid waste before it comes out of the body as feces.

Too slow passage dries up the feces, causing it to become too firm and almost solid. These solid masses of feces are very hard for the intestine to pass, and it further slows down intestine movement. Usually, constipation tends to worsen if you do not move the bowels.

Constipation is often confused as ‘normal’, but it is different normal bowel movements. Normal bowel movements vary among individuals. Some go to the toilet once a day, three times daily, or thrice a week, which is okay. Normal stools are semisolid in texture, like formed mashed potatoes, and not hard or lumpy.

However, features in constipation like straining, the sensation of incomplete evacuation, feeling of obstruction in the anus, or passing out hard solid stools are not part of normal bowel movement. To help you further, the American Family Physician made important definitions to determine constipation.

You have constipation if you have two or more of the following:

Bowel movements where you have to often strain
Passing out lumpy or hard stools
Sensing that there is still some left behind after defecation
Sensing a ‘blockage’ that hinders defecation
The need to perform things like inserting a finger in the anus or pressing the pelvic floor to facilitate defecation
Moving the bowels less than three times a week

Constipation is common because there are plenty of factors that cause it. Ignoring the urge to defecate can make you constipated. Eating too much bread, pasta, starchy items, or consumption of too little fiber-rich food can cause constipation.

Some experience constipation due to anxiety or severe emotional distress, or when not having adequate time to move the bowels. Constipation can also occur as a side effect of certain medicines, especially painkillers, and antacids.

You can also have constipation if you took too many vitamins or supplements such as iron, Psyllium, or vitamin C. Sometimes, constipation occurs if we drink too little water or consume too much coffee, tea, colas or milk.
Sometimes, constipation happens as a symptom of more serious medical conditions. Constipation can be a symptom or feature of the celiac disease, tumors or masses in the large intestines, Parkinson’s disease, colon cancer, proctitis, pelvic floor dysfunction, and other conditions.

If not treated, constipation tends to worsen over time. It can progress to chronic constipation, a condition where constipation occurs for weeks at a time. Chronic constipation is very uncomfortable and can lead to hemorrhoids of the rectum, fecal impaction, or leakage.

There are simple measures effective in addressing constipation. Sometimes, drinking more fluids or eating fiber may solve constipation. Exercise may also help. Medicines may help induce defecation but should be used with doctor’s supervision. Surgery for constipation is uncommon but often done to correct hemorrhoids or remove masses in the intestines that cause the problem.

Many things can cause constipation or make it worse. We will divide the causes of constipation into the following categories:

Lifestyle:

Our lifestyle choices or habits can sometimes cause constipation. Not having a regular time for moving the bowels may cause constipation. You can voluntarily withhold the urge to defecate, but that can cause retention and result to difficulty passing out stool.

Some people are so busy that they neglect to move the bowels. Inactivity or lack of exercise can cause constipation as physical activity makes it easier for food to pass through the intestines.

Diet:

Dehydration or drinking too little water may reduce the water content of the stool, which may result in constipation.

Consumption of too little fiber may cause and worsen constipation. The fiber in food retains water, which eases movement of solid wastes in the intestine. Foods rich in fiber include fresh fruit and whole vegetables, prunes, and whole grains.

Change in diet can sometimes trigger constipation. On the other hand, certain foods can cause constipation especially if eaten in large quantities. Culprit foods include pasta, refined grains, sugar, milk, red meat, unripe bananas or plantains, coffee, tea, white rice, cheese and other dairy products.

Emotions:

Some emotions, like anxiety, may trigger constipation. Some patients who survived sexual abuse may experience constipation.

Medications:

Constipation is often a side effect of certain medications. Here are some common medicines that can make you constipated:

Antacids, especially those that contain aluminum and magnesium
Laxatives, which weaken the muscles that move the bowels if overused
Iron and calcium supplements
Painkillers
Narcotics such as morphine, and codeine
Antidepressants
Medicines for thyroid
Contrast agents used in X-rays in the abdomen
Medicines used for epilepsy
Antipsychotics
Water pills

Medical conditions:

Constipation can be a feature in certain conditions. Bottle-fed babies and pregnant women tend to suffer often from constipation. Here are other medical conditions that feature constipation as a symptom:

It is very easy to diagnose constipation. The doctor only needs you to describe your symptoms. Sometimes, the doctor may order abdominal x-rays, which can show accumulated gas and feces to confirm the diagnosis. X-rays may also identify fecal impaction and other problems in the abdominal cavity that may result to constipation.

You also have to give your medical history, including the drugs you take, the presence of other medical conditions, or any procedures or surgery done. If the doctor suspects that constipation may be caused by other things, he or she may order other tests and other diagnostic procedures.

Some tests used in diagnosing constipation include sigmoidoscopy and colonoscopy, which involves inserting a flexible tube into your anus with a camera to visualize your large intestine to check for masses, fecal impaction, or blockages. Barium paste, which shows up clearly in films, may be used with x-rays to check the muscles of your rectum or reveal blockages or masses.

Treating the cause of constipation often relieves it. However, if tests show that nothing wrong that caused constipation, your doctor may first order simple measures. No matter how simple they appear, they are quite effective in stopping constipation and promoting regular bowel movements.

Here are the remedies to relieve constipation:

Drink more water
Achieve recommended exercise levels
Increasing intake of fiber, like adding whole grains, fresh fruit, whole and leafy vegetables in everyday diet
Do not ignore urge to move the bowels

Drugs for constipation:

In some cases, your doctor may recommend drugs to treat constipation. This may be suitable for cases of chronic constipation, or to constipation not responding to simple treatments. Note that drugs are not routinely used because they sometimes worsen constipation instead. Only use drugs for constipation with doctor’s supervision.

Most drugs used for constipation are taken by mouth, but some are delivered using enemas.

Your doctor may prescribe the following to treat constipation:

Fiber supplements. Fiber retains water and so increase the bulk of the stool to ease its passage out of the body. Fiber supplements contain methylcellulose, psyllium, calcium polycarbophil and guar gum.
Drugs that stimulate the movement of the intestines (laxatives), such as Domperidone (Dulcolax) or Sennosides (Senokot).
Osmotic drugs, which work for constipation by promoting movement of fluids through the large intestines. Osmotic drugs include milk of magnesia, magnesium citrate, lactulose, polyethylene glycol, and sodium phosphate enema.
Lubricants like mineral oil work by making the insides of the intestine slippery to ease passage of stool.
Stool softeners include Docusate sodium (Colace or Surfak)
Lubiprostone (Amitiza)
Linaclotide (Linzess)

Training the pelvic muscles:

Your doctor may advise you to exercise the pelvic muscles so they can give support during defecation to relieve constipation. This requires training by a therapist and may require several sessions.
Procedures to relieve enema

Your doctor may perform certain procedures to relieve constipation If there is fecal impaction just in the rectum, the doctor may attempt to remove it manually by inserting a finger or other instrument carefully into the anus.

If appropriate, your doctor may perform an enema. Enema puts fluid into your anus, so it hydrates inside of the intestines to cause bowel movement and make it easier.

Surgery:

If other methods fail or if constipation is very severe (unresponsive to treatment or if the amount of solid waste in the colon is intestines very high), your doctor may recommend surgery. Surgery is also the option if constipation is caused by tumors, masses or structures in the large intestine or neighboring structures.