Constipation is widespread affecting all ages at some time in their lives. The incidence increases with age. Women are more often affected than men 2:1. It is physically and mentally troublesome for many patients and can significantly interfere with daily living and well-being. Constipation is the most common health complaint causing millions of doctor appointments each year.
A normal bowel movement typically occurs three times a day or three times a week. Occasional constipation is defined as having fewer than three bowel movements a week. Chronic constipation is defined as infrequent bowel movements or difficulty passing stool that persists for more than three weeks. Chronic constipation affects about 10-15% of the population.
Occasional constipation is a common symptom in people of all ages who are otherwise healthy. This usually happens when the person doesn’t have enough fiber in their diet, has changes in their diet or they are not drinking enough water. Constipation can also be caused by stress, pregnancy, certain medications, and other medical conditions like irritable bowel syndrome. However, it can also result from ignoring the urge to have a bowel movement, problems with intestine function, and laxative abuse. Constipation is defined by symptoms that occur in isolation or due to an underlying disorder.
- fewer than three bowel movements per week
- small, hard, dry stool
- straining to defecate
- inability to defecate
- difficult or painful bowel movements
- cramping or a stomachache
- bloating and nausea
- feelings of incomplete evacuation
- Feeling lethargic
Symptoms may be acute lasting less than a week and usually precipitated by a change in diet or lifestyle. Chronic constipation is defined by symptoms that persist for at least three months.
Constipation occurs when the movement of the muscles in the intestine become slowed or halted causing the stool to dry out as the body absorbs water from the stool. This is why the stool are hard and dry.
- Slowed or stopped bowel movements can be caused by a blockage from a bowel obstruction, tears in anus, bowel strictures, colon or rectal cancer and abdominal cancer.
- Constipation that occurs when the muscles in your intestine contract too slowly or not at all may be due to nerves in your intestine that are damaged. Diseases and conditions that can cause nerve damage include MS, Parkinson’s disease, spinal cord injury and stroke.
- Medications that can cause constipation include narcotics, NSAIDS, antidepressants, antacids like Tums, Iron supplements, antihistamines, some blood pressure medications, and some psychiatric medications, anticonvulsants, and antinausea medicines.
- Constipation can occur from problems with the pelvic muscles involved in having a bowel movement.
- Gastrointestinal disorders like irritable bowel syndrome that is problems with how your gut and brain work together. Diverticulitis, a condition where bulges in the colon wall become infected.
- Hormones can also affect the ability to have a bowel movement. Conditions that can alter hormone balance include pregnancy, menopause, diabetes, and hypothyroidism.
Treatment depends upon the cause. Initial therapy involves basic lifestyle and dietary modifications, which may be sufficient to relieve the symptoms of chronic constipation. These include increasing water consumption, increasing the frequency of exercise, and increasing fiber to enhance the water-holding properties of stool and stimulate peristalsis (the involuntary contractions and relaxation of the muscles of the intestines that moves stool out of the body). Laxatives that draw water into the colon are a primary therapy to relieve constipation. They include Milk of Magnesiaâ and MiraLAXâ.
For more severe cases of constipation, there are prescription medications which can help. They include: Lactulose, Lubriprostone (Amitizaâ), Liniclothide (Linzessâ), Plecanatide (Trulanceâ). Medications for constipation caused by opioid pain medications include: Methylnaltrexone (Relistorâ) and Naloxegol (Movantickâ)
If constipation lasts longer than three weeks, bowel movements are painful, or cause bleeding it is important to call Gastroenterology Associates of Brooklyn to get help.