Common Causes and Concerns About Constipation

Those who suffer from constipation have less frequent bowel movements and stools that are difficult to pass. Sometimes, it occurs because of changes made to a routine or your diet. Each person is different when it comes to the length of time between bowel movements. Some people have more than one a day while others have only a few over a week. However, going more than three days without a bowel movement is too long. After three days, stool will become harder and even more difficult to pass. This is when a diagnosis of constipation is made.

How is constipation diagnosed?

Many people who are affected by constipation try to treat it with lifestyle changes like increasing activity or changing their diets. Some resort to over-the-counter laxatives. Even though laxatives are safe, they should not be used for more than two weeks without talking to a physician. The colon easily becomes dependent on them to function.

When you visit with a GI specialist, they will ask you a lot of questions. They will ask about your family and personal medical history, any underlying conditions, any medications you are taking, and your symptoms. You should visit a doctor about constipation if:

  • Your constipation has lasted longer than three weeks
  • There is blood in your stool
  • You have abdominal pain
  • Having bowel movements is painful
  • There have been sudden changes in your bowel habits

A doctor may perform a physical exam which includes blood tests and a rectal exam. They will check your bloodwork to check your electrolyte levels, thyroid function, and blood count. If you have a severe case, they may recommend other tests including:

  • Marker Study: this test determines how fast food is moving through the colon. You’ll be given small pills to swallow. They contain markers that are visible in an x-ray. They will take several abdominal x-rays to determine who well food moves through your colon and how well your intestinal muscles are working.
  • Anorectal Manometry: this test evaluates the function of your anal sphincter muscle. A small thin tube with a balloon tip is inserted through the anus. The doctor will inflate the balloon which is then slowly pulled back out. The test measures the strength of your anal sphincter muscles and can determine if they are contracting as they should.
  • Barium enema xray:  A barium enema x-ray is an analysis of the colon. You’ll be given a special liquid to drink the night before the test to make sure your bowels are cleaned out. The test involves a barium dye that is inserted into the rectum. The barium will highlight the colon and rectum areas. The physician can then see those areas in an x-ray.
  • Colonoscopy: A colonoscopy is used to examine how the colon is functioning. A tube with a special light and camera is used to examine the colon. To prepare for the test, you will be asked to consume only liquids for one to three days beforehand. The physician may ask you to take an enema or a laxative the evening before to be certain the colon is cleaned out for the exam. You’ll be given a sedative and sometimes pain medication so you will be more comfortable during the testing.

What are the main causes of constipation?

Poor Diet

The colon has the task of absorbing water from the residual foods as they pass through the digestive system. Then, it creates waste. Muscles in the colon then eliminate the waste by propelling it through the rectum. If stool stays in the colon for too long, it gets hard and becomes difficult to pass. A poor diet can often lead to constipation. Your diet needs adequate amounts of water and fiber intake to keep stool soft.

Not Enough Fiber in the Diet

Foods with the most fiber come from plant sources. Fiber can be soluble or insoluble. Soluble fiber dissolves in water. It creates a soft, gel-like material as it moves through the digestive system. Insoluble fiber maintains most of its structure as it passes through your digestive system. Both types of fiber join with stool and soften it while also increasing its weight. This helps it pass through the rectum more easily. When you don’t include enough fiber in your diet, it can lead to constipation.

Underlying Medical Conditions

There are a few medical problems that can bring on constipation such as:

  • Hormonal problems such as an underactive thyroid gland
  • Misuse of laxatives
  • Problems with the rectum or colon including irritable bowel syndrome (IBS), diverticulosis, or an intestinal obstruction
  • Other conditions like stroke, diabetes, or Parkinson’s disease

Other Causes

Some of the other common causes of constipation include:

  • Low-fiber diets
  • Eating a diet high in milk, cheese, or meat
  • Dehydration
  • Travel or changes in your routine
  • Pregnancy
  • Some medications including antacids high in calcium and some pain medications
  • Lack of physical activity
  • Delaying the natural impulse to have a bowel movement

Symptoms of Constipation

Every person can be different when it comes to bowel habits. But if you experience constipation, you may have symptoms like:

  • Not having at least three bowel movements in a week
  • Passing stool that is dry and hard
  • Having to strain during a bowel movement
  • Having pain during bowel movements
  • Feeling full even though you have had a bowel movement
  • Experience a rectal blockage

What to do if You are Constipated

Self-Care Options

Mild to moderate constipation can often be effectively treated at home. You will want to begin by assessing what you eat and drink regularly. Then you can make changes as needed. Some of the ways you can relieve constipation include:

  • Unless your physician has limited your intake of fluids, drink two to four extra glasses of water every day.
  • Drink warm liquids, particularly in the morning.
  • Add more fruits and vegetables to your diet.
  • Try eating bran cereal and prunes.
  • Exercise most days. Activity helps the intestinal muscles be more active too. Aim for around 150 minutes of exercise each week. Try to get about 30 minutes of moderate exercise at least five days a week.
  • Do not ignore it when you feel the urge to have a bowel movement.
  • Keep a food diary to determine foods that tend to constipate you.
  • Add an over-the-counter stool softener to your regimen.
  • Fiber supplements may be added to your diet as needed. Just remember to drink plenty of fluids so the fiber can work more effectively.
  • Taking probiotics may help relieve constipation.

You may want to try an over-the-counter laxative. There are a wide variety of types. The different types of laxatives work in different ways to ease constipation. Talk to your physician or pharmacist about which one might work best for you. Also, ask how long you should take it.

Medications or Supplements

Along with good self-care actions, your doctor will need to review any supplements and medications you take regularly. Sometimes they can cause constipation. If you are taking medications that complicate constipation, your doctor may either change the dosage or switch to another drug or supplement. Do not discontinue taking any medications or supplements without discussing it with your doctor beforehand.

Prescriptions Medications for Constipation

Your GI specialist can write a prescription to help treat constipation. They will be able to choose the best medication that will work for you based on the results of their test and exam. A few common prescription medications used include:

  • Lubiprostone
  • Prucalopride
  • Plecanatide
  • Lactulose
  • Linaclotide

Surgical Procedures

Surgery is not typically used to treat constipation. However, if it is caused by a structural issue in the colon, surgery may be necessary.  Some examples include intestinal obstruction, narrowing of the intestinal structure, an anal fissure, or if part of the rectum collapses into the vagina. These options are not usually discussed until after testing. Surgical options may also be discussed if cancer has been found in the rectum, anus, or colon.

Are there ways to prevent constipation?

You can prevent constipation with some of the same self-care methods discussed previously. Developing these habits can help keep it come becoming a huge problem:

  • Eat a well-balanced diet with plenty of natural fiber. Fruits, vegetables, whole-grain breads and cereals, and legumes are good sources of fiber. Most of the fiber in fruits is found in the skins. Fruits with edible seeds, like strawberries, contain higher amounts of fiber. Bran is an excellent source of fiber and can be added to cereal, bread, soups, and yogurt. You should consume between 18 and 30 grams of fiber daily.
  • Drink at least 64 ounces of water daily. Avoid beverages like milk that can cause constipation for some people. Caffeine can be dehydrating and increase your risk of constipation. You can usually stop drinking these types of products until bowel habits return to normal.
  • Exercise regularly.
  • Talk to your doctor about supplements that can help treat mild constipation like magnesium. (Not everyone can take magnesium.)
  • Move your bowels when you feel the urge to do so – do not wait.
  • Try to develop a bowel movements schedule, especially after a meal.
  • Avoid foods with lower fiber content such as dairy products, meat, and processed foods.

Are some people more at risk for experiencing constipation?

The major risk factors for constipation are not exercising and eating a poor diet. But those who are at greater risk include:

  • People who are 65 or older. Older adults are often less active physically, eat poorer diets, and have different underlying conditions.
  • Those who are confined to beds due to medical conditions or spinal cord injuries often have more difficulty with regular bowel movements.
  • Women and children are more likely to have frequent constipation.
  • During pregnancy, pressure on the intestines and hormonal changes can cause constipation.

Can there be complications?

Some complications do occur if constipation isn’t addressed and treated properly. You can develop hemorrhoids if you strain when trying to have a bowel movement. An unusually hard or large stool often causes tiny tears in the anus. Chronic constipation can lead to a fecal impaction, or stool that is stuck in the intestines. Straining can also cause the intestines to protrude from the anus. Treating constipation early on can help prevent these types of problems.

When should I call the doctor?

Most of the time, constipation is easily treated with changes in the diet and increasing exercise. If you have sudden constipation that is accompanied with abdominal pain or cramping and you are unable to have a bowel movement or pass gas at all, call the doctor right away. Other signs you need medical intervention include:

  • Constipation is a brand new problem for you and making lifestyle changes hasn’t helped.
  • You discover blood in your stool.
  • You are losing weight but not trying to.
  • Bowel movements are accompanied with severe pain.
  • You have constipation that has lasted longer than two weeks.
  • You notice drastic changes in the consistency, size, or shape of your stool.

If you or your loved ones are suffering from constipation, please reach out to a GI specialist who can help. With the proper diagnosis, an effective treatment plan can be developed. 


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