Constipation

Chronic Constipation

WHAT IS CHRONIC CONSTIPATION?

Chronic constipation is a common problem related to bowel movement difficulty. Bowel movements might be too small, too hard or too infrequent (fewer than three per week).

At Loma Linda University Health, colorectal conditions may be treated by the experienced physicians at our Digestive Disease Center. Chronic constipation is one of the many conditions these providers specialize in.

WHAT ARE THE SYMPTOMS OF CHRONIC CONSTIPATION?

The symptoms of chronic constipation include:

• Hard bowel movements
• Straining to have a bowel movement
• Fewer than three bowel movements per week
• Blood in the stool

WHAT CAUSES CHRONIC CONSTIPATION?

Causes of chronic constipation include:

• Poor diet
• Poor water intake
• Lack of exercise
• Medication side effects  
• Other digestive diseases

Researchers have found no evidence that an elongated colon is a cause of constipation.

HOW IS CHRONIC CONSTIPATION DIAGNOSED?

Chronic constipation is typically diagnosed during a physical exam, which may include a digital rectal exam.

Diagnostic tests to determine the cause of chronic constipation include:

• Blood tests to search for a systemic cause
• Sigmoidoscopy (a flexible, lighted tube is inserted to explore the rectum and lower portion of the colon)
• Colonoscopy (a flexible, camera-equipped tube is inserted to explore the entire colon)
• An evaluation of anal sphincter muscle function, which measures the coordination of the muscles used to move the bowels
• An evaluation of anal sphincter muscle speed (using a water-filled balloon)

At Loma Linda University Health, we may use additional diagnostic tools to determine cause and look for other underlying conditions. These include:

• Cameras that record the progress of radiocarbon-activated food
• X-ray during defecation (with a soft paste inserted into the rectum)
• MRI defecography (with a gel that inserted into the rectum)

HOW IS CHRONIC CONSTIPATION TREATED?

Diet and lifestyle changes can be the best defense against chronic constipation. Treatments to begin at home include:

• Increased water intake - Water will soften stool consistency and make them easier to pass.  Aim for at least 6-8 glasses daily unless otherwise directed by your provider.
• Increase fiber intake - Adding fiber to the diet increases the weight of stools and speeds their passage through the intestines. The recommended amount of dietary fiber is 20-35 grams per day.
• Increase exercise - Exercise increases muscle activity in the intestines.
• Laxatives and stool softeners - Stimulant laxatives cause the intestines to contract, while softeners moisten stools by drawing water from the intestines. Take these at the advice of your healthcare provider.

Do not ignore your body’s signals to have a bowel movement. Otherwise, these signals can become weaker over time.

Lifestyle changes are the first step, but some patients require more intervention. At Loma Linda University Health, other ways of treating chronic constipation include:  

• Enemas and suppositories
• Biofeedback therapy
• Physical therapy
• Pelvic floor retraining
• Injection treatment

For some patients, surgery may be needed. These procedures for chronic constipation may be performed by our Digestive Disease Center surgeons:

• STARR procedure, a minimally invasive surgery that removes excess tissue to help the rectum function more effectively, leaving no visible scars. This is primarily for women who have rectoceles.
• Antegrade colonic enema (ACE), a procedure designed to help empty the bowel of feces by flushing out the colon through a small incision in the abdomen  
• Subtotal colectomy, which removes part of the colon and reconnects the small bowel to the rectum. This can be performed robotically or laparoscopically.

If chronic constipation is left untreated, you could experience these complications:

• Undesired weight loss
• Blood in your stool
• Hemorrhoids

Further, more serious complications of chronic constipation include:

• Rectal prolapse
• Colon cancer

WHO IS AT RISK FOR CHRONIC CONSTIPATION?

Although constipation is a common condition, those who are pregnant, have recently given birth or have had surgery are at higher risk of chronic constipation.

Lifestyle risk factors for chronic constipation include lack of exercise, poor eating habits and poor water intake. Taking certain medications can put you at risk for chronic constipation, as can other diseases of the digestive system.

NEXT STEPS

Seek medical intervention. If you are experiencing chronic constipation, be proactive and request a medical evaluation. To schedule this appointment at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.