Constipation Causes & Treatment Options

Most people have experienced constipation. Commonly, constipation is uncomfortable yet short-lived. However, some people experience ongoing or chronic constipation which may be a sign of something more serious.

Let's talk about the causes of constipation and when you should seek medical attention.

Defining Constipation and Its Symptoms

Constipation is defined as “a disordered movement of the stool.” This can manifest in many ways, including:

• Fewer than three bowel movements per week
• Lumpy or hard stools
• A feeling of incomplete evacuation or obstruction
• Straining during evacuation more than twenty-five percent of the time
• Using manual manipulation to complete evacuation

Chronic constipation occurs when these symptoms occur for three out of six months. About 15% of the population experiences chronic constipation.

Possible Causes of Constipation

Improper diet is the most common cause of constipation, mainly associated with water and fiber intake. The average person requires 20-35 grams of fiber and 64 ounces of water per day to have normal bowel function. Many people (particularly younger people) consume less than the minimum. If you are constipated, eating more fiber and drinking more water is a common and often effective solution.

Most constipation is idiopathic, meaning it can arise spontaneously from unknown causes. There are three basic types of idiopathic constipation:

• Irritable Bowel Syndrome (IBS) characterized by altered bowel movements and increased pain during defecation. IBS is more common in women than men.
• Dyssynergic defecation, a condition where the nerves and muscles of the pelvic floor do not work as they should.
• Slow transit, or the unusually slow passage of waste through the intestines.

Some common causes of constipation include:

• Obstructive lesions, such as colon cancer, colon polyps or other blockage.
• Medical issues such as diabetes, hypothyroidism, anorexia nervosa, multiple sclerosis, or spinal cord injuries
• Side-effects from medications such as narcotics, antihistamines, antidepressants, iron or calcium supplements and medications containing aluminum
• Decreased physical activity
• Age (constipation tends to increase in patients over 65)

4 Treatments To Try Before Consulting a Doctor

Before consulting a medical professional, there are at-home treatments that may help with constipation:

1. Adding high-fiber foods to your diet and drinking more water.
2. Increasing your physical activity level.
3. Adding over-the-counter fiber supplements to your diet.
4. Taking over-the-counter laxatives, such as Miralax. (Please note: If you find yourself requiring regular use of over-the-counter laxatives to achieve bowel movements, consult a physician.)

When To Seek Medical Treatment for Constipation

If you have tried the solutions above and see no positive results within 2-4 weeks — or if you have experienced constipation for three of the last six months — talk to your doctor. Certain symptoms may be a sign of more serious conditions. If you experience any of these “alarm symptoms,” you should seek medical attention.

• Blood in stool or pencil-thin stool.
• Sudden weight loss of 10 pounds or more without any weight loss effort.
• Chronic constipation combined with a family history of colon cancer or bowel disease
• Anemia or iron deficiency
• Severe abdominal pain, particularly when eating

Further Constipation Treatment Options

Because there are many kinds of constipation, medical treatment will vary. Your doctor will start by identifying the underlying cause of the constipation. A physical examination, your medical history, and blood work (to identify conditions like diabetes or thyroid disease) will all help identify the root of the problem.

Your doctor may begin by adding fiber supplements (like Metamucil or Benefiber) to your diet. Stronger laxatives may be prescribed if required. If that proves ineffective, or if there are the “alarm symptoms” as mentioned above, a colonoscopy may be required. Additional treatment options your doctor may prescribe include:

• An osmotic laxative such as miralax and lactulose are poorly absorbed or nonabsorbable sugars that increase stool frequency.
• A stimulative laxative (for slow transit or IBS) that stimulates intestinal motor activity.
• Medications, such as Linzess, a minimally absorbed peptide and Amitiza, a locally active chloride channel activator, which can soften stool and decrease straining.
• Biofeedback (for dyssynergic defecation) to retrain the muscles to work properly.
• In some cases of severe constipation, surgery can be considered.

If you have concerns about constipation, please contact us to make an appointment to see a physician at Richmond Gastroenterology Associates.