Constipation

Constipation

What is constipation?

Constipation is an imprecise term that refers to several different stool problems.  Constipation can be defined as abnormalities in the frequency or consistency of stool.  Constipation can also refer to stool being difficult to pass.  Unfortunately, there is no “correct” definition of “normal” stools.  What is normal to one person in terms of stool quantity, consistency and ease of passage may be highly abnormal for the next person.  In general, when the inability to pass stool satisfactorily exists due to hardness, infrequency, pain or straining, we refer to this as constipation.

The normal role of the gastrointestinal tract is to process the foods we eat, absorb important nutrients, and pass the leftover waste into the colon to be prepared for excretion.  The intestines are packed full of good bacteria to aid in this digestive process.  Once the small intestines have processed foods appropriately, liquid waste is passed down into the large intestine, also known as the colon.  The colon’s main job is to remove water from the waste, ultimately leading to formed waste material, which we call stool or feces.  About half of the feces we pass are made up of the good bacteria from higher in the gastrointestinal tract.  When something goes wrong with the removal of water, amount of good bacteria, or the time it takes to move waste through the colon, constipation can result.

What are the causes of constipation?

The list of medical problems that can cause constipation is extremely long.  Some of the more common causes of constipation include low thyroid activity, diabetes mellitus, pregnancy, irritable bowel syndrome, medications (the most common offenders are narcotic pain medications, psychiatric medications, some blood pressure pills, calcium, and iron), Parkinson’s syndrome, spinal cord disorders, multiple sclerosis, and colonic inertia (“lazy colon”).

Obstruction of the colon can also causes constipation.  Any process that mechanically blocks stool moving through the colon will cause partial or full colon obstructions.  These processes can include colon polyps, cancers, ulcers, inflammatory conditions known as colitis, or infections (such as diverticulitis).

How do I know if I have constipation?

Your Gastroenterologist will help to guide you through the steps necessary to determine why you suffer from constipation.  He or she may recommend colonoscopy, barium enema, flexible sigmoidoscopy, CT scan, laboratory studies, rectal pressure tests known as anorectal manometry, x-rays following ingested radiologic markers known as colonic transit studies, or specialized x-rays of defecation called defecography.

What is the treatment for constipation?

The treatment for constipation is largely dependent on the cause, thus finding out why you are constipated is very important.  Lifestyle changes such as a diet high in fiber, plenty of daily water intake, and regular exercise can significantly improve stool habits.  Constipation due to medical illnesses such as thyroid or diabetes can often be improved by fixing the underlying medical illness.  In other cases, your physician will prescribe laxatives.  Many laxatives exist ranging from dietary fiber, supplemental fiber, over-the-counter remedies such as milk of magnesia or senna, or prescription laxatives like Miralax or lactulose.  Laxatives come in many forms including oral, suppository, and enema.  On an infrequent basis is surgery necessary or appropriate for the treatment of constipation.

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