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Constipation

Baylor Scott & White Supportive and Palliative Care

What is Constipation?

Constipation is when your stools are painful or they do not happen often enough; it is the most common gastrointestinal problem. Constipation may occur if you have bowel movements less than 3 times a week, and/or your stool is hard, dry, and in small pieces. Normal bowel movements vary depending on the person; they may happen as often as 3 times a day, or they may happen just 3 times a week.

What Causes Constipation?

Your stool gets hard and dry when your colon​​ absorbs too much water. In most cases, as food moves through your colon, it absorbs water when it makes stool. Muscle movements push the stool toward your rectum, and when the stool gets to the rectum, most of the water has been soaked up. The stool is now solid. If you have constipation, your colon's muscle movements are too slow which causes the stool to move through your colon too slowly. The colon absorbs too much water, and the stool gets very hard and dry. Some of the most common diet and lifestyle causes of constipation include:​

  • Not getting enough exercise
  • Not drinking enough liquids
  • Not eating enough fiber
  • Not taking bowel movements when you need to
  • Changes in your lifestyle, such as travel, pregnancy, and old age

Other causes of constipation are:​

  • Medicines
  • A problem with how your stomach and bowels work such as irritable bowel syndrome
  • Your intestine does not work well
  • Taking too many medicines that help loosen your bowels
  • Metabolic problems such as thyroid disease
  • Intestinal blockage

What are the Symptoms of Constipation?

Although each person's symptoms may vary, symptoms may include:​

  • Difficulty and painful bowel movements
  • Less than 3 bowel movements a week
  • Feeling swollen or bloated
  • Not having much energy
  • Stomach pain
  • Ineffective straining to move your bowels

These symptoms can look like other health problems. Always consult with your physician to be sure.

How is Constipation Diagnosed?

Most people have constipation at one time or another. To see if you have constipation, your physician will do several tests; these tests will depend on how long you have had symptoms and how serious your case is. Your physician will look at your age, if you have any blood in your stool, any changes in your bowel habits and if any weight loss has occurred​ first. Your physician will also ask about your past health. You will be asked to give details about your constipation​; this includes how long you have had symptoms, how often you have bowel movements, and any other information that may be helpful. You will be given a physical exam. You physician may also want to do a digital rectal exam, where a gloved, lubricated finger is gentled put into your rectum. Your physician will check the muscle that closes off the anus with his or her finger. This exam helps tell if the area is soft, blocked, or bloody. It can also check how much and what kind of stool you have and whether your rectum is bigger than normal. Your physician may want to include other tests such as:​

  • Abdominal X-ray
  • Blood work
  • Lower GI series (also called barium enema); this is an X-ray exam of your rectum, the large intestine, and the lower part of your small intestine. You will be given a fluid called barium which coats the organs so that they can be seen on an X-ray. The barium is put into a tube and inserted into your rectum as an enema. An X-ray of your belly will show if you have any narrowed areas, blockages, or other problems.
  • Colonoscopy; this test looks at the full length of your large intestine and can help check for any abnormal growths, tissue that is red or swollen, ulcers, or bleeding. A long, flexible, lighted tube is put into your rectum up into the colon which allows your physician to see the lining of your colon and take out a tissue sample to test it. Any problems found can be treated as well.
  • Sigmoidoscopy; this test allows your physician to check the inside of your large intestine which helps tell what is causing constipation. A short, flexible, lighted tube is put into your intestine through the rectum and blows air into your intestine to make it swell; this makes it easier to see inside.
  • Colorectal transit study; this test shows how long it takes for food to move through y our colon. You will be asked to swallow pills filled with small markers that can be seen on an X-ray; you must also eat a high-fiber diet during the test. X-rays will be taken 3 to 7 days after you have the capsules and will show how the capsules have moved through your colon.
  • Anus and rectum function tests; these tests can tell if you are constipated because your anus or rectum is not working well.

How is Constipation Treated?

Your physician will come up with a care plan for you based on:​

  • Your age, overall health, and past health
  • How serious your case is
  • How well you handle certain medications, treatments, or therapies
  • Your opinion and preferences

In most cases, diet and lifestyle changes can help reduce constipation symptoms; they can also stop it from happening. These changes may include:​

  • Drinking more water and juice
  • Getting regular exercise
  • Giving yourself time to have a bowel movement each day
  • Eat more fiber
  • Taking laxatives; your physician may have you take laxatives to help loosen your bowels if diet and lifestyle changes have not worked
  • Stopping or changing medication
  • Doing biofeedback; this is a way of using the mind to control a body function. It is used for chronic constipation that is cause by problems with the anus or rectum and retains the muscles that control the release of bowel movements.​
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