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Constipation mean different things to different people. Hard stools, infrequent stools, excessive straining, sensation of incomplete evacuation, and use of digital maneuvers are examples of what people describe when they talk about constipation. Constipation can be acute or chronic. Acute constipation can occur due to changes in diet, stress, travel or change in daily activities. It can also occur due to blockage in the colon, rectum or anus. Acute constipation does not last long unlike chronic constipation. Chronic constipation can cause psychological stress and poor quality of life.
What is chronic constipation?
The Rome IV diagnostic criteria for functional constipation are :
- Two or more of the following in more than 25% of defecations: straining, lumpy or hard stools (Bristol stool types 1-2), sensation of incomplete evacuation, sensation of blockage in the rectum or anus or manual maneuvers to facilitate defecation.
- Loose stools are rarely present without the use of laxatives.
- Insufficient criteria for the diagnosis of irritable bowel syndrome.
- The criteria should be fulfilled for the last 3 months but symptom should have started at least 6 months before diagnosis.
How common is chronic constipation?
- It affects 20% of the population.
- It affects over 30% of elderly persons.
What are the different manifestations of constipation?
- Lumpy or hard stools (Bristol stool types 1-2).
- Sensation of incomplete evacuation.
- Sensation of blockage in the rectum or anus.
- Manual maneuvers to facilitate defecation such as use of fingers to remove stools or use of hands to support the belly or pelvis.
The Bristol Stool Chart
What are the types of chronic constipation?
- Primary constipation
- Secondary constipation
What causes chronic constipation?
- No apparent cause is found in most cases especially patients with primary constipation.
- Diabetes mellitus.
- Parkinson’s disease.
- Spinal cord injury.
- Colon obstruction from cancer, stricture, or inflammation.
- Medications such as opioids, antipsychotics, anti-hypertensive medications such as amlodipine, and diltiazem.
What tests do I need for chronic constipation?
- You do not need a test for the diagnosis of constipation.
- In the appropriate setting, your physician may do a digital rectal exam, order certain blood tests, Xray, CT scan, MRI, colonoscopy, smart pill motility capsule, and anorectal manometry.
How can I find relieve for chronic constipation?
- Dietary fiber.
- Fiber supplements.
- Non-prescription laxatives like docusate sodium (Colace), bisacodyl (Dulcolax), lactulose, senna, Miralax, magnesium citrate.
- Prescription laxatives like lubiprostone (Amitiza), linaclotide (Linzess), plecanatide (Trulance).
- Prescription medications for opioid-induced constipation like methylnaltrexone (Relistor), naloxegol (Movantik).
- Golytely, a medication used for bowel prep prior to colonoscopy can be used for chronic constipation.
- Biofeedback therapy for dyssynergic defecation. This includes diaphragmatic breathing, pelvic floor retraining and simulated defecation training.
- Surgery. Surgical options in the appropriate patients and always the last resort include colectomy, cecostomy.