Constipation: Symptoms, Causes and Treatments

Constipation: Symptoms, Causes and Treatments
  • Being constipated is not something to be overlooked as it has the potential to cause more serious, life-threatening disorders like colon cancer.
  • If using a western style toilet, a small stool should be used to prop up both feet as this will help mimic the crouching position that can help open up the colon, making bowel movements easier and reducing build-up of fecal matter in the colon.
  • Darkened or reddened stools could be a sign of digestive system bleeding, so medical attention should be sought to diagnose and treat such symptoms.

What are the symptoms of constipation?

Constipation is a common disorder that affects approximately 10% of the population, while women are twice as likely to suffer from the condition as their male counterparts. Its symptoms can differ depending on the individual, with some common symptoms as follows: difficulties passing stools without excessive straining, hardened stools, taking a long time to empty the bowels, and wider digestive issues including stomach pain and gas.

What constitutes constipation?

Constipation refers to irregularities affecting bowel movements. Normal bowel movements occur 1-3 times a day or at least every 2-3 days in healthy individuals, and are not associated with stomach pain, stomach discomfort, or gas. Indeed, the stools passed through normal bowel movements are generally quite soft, and neither too hard nor too fluid. Healthy stools are also dark yellow or pale yellow depending on the person’s diet. Therefore, reddened stools can be a signal that digestive bleeding is taking place. Moreover, stools causing an oily residue to form in the water may be a signal of pancreas or bladder issues.

Causes of Constipation

There are three main causes of constipation, as follows:

  1. An unhealthy lifestyle and diet, which is a particular risk among those who do not eat enough fruit and vegetables, and also neglect to drink enough water each day. However, not exercising regularly can also be a cause of constipation.
  2. Some medications can lead to constipation, including blood pressure drugs, some painkillers used to treat stomach pain, and cough medicine. Certain supplements can also have this effect, such as calcium, iron, vitamins, and some minerals.
  3. Certain underlying health conditions, such as diabetes and hypothyroidism, as well as some neurological disorders, can also affect a person’s susceptibility to constipation. Additionally, constipation is considered a risk factor for the onset of colon cancer.

Detrimental Effects of Constipation

Patients who suffer from chronic constipation are susceptible to a range of other complications, including hemorrhoids or hardened stools that can cause colon or rectal ulcers, which result in passing blood with stools. Moreover, constipation can signal other physical ailments including an underactive thyroid and, in cases of alternating bouts of constipation and diarrhea or decreased stool size, it could even be a warning sign of colon cancer.

Additionally, studies have shown that issues surrounding bowel movements are capable of severely affecting a person’s mental health, with a great deal of research showing a link between bowel disorders—whether that means greater or fewer bowel movements than normal—and a severe reduction in emotional wellbeing. Indeed, patients suffering with irritable bowel syndrome (IBS), which can cause either constipation or diarrhea, have been found to be more at risk from mental health disorders, such as depression and anxiety, than the general population.

Practical advice for steering clear of constipation

  • A diet high in fiber, including fruit and vegetables, proper hydration by drinking 1.5-2 liters of water each day, and exercising for at least 30 minutes 5 times a week will aid colon function.
  • Train yourself to visit the bathroom regularly and be sure to never hold in a bowel movement.
  • Avoid doing anything else while using the toilet, including playing on a mobile phone or reading a book because lengthening the amount of time spent on the toilet is suspected of being a key cause for the onset of constipation. Bowel movements should not take longer than a minute to complete, so if you are in the habit of spending long periods on the toilet you are advised to seek medical advice to check whether you are at risk of developing constipation.
  • Train yourself how to use the toilet properly. Homes with western style toilets should have a small stool nearby for placing the feet on during bowel movements as this replicates the crouching position required to help the colon open up, making bowel movements easier and reducing build-up of fecal matter. Furthermore, there are breathing techniques that can also aid bowel movements, with constipation sufferers advised to breathe in deeply before slowly breathing out at the same time as they exert force on the rectum. This will help the fecal matter to move and empty the bowels.

Treating constipation

Constipation can generally be treated with lifestyle adjustments and laxative medication. However, patients also suffering from other symptoms, such as weight loss, passing bloody stools, alternating bouts of diarrhea and constipation, or a lump forming, as well as having certain risk factors, including a family history of colon cancer or constipation that first presents after the age of 50 years, should seek medical attention as it is possible they could be suffering from a more serious condition such as colon cancer.

Treating constipation using lifestyle modifications should involve increasing the intake of fiber, drinking more fluids, exercising regularly, applying bowel retraining techniques, and taking laxative medication.

Nevertheless, patients who have used laxative drugs for a certain period without success are recommended to consult a trained specialist, who will be able to carry out anorectal manometry to assess organ function. Proper function involves the rectum constricting as the muscles in the anus relax. However, this does not occur in some patients, while others experience a tightening of the anus instead, which can lead to difficulties emptying the bowels. Fortunately, this screening is quick and painless.

Unsuccessful Treatment of Constipation and Diagnosis of Dyssynergia

Patients suffering from chronic constipation who have undergone a general diagnosis and have tried the aforementioned treatments without success could be suffering from dyssynergia, which accounts for up to 30% of secondary constipation cases. Many either tense up or do not relax the anus during bowel movements, making it difficult to pass stools. Unfortunately, there are not many hospitals that can diagnose dyssynergia using anorectal manometry. However, when successful diagnosis does take place, patients will be given biofeedback training instead of being prescribed laxatives, which can benefit them in the long-term. 

Anorectal Manometry Testing

Preparations for the test require patients to empty their bowels naturally or through the use of an enema procedure at least 2 hours prior to testing. Patients should lay on their side while waiting for the test to begin as there is no anesthetic required. The test starts with medical staff gently inserting a tube into the patient’s anus and asking the patient to tense and relax that muscle periodically so that analysis of anus and rectum function can take place. If patients are found to have issues with their anorectal function, doctors may prescribe laxative medication alongside biofeedback training, which is 70% effective in treating the condition.

Patients suffering from chronic constipation are advised to seek diagnosis and treatment from medical professionals as this condition could be one of the warning signs for colon cancer.

The Liver and Digestive Institute at Samitivej Hospital, Bangkok uses innovative, state-of-the-art medical equipment necessary to provide speedy, accurate and reliable screening for a complete range of gastrointestinal and liver disorders. Our team of expert gastroenterologist and hepatologist has experience from within Thailand and abroad. The Liver and Digestive Institute, located on the 1st Floor of The Japanese Hospital, Samitivej Sukhumvit Hospital, Thailand.


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