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Constipation

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Constipation is a common occurrence. It refers to infrequent bowel movements or the difficulty in passing stools. The frequency of bowel movements can vary from person to person but typically, having fewer than three bowel movements a week, or stools that are hard and dry is considered constipation.

Normal bowel habits are affected by diet. The average American diet includes 12 to 15 grams of fiber per day, although 25 to 30 grams of fiber and about 60 to 80 ounces of fluid daily are recommended for proper bowel function. Exercise is also beneficial to proper function of the colon.

Symptoms

It’s not necessary to have a bowel movement every day. However, if you experience at least two of the following symptoms you may be constipated.

  • Pass fewer than three stools a week
  • Experience hard stools
  • Strain excessively during bowel movements
  • Experience a sense of rectal blockage
  • Have a feeling of incomplete evacuation after having a bowel movement
  • Need to use manual maneuvers to have a bowel movement, such as finger evacuation or manipulation of your lower abdomen

Constipation can disrupt your daily routine, but it’s not usually serious. If you experience chronic constipation, however, it may lead to serious complications or be a sign of another condition.

  • Unexplained onset of constipation
  • Symptoms that are severe and last longer than three weeks
  • Bowel movements occurring more than three days apart, despite corrective changes in diet or exercise
  • Intense abdominal pain
  • Blood in your stool
  • Constipation that alternates with diarrhea
  • Rectal pain
  • Thin, pencil-like stools
  • Unexplained weight loss

Causes and Risk Factors

When you eat or drink something it passes through your digestive tract where your colon absorbs liquids leaving a semisolid stool. However, if you haven’t had enough fluids or eaten foods rich in fiber, or if the muscles in your colon are weak, the stool hardens and dries.

Factors that may lead to constipation include:

  • Inadequate fluid intake or dehydration
  • Inadequate amounts of fiber in your diet
  • Ignoring the urge to have a bowel movement or delaying until later
  • Lack of physical activity (especially in older adults)
  • Irritable bowel syndrome
  • Changes in lifestyle or routine, including pregnancy, aging and travel
  • Illness
  • Frequent use or misuse of laxatives
  • Specific diseases, such as stroke, diabetes, thyroid disease and Parkinson's disease
  • Problems with the colon and rectum, such as intestinal obstruction or diverticulosis
  • Certain medications, including pain medications, diuretics and those used to treat Parkinson's disease, high blood pressure and depression
  • Hormonal disturbances, such as an underactive thyroid gland
  • Anal fissures and hemorrhoids, which can produce a spasm of the anal sphincter muscle
  • Loss of body salts through vomiting or diarrhea
  • Injuries to the spinal cord, which can affect the nerves that lead to and from the intestine

While constipation is typically harmless, sometimes it may signal serious medical conditions, such as colorectal cancer, hormonal disturbances or autoimmune diseases. Constipation may also be associated with scleroderma, or disorders of the nervous or endocrine systems, including thyroid disease, multiple sclerosis, or Parkinson's disease.

Diagnostic Tests

Most cases of diarrhea go away without treatment. See your doctor if diarrhea persists, if you become dehydrated or if you pass blood in your stool or if you have any symptoms that worry you. Your doctor will start with a complete medical history to determine the frequency and duration of your symptoms.

Your doctor may also perform additional tests to aid in diagnosis including:

  • Physical exam
  • Review of your medications including prescription drugs, over-the-counter medications, and herbal supplements
  • Blood tests

Further testing might be done if your symptoms are severe or if your primary exam shows evidence of other problems.

  • Barium enema X-ray to see the interior of the colon
  • Defecography to evaluate the completeness of stool elimination and rectal muscle contractions
  • Sigmoidoscopy to visually inspect the rectum and lower sigmoid
  • Colonoscopy to examine the entire colon
  • Anorectal manometry to evaluate anal sphincter muscle function

Treatment and Procedures

In most cases, constipation is temporary. Often lifestyle changes can treat constipation and help prevent most recurrences.

Your doctor might recommend the following diet and lifestyle changes:

  • A high-fiber diet
  • Limit foods that have little to no fiber, such as cheese, meat and processed foods
  • Regular exercise
  • Adequate fluid intake
  • Take the time for bowel movements and don't ignore the urge to have a bowel movement
  • Over-the-counter laxatives
  • Prescription medications

If lifestyle changes, over-the-counter or prescription medications don't improve your symptoms, your doctor might recommend additional procedures.

Biofeedback to help you learn to better coordinate the muscles you use to have a bowel movement.

Surgery can help relieve chronic, severe constipation when other treatments haven't helped. A portion of the colon along with the problem segment or segments of the anal sphincter or rectum is removed.

Your health is our greatest concern. Please contact the Center for Colon & Rectal Surgery at 407.303.2615for a private consultation today.