What is constipation?
Constipation is a change in bowel habits. It varies from person to person and there are many definitions of constipation. However, most doctors’ societies agree that constipation involves two key aspects. 1) Decreased stool frequency: Passing fewer than three bowel movements per week. 2) Difficulty passing stools: Stools are too hard or too small, difficult to evacuate, involve straining, etc.
How is constipation diagnosed?
Constipation is usually diagnosed based on your symptoms and a physical examination.Your doctor may perform a digital rectal examination (DRE) as part of your physical examination. During a DRE, a doctor inserts a gloved finger inside your anus and rectum to feel for any lumps or abnormalities. A DRE may also be used to check for blood in the stool.
Many doctors use the symptoms included in the Rome III criteria to diagnose chronic constipation. Acute constipation has symptoms lasting less than 3 months. Chronic constipation, according to the Rome III criteria, has symptoms that start more than six months prior to the day of diagnosis with the following criteria fulfilled for the past 3 months:
The patient doesn’t meet criteria for the diagnosis of irritable bowel syndrome, rarely (almost never) has loose stools without the use of laxatives, and meets two or more of the following criteria:
- Fewer than three bowel movements per week.
- Hard or lumpy stools more than 25% of the time
- Straining with defecation more than 25% of the time.
- Sensation of incomplete evacuation more than 25% of the time
- Sensation of anal or rectal obstruction more than 25%of the time
- Manual maneuvers necessary to facilitate defecation more than 25% of the time.
When may further testing be considered?
If the patient has a family history of colon and rectal cancer, bright red blood in stools, dark tarry stools, weight loss, night-time symptoms, or any other concerning symptoms, the doctor may get blood tests, imaging, colonoscopy or other tests.
What causes constipation?
Common causes of constipation include:
-Low fiber diet: Not eating enough fiber in your diet. The average American diet doesn’t have enough fiber in it. You need to eat 20 to 35 grams of fiber per day.
-Weight loss diets: Some weight loss diets are low in fiber and can cause constipation. This is especially true when you start eating smaller portions.
-Low water intake (Dehydration): Not drinking enough water. If you are eating enough fiber and drinking enough water, your stools will usually be soft and firm.
-Sedentary lifestyle
-Medications: E.g. narcotics, blood pressure pills, and some psychiatric medications. You should tell your doctor about any medications you are taking.
-Medical conditions: E.g. hypothyroidism, irritable bowel syndrome, diabetes, scleroderma, lupus, depression.
-Pregnancy: Many women find that they get constipated when they are pregnant.
-Cancer: Colon or rectal cancer, as well as anal cancer can cause constipation. This is rare in people younger than 50 who don’t have a family history of colon cancer. When you turn 50, make sure to get your colonoscopy to screen for colon and rectal cancer. If you have a family history or other concerns, tell your doctor.
-Other rare causes: Stricture or narrowing of the colon or anus (e.g. from Crohn’s disease, radiation or ischemia). Also rarely from anatomic causes such as intussusception, enterocele, sigmoidocele, and rectocele.
How is constipation treated?
Constipation can be treated with dietary changes, behavioral changes, and when needed stool softeners and laxatives.
Related article: How to treat constipation without using medications.
A) Dietary changes
1) High-fiber diet: Eat more high-fiber foods like whole grains, fruits, and vegetables to increase the bulk of the stool. The recommended dietary fiber intake is between 20 and 35 grams per day.
2) Drink lots of water: Drink at least 2 Liters or 67 ounces per day. That is eight 8-oz glasses of water.
3) Fiber supplements: If you are is still passing hard stools after dietary fiber and increased water intake, take either psyllium husk (Metamucil), or methylcellulose (Citrucel), or wheat dextrin (Benefiber), or calcium polycarbophil (Fibercon). Take as directed.
4) Prunes and prune juice: Prunes are helpful for treating constipation.
B) Behavioral changes
1) Schedule toilet times right after meals to take advantage of the gastrocolic reflex.
2) If you feel like you need to have a BM, you should go right away and not hold back.
3) Use Squatty Potty or place your feet on a small step stool instead of on the floor to straighten the anorectal junction.
C) Stool softeners and laxatives
-If you’re still constipated, try a stool softener daily.
-If all of the above doesn’t work, try an over-the-counter laxative like polyethylene glycol (Miralax).