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What is Chronic Constipation?
Constipation is a very common condition that involves going to the toilet less often to empty your bowels or passing hard or painful stools (poo). Many people experience constipation for a short time, over days or weeks but it can become a long-term (chronic) condition.
Chronic constipation may be mild to severe. It is typically diagnosed if you have had 2 or more of the symptoms below for at least 3 months or more:
- Straining to empty your bowels
- Hard or lumpy stools (poo)
- Needing a longer time to empty your bowels
- A feeling of incomplete bowel evacuation
- Abdominal pain (tummy ache)
- Abdominal bloating
- Having to press your abdomen and/or use a finger to remove poo from your bottom
Constipation can often be treated at home, but chronic constipation that reduces your quality of life requires a visit to a specialist.
Causes of Chronic Constipation
Several factors can cause chronic constipation. Common causes include.
- Not eating enough fibre, such as fruit, vegetables and cereals
- Ignoring the urge to pass stools
- Lack of exercise
- Not drinking enough fluids
- Being under or overweight
- Use of certain medicines or supplements
- Muscle or structural abnormalities
- Changes to your daily routine
- Anxiety or depression
For people of all ages, chronic constipation may be a side effect of certain medication that they are taking. These treatments can include medicines for pain, high blood pressure, depression or epilepsy.
Calcium supplements, iron supplements and even laxatives may also increase the chances of severe constipation symptoms. Using other types of medicines may help to relieve the symptoms of the condition but you should never stop taking any medicines without speaking to your doctor first.
In rare cases, chronic constipation can be a sign of a more serious medical condition. In adults, these can include:
- Colon or rectal cancer
- Inflammatory bowel disease (IBD)
- Irritable bowel syndrome (IBS)
- Parkinson’s disease
- Underactive thyroid
- Muscular dystrophy
- Multiple sclerosis
- Spinal cord injury
It is important to see a gastroenterologist or qualified healthcare professional to rule out any serious medical causes.
Around one third of chronic constipation cases are caused by dyssynergic defecation. This healthcare condition is also called pelvic floor dysfunction or anismus.
Dyssynergic defecation is thought to be caused when the muscles and nerves within the pelvic floor are not functioning normally. Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis.
Symptoms of Chronic Constipation
Signs and symptoms of chronic constipation include:
- Passing fewer than three stools a week
- Lumpy or hard stools
- Feeling as though there’s a blockage in your rectum
- Feeling as though you can’t completely empty the stool from your rectum
- Needing help to empty your rectum, using your hands or a finger to remove stool from your rectum
Diagnosis of Chronic Constipation
To confirm a diagnosis of severe constipation, your doctor will start by asking you about your medical history and your symptoms. In some cases, no tests or procedures are needed. In other cases, these chronic constipation tests and procedures may include:
- A physical examination of the bottom (rectum)
- Blood tests
- Colonoscopy: an examination of the entire colon
- Flexible sigmoidoscopy: an examination of the bottom and lower colon
- Anorectal manometry: to measure how well the muscles and nerves in and around the bottom (rectum function)
- Balloon expulsion test: to measure the anal sphincter muscle speed
- Ano-rectal motility studies: to assess the function of the muscles and nerves of the bottom
- Colonic transit study: to measure how well food moves through the colon
- Defecography: a X-ray of the bottom (rectum) during a bowel movement
- MRI defecography: a test to assess the function of the defecation muscle during a bowel movement
The new Digestive Health Centre at OneWelbeck in London can provide you with fast, high-quality-services to investigate severe constipation symptoms. OneWelbeck provides private gastroscopy procedures, which are day procedures, without the need for overnight stay.
Treatment of Chronic Constipation
Once your specialist has diagnosed chronic constipation and the causes of your condition, they will usually start treatment by recommending changes to your diet and lifestyle changes. If those changes don’t help, they may recommend the use of medicines or surgery.
Diet and Lifestyle Changes
Making changes to your diet and lifestyle may include:
- Increasing the fibre in your diet (eat more fresh fruits and vegetables,-whole grain breads and cereals each day)
- Exercising most days of the week
- Don’t ignore the urge to poo
- Drinking plenty of fluids
- Avoiding alcohol
- Keeping to a regular toilet routine, time and place
- Resting your feet on a low stool while going to the toilet
- Reducing stress: try mindfulness meditation
- Trying abdominal massage to move poo through the bowels
Laxatives & Supplements
If diet and lifestyle do not relieve your condition, your GI specialist may prescribe one of the medicines below, or a combination of these treatments:
- Bulking agents: (fibre supplements) These help to soak up the water in the colon making stools softer and heavier, helping them to pass through the bowel more easily.
- Osmotic laxatives: These medicines work by increasing the amount of fluid in the colon. Osmotic laxatives include lactulose, macrogols, sodium citrate enema and phosphate enema.
- Stimulants: These stimulate the nerves in your bowel to move your stools out more quickly. Stimulant laxatives include senna and glycerol or bisacodyl.
- Faecal softener laxatives: (stool softeners) They work by softening poo to make it easier to pass through the bowel. Docusate is the main type of faecal softener.
- Lubricant laxatives: These coat the surface of the stool (poo) and intestinal lining to keep in moisture, making the stools softer and easier to pass through the colon. These laxatives include liquid paraffin and arachis oil.
If your severe constipation is caused by irritable bowel syndrome (IBS) or chronic idiopathic constipation (where the cause is unknown), your specialist may prescribe various prescription medicines .
It is important that you speak to your specialist doctor before you start taking any over-the-counter medicines or laxatives. They should be taken carefully and only for short periods of time.
If oral laxatives and supplements do not work, your specialist may suggest treatments, such as a suppository or a mini enema to move stools (poo) through the bottom (rectum).
Biofeedback training exercises are non-surgical, non-invasive therapy options that have been shown to reduce symptoms and causes of some bowel problems, such as constipation, incontinence, dyssynergic defecation and irritable bowel syndrome (IBS).
Biofeedback training involves working with a specialist doctor, nurse or physiotherapist. They can use various devices to help you learn to relax and tighten the muscles in your pelvis to help you pass your stools (poo) more easily. Speak to your specialist to see what they recommend.
Frequently Asked Questions
What is acute constipation?
Constipation is classified as acute constipation if it starts suddenly and lasts for a few days, unlike chronic constipation which can last for weeks or months.
Acute constipation can be more dangerous, especially if it is associated with sudden pain, vomiting, nausea (feeling sick), bleeding and unexplained weight loss. If you think you have acute constipation, then see a qualified specialist for immediate treatment.
How often do I need to see my doctor?
This will depend your individual needs and your specialist doctor’s advice. To begin with, you may need to see them more often until your chronic constipation is diagnosed and well managed with the right course of treatment.
Once your condition is controlled, you may not see your specialist as often but at OneWelbeck you will still have follow-up appointments to manage your condition over the long-term.
All our private digestive health specialists at OneWelbeck in London are leaders in their field. They are equipped with the latest medical technology, so they can provide the highest quality treatment at custom-built facilities to ensure you receive the best available care.
Specialists at OneWelbeck
To ask a question about our procedures at OneWelbeck or to book an appointment, contact our team today.
We are available from Monday to Friday: 8am – 8pm.