Complications of chronic constipation

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Clinical Significance

The commonest causes of constipation are:

  • Decreased stool weight or bulk, usually from a lack of dietary fiber. Certain fibers, such as bran or psyllium, are hygroscopic, increasing stool water content and weight.
  • Decreased propulsive activity, usually from medication but occasionally from intrinsic muscle disease such as scleroderma, amyloid, and certain neurologic disorders. Medications include those with anticholinergic properties, such as the antidepressants and some antiarrhythmic drugs, the opiates, certain antacids, calcium channel blockers, and laxatives. The latter initially stimulate the musculature of the bowel through irritant properties, but with repeated use induce a hypotonia that responds only to more potent irritants, ultimately resulting in an atonic colon. Laxative “addiction” refers to a situation when defecation occurs only with the use of a laxative.
  • Suppression of the normal defecatory rectal stimulus by voluntarily contracting the external anal sphincter because of inconvenience or painful anal disease, such as a thrombosed hemorrhoid or anal fissure.
  • Depression. Along with a decrease in many bodily functions, such as anorexia and insomnia, the bowel function declines.
  • Decrease in physical activity. Exercise stimulates colonic motility, so the saying “There is no such thing as a constipated runner” generally holds true. Conversely, sudden inactivity, such as an illness forcing bedrest, frequently leads to constipation.
  • Hypothyroidism. Constipation rather than lack of energy may be the presenting symptom.

Constipation may be acute or chronic. An acute change in bowel habits, particularly over the age of 40, is a cause for concern because it may be a symptom of a colonic neoplasm. Appropriate diagnostic studies, including proctosigmoidoscopy or flexible sigmoidoscopy plus an air-contrast barium enema or colonoscopy, should be performed when a concern regarding neoplasm exists. Other acute causes are a sudden decrease in physical activity, change in diet, particularly reducing fiber, medications noted above, and anal pain.

Chronic constipation is more common and often more difficult to remedy. Once organic causes such as hypothyroidism are ruled out, chronic constipation often falls into two categories: the older patient with a well-established laxative habit and the younger patient, often female, who is constipated because of her lifestyle and often is headed toward laxative dependence. Sigmoid spasm often contributes to constipation by interfering with normal colonic motility so that colonic contents are held proximal to the sigmoid, resulting in overdesiccation or scyballous stools.

The documentation of colonic hypomotility is difficult. Recently, the passage of radiopaque markers followed by serial radiographs has been utilized, but these markers probably ate not handled in the same fashion as colonic contents.

Megacolon is an extreme example of constipation, where the colon musculature is hypotonic, allowing huge fecal accumulations. Congenital megacolon, or Hirschsprung’s disease, is due to an aganglionic segment of the colon destroying the normal neurologic defactory reflex. Acquired megacolon is due to factors such as psychosis or senility. A simple but effective method of differentiating congenital from acquired megacolon is the rectal examination. In congenital megacolon, the rectum is empty despite huge accumulations of stool proximally; in psychogenic megacolon, the rectum is lull of stool. The latter often is associated with constant fecal soiling and encopresis (spontaneous defecation at night). Additional, more sophisticated diagnostic studies include biopsy for ganglion cells and rectosphincteric manometry.

Once readily diagnosable conditions (e.g., neoplasm, medication, hypothyroidism) have been excluded, functional and dietary factors must be considered. A common example of chronic constipation is the young woman who perfers an extra half hour of sleep in the morning to eating breakfast and attempting to defecate spontaneously. Indeed, the normal urge to defecate in the morning may be suppressed as a matter of convenience. Her diet is either “junk food” or salad, both surprisingly low in fiber. In contrast to popular opinion, lettuce and similar vegetables are quite low in fiber content (see Table 89.1), so large amounts of salads would be necessary to supply the same fiber content as an ounce or two of All-Bran cereal. She begins to lake laxatives as a matter of expediency, rapidly leading to dependency. The cycle can be broken in several places: by eating a breakfast containing one of the bran cereals, taking time to defecate after breakfast, encouraging increased physical activity, and stopping the laxatives. Enemas and suppositories are lesser evils because they stimulate only the rectosigmoid or rectum, respectively, rather than the entire colon, so that these can be used to retrain the bowel.

Table 89.1

Quantity of Various Foods Needed to Supply 10 Grams of Dietary Fiber.

Fiber therapy has become appropriately popular among patients and physicians because it creates a physiologic stimulus by increasing stool bulk and thereby increasing colonic contractions. Psyllium products and methylcellulose are artificial forms of bran, being similarly hygroscopic.

Lactulose is a disaccharide that is not digested in the intestine, so it enters the colon intact, where it is broken down to one and two carbon fragments by bacterial digestion, creating an osmotic load, similar to the situation that occurs when milk is ingested by a lactose-deficient individual. Lactulose may be useful in stimulating colonic emptying, although patients frequently complain about excess gas. Other than lactulose, there is no nonlaxative colonic stimulant. Metoclopramide stimulates peristalsis in the esophagus, stomach, and small bowel, but not in the colon.

Some surgeons have proposed surgical procedures to correct constipation, ranging from subtotal colectomy to segmental resections. A theory of inappropriate relaxation of the anal musculature has prompted some to recommend anal myectomies. Although in isolated situations this approach might be useful, in many patients where this has been tried, only temporary relief occurs.

What Is Constipation?

Constipation occurs when you have fewer than three bowel movements in a week.

Constipation is a common digestive issue in which bowel movements are infrequent or difficult to pass.

It’s considered a symptom of various health issues, rather than a disease in and of itself.

“Normal” bowel habits differ between people. Some people may pass stool three times a day, while others may only have a bowel movement three times a week.

You’re considered constipated if you have fewer than three bowel movements in a week. After this point, your stool may harden and become difficult or even painful to pass.

While constipated, you may strain to pass stool or feel that you are unable to completely empty your bowels.

Prevalence and Risk Factors

Constipation is one of the most common gastrointestinal (GI) issues in the United States, affecting about 42 million people, or nearly 15 percent of the population, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

In 2004, constipation resulted in 6.3 million outpatient visits and 5.3 million prescriptions, the NIDDK notes.

Although constipation can affect anyone, you’re at highest risk for it if you are:

  • Female
  • Age 65 or older
  • Low-income
  • Of non-European ancestry

You’re also at higher risk for constipation if you’re pregnant, or if you just gave birth or had surgery.

Causes of Constipation

The GI tract, which consists of a series of hollow organs stretching from your mouth to your anus, is responsible for digestion, nutrient absorption, and waste removal.

In your lower GI tract, your large intestine, or bowel — which includes your colon and rectum — absorbs water from your digested food, changing it from a liquid to a solid (stool).

Constipation occurs when digested food spends too much time in your colon.

Your colon absorbs too much water, making your stool hard and dry — and difficult for your rectal muscles to push out of your body.

A wide range of factors can lead to constipation, including:

  • Lack of fiber in the diet
  • Lack of physical activity
  • Low fluid intake
  • Certain medications (such as antidepressants, painkillers, certain antacids and iron supplements, anticonvulsants and antispasmodics, Parkinson’s disease drugs, and calcium channel blockers for high blood pressure and heart disease)
  • Frequently taking laxatives or using enemas
  • Changes in your life or daily routines, such as travelling
  • Poor bowel habits (ignoring the urge to go)
  • GI tract problems or disorders, such as irritable bowel syndrome, tumors or other obstructions, celiac disease, and colon polyps
  • Various medical conditions and diseases, including multiple sclerosis, diabetes, hypothyroidism, Parkinson’s disease, stroke, and nerve damage

Constipation Complications

Constipation is most often acute, meaning that it appears suddenly and lasts for a short time.

But it can also be chronic, or long-lasting — and this type of constipation can have complications.

These potential complications include:

  • Hemorrhoids (swollen, inflamed veins in the rectum or around the anus that may cause rectal pain and bleeding)
  • Anal fissures (small tears in the skin around the anus that are often accompanied by itchiness, pain, and bleeding)
  • Fecal impaction (inability to push stool out because it has hardened and packed in the colon and rectum too tightly)
  • Rectal prolapse (a condition in which part of the rectum sticks out of the anus)

Learn More About Baby Constipation

Learn More About Constipation Symptoms

Learn More About Constipation Treatment

What Is Lazy Bowel Syndrome?

Depending on the cause of your slow bowel movements, your treatments may vary. Here are some solutions you can try to encourage more frequent and easier-to-pass bowel movements.

Dietary changes

Delayed or slower bowel movements can be caused by a lack of fiber in your diet. A diet that emphasizes natural, unprocessed fruit and vegetables can kick-start digestion and help make you more regular unless you have IBS, gastroparesis or other chronic gastrointestinal condition.

Good sources of fiber include:

  • almonds and almond milk
  • prunes, figs, apples, and bananas
  • cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and bok choy
  • flax seeds, sunflower seeds, and pumpkin seeds

Also consider adding two to four extra glasses of water to your daily routine.

Limiting dairy, which can be difficult to digest, and cutting out bleached, processed, and heavily preserved baked goods may also help. Ice cream, potato chips, and frozen meals have little to no fiber and should be avoided.

Cutting back on coffee, which dehydrates the digestive system, could also be a way to balance out your bowel movements.

Additionally, adding over-the-counter fiber supplements that contain psyllium have been shown in clinical studies to make bowel movements more regular.

Natural laxatives

Artificial laxatives can make lazy bowel symptoms worse or even cause the condition. But there are natural laxatives you can try to kick your digestion back into gear.

Adding 3 to 4 cups of green tea to your daily routine may act to improve your digestion.

Using agar wood leaves as a gentle, natural laxative is less likely to cause the side effect of some other chemical laxatives, according to one animal study. Other natural laxatives include chia seeds, leafy greens and castor oil. However, all laxatives may eventually train your gut to depend on them to get things moving so when possible, even if they are natural, use laxatives infrequently.

Probiotics

Taking probiotic supplements has been shown to improve the transit time and regularity of bowel movements. Currently, more research is still needed to determine what the best strain of probiotics is for constipation treatment.

Eating probiotic foods, such as kimchi, sauerkraut, and yogurt, is another way to consume live strains of probiotic bacteria.

Exercise

Light exercise can direct your blood to circulate through your abdomen. For some people, this gets the system going. Consistent exercise may impact your lazy bowel symptoms by keeping your digestive system turned “on” and engaged. Some yoga poses may even help relieve constipation.

Adjust bathroom behaviors

There are products on the market claiming that changing your posture during a bowel movement can improve the consistency and ease of using the bathroom. Anecdotally, this seems to work for some people.

If you’ve experienced lazy bowel symptoms, it might be worth it to check out one of these products, which change the angle of your legs to more of a “squat” than a seated position during trips to the toilet. Here’s our take on whether the Squatty Potty really works.

Summit Medical Group Web Site

What is fecal incontinence?

Fecal incontinence is trouble keeping control of your bowel movements. It means that you have bowel movements that you cannot stop from coming out.

Having an urgent need for a bowel movement but having enough control to get to a toilet in time and avoid bowel accidents is not incontinence. However, it may mean that you have a bowel problem.

How does it occur?

Loss of bowel control can happen to anyone. The loss of control may be a one-time accident. Or it may happen several times in a short period of time. In some cases it is an ongoing problem that cannot be cured.

Bowel accidents can happen because you don’t feel the warning urges, and the movement just happens. This type of incontinence can happen if you have had a stroke, a paralyzing accident, or illness. It may result from being confused or having dementia. It can also happen because the bowel is irritated.

Loss of bowel control can happen if you have:

  • Inflammatory bowel disease, like Crohn’s disease or ulcerative colitis
  • An injury in the rectal area
  • Irritation or infection of the rectum, anus, or the area around the anus
  • Radiation therapy to the rectal area
  • Spinal cord injury
  • A brain condition such as head injury, stroke, or coma
  • Alzheimer’s disease or another type of dementia
  • Weakening of the muscles and ligaments that control your bowels as you get older,

Bowel accidents that happen despite your efforts to stop them are called urge incontinence. Bowel habit problems or diseases that irritate the bowel and cause diarrhea are common causes of urge incontinence.

Sometimes constipation causes incontinence. The bowel movements (stool) get dry and hard and difficult to pass. As a result, the muscles of the rectum and intestines stretch and weaken. The weakened muscles may then allow some stool to leak out. Lack of activity and not getting enough fiber in the diet make constipation worse.

Medicines can cause incontinence. They may make it harder for you to know when your rectum is full. As a result, you may have a delayed and sudden need for a bowel movement. Some medicines also can cause severe constipation, leading to irritation and overflow incontinence. For example, some narcotic pain killers have a strong constipating effect and often are overlooked as something that may be causing fecal incontinence.

What are the symptoms?

The main symptom is having a complete or partial bowel movement when you don’t want one. You then have to clean up your clothes. If it happens often, you may need to wear protective underwear (usually called incontinence briefs).

If you have weak anal control, you may leak bowel material. If you are paralyzed, you may not know about your bowel accidents because you have no feeling in that area.

If you have more irritation than weakness, you may have urgency that gets too strong for your control.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you.

You may have some tests. For example:

  • Your provider will probably test sensation around your anus. You may have a rectal exam that allows your provider to use his or her finger to feel for lumps, scars, or enlarged glands pressing into the rectum. The exam can also help your provider learn how strong your rectal and anal muscles are.
  • Your provider may check spinal cord and nerve functions in your back, groin, and legs. Fecal incontinence can be a sign of spinal nerve problems.
  • You may have a test called anal manometry to check the pressure your anal and rectal muscles can produce.
  • A nerve conduction study or an electromyogram can check the nerves directly. For these tests, very thin needles are put into various muscles or alongside certain nerves in your buttocks area.

All this helps your healthcare provider find if the problem is a nerve, muscle, or coordination problem.

How is it treated?

Treatment depends on the cause.

If constipation is the cause, or if constipation is making bowel movements more irritating, the treatment may include:

  • Stool softeners
  • Laxatives
  • More fiber and liquid in the diet
  • Increased physical activity
  • Regularly going to the toilet to try to have a bowel movement (scheduled toileting)
  • Trying certain medicines to see if they help

In rare cases, surgery may be needed. It may be done to:

  • Repair the muscle at the opening of the rectum.
  • Remove a problem area of the bowel (colon resection).
  • Attach part of the colon to an opening in the wall of the abdomen (a colostomy). Bowel movements then pass through this opening instead of the rectum. They are collected in a bag outside the body.

When damage to the brain or spinal cord causes fecal incontinence, planning a schedule for regular bowel movements and wearing incontinence pads or briefs are the main treatments. Suppositories often are needed to help empty the bowel on a schedule.

How can I help take care of myself and prevent accidents?

  • You can wear protective pads inside your clothing.
  • Clean the rectal area after each bowel movement to protect the skin.
  • Strengthen your pelvic floor muscles by doing Kegel exercises.
  • Try sitting on the toilet at certain times every day. Having a routine helps your brain and body learn when to have a bowel movement. Also, having a more empty bowel lessens the extent of problems if you have incontinence later in the day. For people with dementia, scheduled toileting is managed by family caregivers or nursing staff.

Constipation

Treatment for constipation depends on the cause, how long you’ve had it and how severe your symptoms are.

In many cases, it’s possible to relieve the symptoms by making dietary and lifestyle changes.

The various treatments for constipation are outlined below.

Lifestyle advice

Changes to diet and lifestyle are often recommended as the first treatment for constipation. In many cases, this will improve the condition without the need for medication.

Some self-help methods of treating constipation are listed below:

  • Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include plenty of fresh fruit and vegetables and cereals.
  • Add some bulking agents, such as wheat bran, to your diet. This will help to make your stools softer and easier to pass.
  • Avoid dehydration by drinking plenty of water.
  • Exercise more regularly – for example, by going for a daily walk or run.
  • If constipation is causing pain or discomfort, you may want to take a painkiller, such as paracetamol. Always follow the dosage instructions carefully. Children under 16 shouldn’t take aspirin.
  • Keep to a routine (a place and time of day) when you’re able to spend time on the toilet. Respond to your bowel’s natural pattern: when you feel the urge, don’t delay.
  • Try resting your feet on a low stool while going to the toilet, so that your knees are above your hips; this can make passing stools easier.
  • If medication you’re taking could be causing constipation, your GP may be able to prescribe an alternative.

Read about preventing constipation for more ways to change your diet and lifestyle.

Your GP may prescribe an oral laxative if diet and lifestyle changes don’t help.

Laxatives

Laxatives are a type of medicine that help you pass stools. There are several different types of laxative and each one has a different effect on your digestive system.

Bulk-forming laxatives

Your GP will usually start you on a bulk-forming laxative. These work by helping your stools to retain fluid. This means they’re less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools softer, which means they should be easier to pass.

Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids, and don’t take them before going to bed. It will usually be 2 to 3 days before you feel the effects of a bulk-forming laxative.

Osmotic laxatives

If your stools remain hard after you’ve taken a bulk-forming laxative, your GP may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This softens your stools and stimulates your body to pass them.

Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be 2 to 3 days before you feel the effect of the laxative.

Stimulant laxatives

If your stools are soft, but you still have difficulty passing them, your GP may prescribe a stimulant laxative. This type of laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.

The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they start to work within 6 to 12 hours.

According to your individual preference and how quickly you need relief, your GP may decide to combine different laxatives.

How long will I need to take laxatives for?

If you’ve had constipation for a short time, your GP will usually advise you to stop taking the laxative once your stools are soft and easily passed.

However, if your constipation is caused by an underlying medical condition or a medicine you’re taking, you may have to take laxatives for much longer, possibly many months or even years.

If you’ve been taking laxatives for some time, you may have to gradually reduce your dose, rather than coming off them straight away. If you have been prescribed a combination of laxatives, you’ll normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.

Your GP will advise you about when it’s best to stop taking laxatives.

Treating faecal impaction

Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.

Sometimes as a result of impaction, overflow diarrhoea may occur (where loose stools leak around the obstruction). You may have difficulty controlling this.

If you have faecal impaction, you’ll initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using macrogol, you may also have to start taking a stimulant laxative.

If you don’t respond to these laxatives, and/or if you have overflow diarrhoea, you may need one of the medications described below.

  • Suppository – this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form.
  • Mini enema – where a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.

Pregnancy or breastfeeding

If you’re pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your GP will first advise you to change your diet by increasing fibre and fluid intake. You’ll also be advised to do gentle exercise.

If dietary and lifestyle changes don’t work, you may be prescribed a laxative to help you pass stools more regularly.

Lots of laxatives are safe for pregnant women to use because most aren’t absorbed by the digestive system. This means that your baby won’t feel the effects of the laxative.

Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these don’t work, your GP may recommend taking a small dose of bisacodyl or senna (stimulant laxatives).

However, senna may not be suitable if you’re in your third trimester of pregnancy, because it’s partially absorbed by your digestive system.

Read more about constipation and other common pregnancy problems.

Babies who haven’t been weaned

If your baby is constipated but hasn’t started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you’re using formula milk, make the formula as directed by the manufacturer and don’t dilute the mixture.

You may want to try gently moving your baby’s legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels.

Babies who are eating solids

If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be puréed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:

  • apples
  • apricots
  • grapes
  • peaches
  • pears
  • plums
  • prunes
  • raspberries
  • strawberries

Never force your baby to eat food if they don’t want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.

If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives aren’t suitable for babies, so they’ll usually be given an osmotic laxative. However, if this doesn’t work, they can be prescribed a stimulant laxative.

Children

For children, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary.

As well as eating fruit, older children should have a healthy, balanced diet, which also contains vegetables and wholegrain foods, such as wholemeal bread and pasta.

Try to minimise stress or conflict associated with meal times or using the toilet. It’s important to be positive and encouraging when it comes to establishing a toilet routine. Allow your child at least 10 minutes on the toilet, to make sure they’ve passed as many stools as possible.

To encourage a positive toilet routine, try making a diary of your child’s bowel movements linked to a reward system. This can help them focus on using the toilet successfully.

Constipation

What is constipation?

Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week. However, normal stool elimination may consist of having a bowel movement three times a day or three times a week; it depends on the person.

About 4 million people in the United States have frequent constipation. Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually.

What causes constipation?

Hard, dry stools are the result of the colon absorbing too much water. Normally, as food moves through the colon (also known as the large intestine) the colon absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.

When the colon’s muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. Some of the most common causes of constipation include the following:

  • Medications

  • Lack of exercise

  • Not enough liquids

  • Not enough fiber in the diet

  • Irritable bowel syndrome

  • Ignoring the urge to have a bowel movement

  • Changes in habits or lifestyle, such as travel, pregnancy, and old age

  • Problems with intestinal function

  • Abuse of laxatives

What are the symptoms of constipation?

The following are the most common symptoms of constipation. However, each individual may experience symptoms differently. Symptoms may include:

  • Difficult and painful bowel movements

  • Bowel movements fewer than three times a week

  • Feeling bloated or uncomfortable

  • Feeling sluggish

  • Abdominal pain

The symptoms of constipation may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is constipation diagnosed?

The tests performed by a doctor will depend on the duration and severity of the constipation, since most persons experience constipation at one time or another. The doctor will also take into account the patient’s age, and whether there is blood in the stool, recent changes in bowel habits, or weight loss.

Diagnosing constipation may include:

  • Medical history. The doctor will ask for a description of the constipation, including duration of symptoms, frequency of bowel movements, and other information to help determine the cause of the constipation.

  • Physical examination. A physical examination may also include a digital rectal examination (DRE), in which the doctor inserts a gloved, lubricated finger into the rectum to evaluate the tone of the muscle that closes off the anus. This examination also helps detect tenderness, obstruction, blood, amount and caliber of stool, and if enlargement of the rectum is present.

Other diagnostic tests may include:

  • Abdominal X-ray

  • Lower GI (gastrointestinal) series (also called barium enema). A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

  • Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

  • Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

  • Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers which are visible on X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed.

  • Anorectal function tests. These tests diagnose constipation caused by an abnormal functioning of the anus or rectum.

Treatment for constipation

Specific treatment for constipation will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of this condition

  • Your opinion or preference

Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms and help prevent the condition. Treatment may include:

  • Diet modifications. A diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. While adding foods such as beans, whole grains, bran cereals, fresh fruits and vegetables is helpful in adding fiber to the diet. Limiting foods such as ice cream, cheeses, meats, and processed foods, which contain little or no fiber can also be helpful.

  • Laxatives. Laxatives may be prescribed after diet and lifestyle changes have failed to be effective.

  • Eliminating or changing medication

  • Biofeedback. Biofeedback is used to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control release of bowel movements.

Lifestyle changes, such as increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements can be helpful.

What are good fiber sources?

Foods

Moderate fiber

High fiber

Bread

Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn

Cereal

Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Muslix, granola, oat bran

All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran

Vegetables

Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado

Fruits

Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins

Cooked prunes, dried figs

Meat substitutes

Peanut butter , nuts

Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

What are complications of constipation?

Constipation can cause complications, such as hemorrhoids, which occur by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding.

Sometimes, straining also causes rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening. Constipation may also cause fecal impaction, which occurs mostly in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.

Babies and toddlers: treating constipation

Simple changes to your child’s diet and potty training can help treat constipation.

You may notice a difference within a few days.

Sometimes it takes a few weeks before their symptoms improve.

Make changes to your child’s diet

If your baby is formula-fed, you can offer them extra drinks of water between feeds.

Do not add more water to formula feeds.

Breastfed babies rarely get constipated. They do not need anything but breast milk for the first 6 months.

Try gently moving your baby’s legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels.

Give older children plenty of fluids and encourage them to eat fruit.

Chop or purée it if it’s easier for them to eat. The best fruits for constipation include apples, grapes, pears and strawberries.

Do not force your child to eat as this can make mealtimes stressful.

Find out what to feed young children.

Helping your child with potty training

Some children feel anxious or stressed about using the toilet. This can cause them to hold in their poo and lead to constipation.

This usually happens during potty training or if their usual toilet routine has changed. For example, after moving house or starting nursery.

Give your child plenty of time to use the toilet while they’re still learning.

Encourage them when they do use the toilet. Some parents find a reward chart works.

Try these potty training tips.

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