Constipation is a condition in which bowel movements occur less than three times a week. Although constipation that does not persist is quite common, some individuals may experience chronic or prolonged constipation. This can cause excessive straining during bowel movements, as well as several other signs and symptoms.
Treatment of chronic constipation depends on the underlying cause. However, in some cases, no underlying cause for constipation is found.
Constipation most often occurs when feces or feces move very slowly in the digestive tract or cannot be evacuated effectively from the rectum, which causes the stool to become hard and dry.
Chronic constipation has several possible causes, including:
• Blockage of the large intestine or rectum. An obstruction in the colon or rectum can slow or stop stool movement.
Causes of blockage can include fissures or tears in the skin of the anus, intestinal obstruction, colon cancer, narrowing of the colon, other cancers of the abdomen pressing on the intestine, rectal cancer, and so on.
• Nerve disorders around the large intestine and rectum. Neurological disorders can affect innervation causing muscle contractions in the large intestine and movement of stool through the intestine. This can be caused by strokes, spinal cord injuries, and several other neurological disorders.
• Disorders of the muscles involved in defecation. Disorders of the pelvic floor muscles that play a role in bowel movements can cause chronic constipation.
These problems can include difficulty relaxing the pelvic floor muscles that help with bowel movements, difficulty for the pelvic muscles to coordinate muscle relaxation and contraction, and increasing pelvic floor muscle weakness.
• Conditions that affect hormones in the body. Hormones help maintain fluid balance in the body. Diseases and conditions that disrupt hormone balance can cause constipation, including diabetes, hyperparathyroidism, and hypothyroidism.
Several factors are associated with an increased risk of chronic constipation, including:
• Older age
• Female gender
• Eating a low-fiber diet
• Limited or no physical activity
• Taking certain medications, such as sedatives, narcotics, and so on
Common signs and symptoms of chronic constipation include:
• Frequency of bowel movements less than three times a week
• Hard stools
• Straining during bowel movements
• Feeling of an obstruction in the rectum that makes it difficult to pass stools
• Feeling unable to empty stool from the rectum
• Needing help to empty the rectum, such as using the hand to apply pressure to the abdomen or using fingers to expel feces from the rectum
Constipation can be considered chronic constipation if a person has had two or more of the above symptoms for at least the last three months.
Doctors can determine the diagnosis of constipation by conducting a detailed medical interview, direct physical examination, examination of the rectum with a finger, and several supporting examinations.
Examples of supporting examinations that can be carried out are:
• Blood tests. The doctor will watch for systemic conditions, such as low thyroid hormone levels.
• Examination of the rectum and lower colon (sigmoidoscopy). In this procedure, the doctor uses a thin, flexible tube accompanied by a camera that is inserted into the anus to examine the condition of the rectum and lower intestine.
• Examination of the rectum and entire colon (colonoscopy). In this diagnostic procedure, the doctor uses a thin, flexible tube with a camera inserted into the anus to examine the rectum and the entire large intestine.
• Examination of anal sphincter muscle function (anorectal manometry). In this procedure, the doctor inserts a thin, flexible tube into the anus and inflates a small balloon at the end of the tube.
Then, this tool is pulled out. This procedure helps the doctor measure the coordination of the muscles used for bowel movements.
• Check anal sphincter muscle velocity (balloon expulsion check). This examination is often performed in conjunction with anorectal manometry and is useful for measuring the time it takes to push up a balloon filled with water and placed in the rectum.
• Examination of the movement of food through the large intestine (colon transit test). In this procedure, the patient takes a capsule containing a dye or a recording device. The capsule’s journey through the digestive tract will be recorded over several days and shown on an X-ray examination.
• X-ray examination inside the rectum during the process of defecation or defecation (defecography). In this procedure, the doctor inserts a substance filled with barium into the rectum, which can be expelled through the rectum just like feces. Barium may appear on an X-ray, which can indicate a problem with muscle function or coordination.
• Magnetic Resonance Imaging (MRI). In this procedure, the doctor may insert a contrast gel into the rectum, which can be expelled through the rectum just like feces.
An MRI examination is performed to visualize the function of the defecation muscles. This examination can also help determine the diagnosis of a problem that can cause constipation.
Treatment of chronic constipation generally starts with changes in diet and lifestyle aimed at increasing the speed of movement of feces through the intestines. If this does not show any improvement, the doctor can prescribe treatment or suggest surgery.
Doctors may recommend the following lifestyle changes to help with constipation:
• Increase fiber consumption. Adding fiber to the diet can increase the bulk of the stool and speed up its passage through the intestines. Increase consumption of fruits, vegetables, breads, and fiber-rich cereals.
• Perform regular physical activity. Physical activity can increase muscle activity in the intestines when done regularly.
• Avoid holding bowel movements. Take time to have an uninterrupted bowel movement and without feeling rushed.
• Exercising the pelvic floor muscles. Doing pelvic floor muscle exercises with a trained therapist can help with bowel movements.
Doctors can also prescribe drugs that facilitate bowel movements, depending on the severity of the complaint. In addition, surgical procedures are an option if various treatments have been tried but to no avail.
Discuss with your doctor to determine the most appropriate treatment for your chronic constipation.
Several things can be done to prevent chronic constipation from occurring, including:
• Eat a diet that includes foods rich in fiber, such as beans, vegetables, fruits, cereals, and so on.
• Consume adequate amounts of fluids.
• Ensure that the body remains active by doing physical activity or sports regularly.
• Practice good stress management.
• Not holding bowel movements.
• Trying to schedule regular bowel movements.
• Ensure that children who are already eating solid foods get enough fiber in their daily diet.