Constipation

Constipation is defined as less than three bowel movements per week. It is usually characterized as the passage of hard, dry, lumpy stool. Constipation can be accompanied by cramping, nausea, bloating, and fatigue. In most cases, Constipation is temporary, usually as a result of lack of water intake or poor diet. If this condition becomes chronic, seeing your primary care physician for advice is appropriate. If minor alterations in lifestyle do not improve the Constipation, a referral to a gastroenterologist is appropriate.

Physiologically, Constipation occurs when too much water is absorbed from the colon, resulting in hard, dry stool. As this stool becomes dryer, it is harder for it to pass through the colon and eventually harder for it to be evacuated.

Causes of Constipation include poor diet, lack of water intake, medication side effect, irritable bowel syndrome, pregnancy, hypothyroidism, colon cancer and diabetes mellitus. Most people with Constipation do not need extensive medical testing and can be treated with alteration in diet and exercise.

Patients with mild symptoms may need just a visit to the doctor, a physical exam, and very few medical tests. These tests include blood work and colonoscopy if needed.

The doctor may ask a patient to describe duration of symptoms, frequency of bowel movements, shape and consistency of stool and presence of any blood in the stool or black tarry stool.

The clinical definition of Constipation is any two of the following symptoms for at least 12 weeks in the previous year:

• Fewer than three bowel movements per week;
• Straining during bowel movements;
• Hard stool;
• Feeling of incomplete evacuation of stool.

A physical exam includes a rectal exam with a gloved, lubricated finger to test the strength of the anal muscle and to look for any masses which may be sitting low in the rectum while also testing the stool for blood.

Diagnostic testing for severe symptoms may include not only blood work to look for diabetes mellitus and hypothyroidism, but also may include colonoscopy, sitz marker studies, anorectal manometry, and Defecography.

Colonoscopy utilizes a lighted camera which resembles a long tube to investigate the entire colon.

Sitz marker studies involve the swallowing of different shaped markers which will pass through the gastrointestinal (GI tract) and are visible by X-Ray a few days after ingestion. Determining where these different shaped markers are within the GI tract will define what type of Constipation may be present.

Anorectal function tests utilize pressure sensors to determine the function of the anorectal muscles. Muscle contraction is measured while a pressure sensitive balloon is pulled back across the anus.

Defecography is an x ray of the anorectal area that evaluates stool evacuation, identifies anorectal abnormalities and evaluates muscle contraction and relaxation near the anus.

Treatment
Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms of Constipation.

A doctor will likely ask you to increase your water intake to at least ten, 8-ounce glasses of water per day. Fiber will be added to your diet, usually in the form of fiber supplement. These supplements come in powder form, wafer form, and capsule form. The doctor will ask you to consume at least 20-30 grams of fiber per day. If this can be achieved within your diet, this is acceptable; if not a supplement will be added. Common fiber supplements include Metamucil, Fibercon, and Benefiber.

High-fiber foods include beans, grains and bran cereals, fruits, and vegetables. Limiting processed foods will improve your Constipation.

For people, for whom diet change and increased exercise do not improve Constipation, laxatives may be necessary.
Treatment may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem.