Common causes of constipation

Chronic constipation is a condition that is different to different people. For some it is infrequent bowel movement over time, for others, it is straining and effort to move the bowel, and for yet others, it is a feeling of more stools inside with a constant feeling of the need to move bowel. However, the classic definition is the condition of having fewer than three bowel movements in a week. The truth may be a combination of all the above. Some doctors prefer to describe it as a system complex of:

• Excessive straining
• A feeling of incomplete evacuation and the need for another
• Hard stools
• A sensation that one will not be able to move bowels
• A decreased frequency, and the need to use pelvic floor support with digital aid

Chronic constipation – Causes
Whatever the definition or description is, a host of reasons are behind chronic constipation.

The body needs water for its various functions including for waste disposal through the lungs, carbon dioxide, some others through kidney as urine, and wastes like roughage and other undigested as stools through the digestive system and some through the skin as sweat. There are mechanisms to regulate the water left in the body by reducing the amount used in excretion. Hence one of the reasons for chronic constipation can be lack of fluid intake. Insufficient roughage in the diet is also one of the chronic constipation causes. Roughage helps the intestine to move the contents quicker. It is the alternate contraction and relaxation of the guts, peristalsis that helps the intestine to move its content.

A normal or slow transit time can, sometimes, be the cause of chronic constipation. There can be neurologic problems that can delay the expulsion of the stools from rectum like nerve degeneration due to diabetes, Multiple sclerosis, autonomic neuropathy, Parkinson’s disease, stroke, spinal injury, all can cause chronic constipation. The inability of the pelvic muscles to relax and allow the stools to pass, and their inability to relax and contract in a synchronized manner, and dyssynergia are also some chronic constipation causes. Weakened pelvic muscle can also contribute to chronic constipation. Other medical conditions like hypothyroidism, Diabetes, Hyperparathyroidism, can all contribute to chronic constipation. Medications can also be the chronic constipation causes. Besides physical obstruction due to growths of tumors, anywhere in the intestinal tract, constrictions of the tract due to bowel strictures, colon and rectal cancer, anal fissures, piles can all contribute to chronic constipation

In diagnosing the reasons for chronic constipation, the doctor will look into the history, conduct a thorough physical examination including a digital examination of the rectum to detect any physical abnormality. The doctor will order some blood tests to see if any systemic conditions like hypothyroidism, hypercalcemia and other factors that can cause the condition. A sigmoidoscopy, for the end portion and colonoscopy, is done to see the lumen of the entire colon may biopsy any abnormal tissue seen. Another test is an evaluation of the anal sphincter muscle, anorectal manometry, in which small balloon is inserted via catheter, inflated and pulled out. The doctor during the test measures the coordination of the muscles used in bowel movement. Another test is balloon expulsion test, conducted along with anorectal manometry. This evaluates the time taken to expel a water-filled balloon. Another test is called colonic transit study, and this is to see how fast food passes through the colon. The patient is asked to swallow a capsule containing a radiopaque marker or a wireless device. The progress of the capsule is recorded over a period of several days and would be seen on X-rays. Instead, radiocarbon–activated food is given and its progress recorded for several days. This is called scintigraphy, helps to detect any muscle dysfunction and how well food moves through the colon. Other two tests are defecography and MRI defecography. These are X-rays and MRI taken at the time of actual defecation. These help to detect problems with muscle function and coordination and also any rectal prolapse or rectocele.

If an underlying cause is found it is treated. In a small percentage of cases, no specific cause is found. There are a few changes one can make in lifestyles, like taking more fluids, preferably, water, more vegetables like beans and fruits having more soluble fiber, fiber supplement with a tall glass of water, learn to relax, make a habit of going to toilet at a particular time every day, not neglecting an urge, avoid highly processed food and increase one’s activity level and finally talk with one’s doctor to change or modify current medication as needed. However, if one has chronic constipation, any change in bowel movement or changes in the stool that persist for more than a few days call on the doctor and eliminate any underlying serious causes of chronic constipation. In the incorrigible palliatives are used.