Chronic constipation - what is it, what are the symptoms and how is it diagnosed?

Constipation is a term that many of us use when we have difficulties going for a poo. It’s a very common condition that can have many different root causes and, although uncomfortable, it’s usually not something life-threatening.

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Constipation generally leads to hard or formed stools that are difficult or impossible to pass. It will generally make you feel bloated and can cause headaches. There’s also a chance that you’re not eating properly when you’re constipated because you’re feeling full very quickly. Relieving constipation, especially chronic constipation, is very time consuming but generally possible.

So, what exactly does chronic constipation mean? Chronic constipation means that you are having infrequent bowel movements – generally less than 3 times a week – or difficulty passing stools for several weeks or longer. During this time, you are likely to experience hard and formed stools, small stools, or a combination of both.


What causes chronic constipation?

There are a number of different things that can cause constipation. Possible causes are:

  • Bowel obstruction
  • Bowel disease like Crohn’s disease, colon cancer, diverticulosis, or Irritable Bowel Syndrome (IBS)
  • Pelvic floor dysfunction which may make it difficult to coordinate muscle contractions in the rectum
  • Pregnancy
  • Medical conditions like diabetes, thyroid disorders, Parkinson’s disease, spinal cord injuries, strokes, or MS
  • Structural lesions of the colon (e.g. colon stricture – a narrowing in your bowel that makes it difficult or impossible to pass stools)
  • Cancer such as bowel cancer, rectal cancer, or an abdominal cancer that presses on the colon
  • Medication such as pain killers, blood pressure medication, and anti-seizure medication
  • Mental health problems such as depression, eating disorders, and anxiety
  • Anal fissures (small tears in the rectum or anus, often caused by hard stools)
  • Physical disabilities that lead to immobility


Different types of constipation

Functional Constipation - If you’re constipated for a prolonged period of time but none of the above reasons apply to your situation, you might be suffering from functional constipation. This is also a type of chronic constipation but is caused by your digestive system not working properly. It is most common in young children and older adults.

Normal Transit Constipation - This means that even though the stool passes through your colon at a normal speed you still feel constipated, bloated, and maybe also have a belly ache. Normal transit constipation can be caused by changes in the water content of your colon and is generally treatable with a diet that’s higher in fibre or certain laxatives.

Slow Transit Constipation - If you’re suffering from this type of constipation, your colon is moving stools at a slower rate than normal. Unfortunately, doctors are not sure why this happens, but it could be due to nerves not sending the right signals to the colon muscles. The signs of slow transit constipation include passing dry and hard stools, going for a poo less than once a week, a bloated or painful belly or no urge to go to the bathroom at all. This type of constipation is usually treated with behavioural training – also called biofeedback – or, in severe cases, surgical treatment is needed.


Defecation Disorders - As we already know, it takes a lot of coordinated muscle movement for you to be able to go for a poo comfortably. So, if you’re suffering from a defecation disorder, you may feel the urge to go to the toilet, but you have a hard time actually going and it might also be painful. You should consider seeing a doctor if you spend a lot of time on the toilet straining or if you regularly use your fingers or enemas to remove stools. People with this type of constipation often suffer from haemorrhoids, anal fissures, and hard, impacted stools. It is unclear, where it comes from, but it’s often successfully treated with behavioural and relaxation training.


Symptoms of Chronic Constipation

Chronic constipation can have many possible symptoms. These are:

  • Feeling like there’s some sort of blockage in the rectum that prevents you from going for a poo
  • Excessive straining
  • Higher flatulence than normal
  • Passing hard and lumpy stools
  • Infrequent bowel movements (generally fewer than 3 per week) over the course of several weeks or months
  • Difficulty getting your bowels to move
  • Frequent cramps and abdominal pains
  • Bloating
  • Feeling like you can’t empty your bowel completely
  • Using your hands to press on the abdomen or using your fingers to remove stool from the rectum


When to seek help

If you experience any symptoms of chronic constipation or if being constipated is not normal for you, you should consider seeing a healthcare professional about it. If you can see blood in your stool, if you’re having serious stomach pains, or if you’re starting to lose weight without trying you should speak to your nurse or GP immediately. These symptoms can be signs that something more serious is going on in your body and needs to be investigated further.


How is chronic constipation diagnosed?

To diagnose chronic constipation, your doctor or nurse will ask you questions about your symptoms, medical history, and any medications that you are currently taking. If you have been suffering from constipation for more than 3 months, your doctor may also want to perform a physical exam. The physical exam may include blood tests and a rectal exam, where a healthcare professional will insert a gloved finger into the rectum to check for tenderness, blockages, and blood. The rectal exam is done to see how and if your sphincters work, if there is any numbness around your bum, or if you’re suffering from anal fissures or haemorrhoids.

If your doctor or nurse can’t find the cause for your constipation with these exams, they might want to do additional tests. These can include:

  • Marker study or colorectal transit study: With this type of exam, you will be asked to swallow a pill that contains markers that will show up on an X-ray. Your doctor or nurse can then see how food is moving through your intestines and how well the muscles in your intestines are working.
  • Anorectal manometry: A doctor will insert a tube with a balloon on the tip into your anus. Once inserted, the balloon is inflated, and your doctor will pull it out slowly. This allows to measure the tightness of the muscles around the anus and how well the rectum functions.
  • Barium enema X-ray: With a tube, your doctor will insert barium dye into your rectum. The dye highlights the rectum and large intestine, allowing your doctor to get a better view of them on an X-ray.
  • Colonoscopy: At a colonoscopy, your doctor examines your colon using a camera and light attached to a flexible tube called the colonoscope. For this procedure, you will usually get a sedative and pain medication as it can be quite uncomfortable.


How is chronic constipation treated?

If you are suffering from chronic constipation, then a multilevel approach is a common way to relieve it. But what can such a program contain? We’ve got everything you need to know right here.

Get regular - Establishing a routine can start with the most basic of them all – make toilet trips a habit and try to go at the same time each day. Your doctor might suggest that you try and go to the bathroom at some point in the morning. Why? Because that’s when your colon is the most active.

Lifestyle changes - Often, simple things in our live can be the root cause for our bowel problems. That’s why your doctor might ask you to try and change certain things about your lifestyle. This can be anything from reducing stress, increasing your activity level, quitting smoking, or changing your bathroom habits. The latter is especially important if you either hold bowel movements or urge yourself to go when you don’t need to on a regular basis.

Dietary changes - What you eat and drink can play a significant role in your bowel health. To treat your problem, your doctor might give you a diet plan that contains more high-fibre foods like fruit, vegetables, beans, and wholegrain foods (e.g. wholemeal bread). You will also likely be reminded to drink enough fluids – especially water.

Medication - Certain medications and laxatives can help to relieve your constipation but it’s important that you talk to a healthcare professional before you start taking anything. Most of these medications have to be taken very carefully and only for a short period of time. So by simply taking something without consulting your GP first, you might actually be making matters worse for yourself.

Pain management - Chronic constipation can be painful, and you might require pain medication. If the medication your doctor prescribes for you doesn’t help, you might have to see a pain management specialist.

Fibre supplements - If you’re not getting enough fibre from your diet, your doctor will likely prescribe a fibre supplement. This will add bulk to your stool and make it easier for your body to pass the stool through your intestines.

Abdominal massage - As an addition to other treatments, your nurse or doctor might teach you how to do an abdominal massage on yourself. This helps to move stool through the colon and can help to relieve constipation.

Surgery - If all other treatments are unsuccessful, and, especially if you have structural issues in your small intestine, you will have to undergo surgery to remove the stools from your colon. This is often done if you are already suffering from a faecal impaction.