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Updated on Aug 4, 2021 by Dr. Shawn Khodadadian (Gastroenterologist) of Manhattan Gastroenterollogy

What Is Constipation?

If you have difficulty moving your bowels, you may be suffering from constipation. Constipation is when a person either moves their bowels infrequently, less than once every 3 days or has to strain when passing stool. Persistent constipation should always be evaluated with a thorough consultation and examination by a physician for an accurate diagnosis and constipation treatment plan and exclude a serious illness or condition.



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What Is Chronic Constipation?

Chronic constipation is defined as the presence of two or more of the following:

  • Straining during at least 25% of bowel movements;
  • Lumpy or hard stools in at least 25% of bowel movements;
  • The sensation of incomplete evacuations for at least 25% of bowel movements;
  • The sensation of anorectal blockage for at least 25% of bowel movements;
  • Manual maneuvers to facilitate at least 25% of bowel movements;
  • Fewer than three bowel movements each week.

What Causes Constipation?

There are many causes of constipation. The most common is simply poor eating habits. Many people don’t realize it, but they eat a low fiber diet, do not take in enough fluids, or don’t get enough exercise. Constipation can occur at any age, from newborns to older people. Although the problem is seen more in females than in males, the cause of constipation is multifactorial. The issue may arise in the rectum or colon or because of an external factor.

External causes include:

  • Lack of fluid consumption
  • Poor dietary habits
  • Overuse of certain medications
  • Emotional disorder

Any changes to your routine, stress, and conditions that slow muscle contractions of the colon or delay the urge to go may also lead to constipation.

The most common causes of constipation are:

  • Dehydration
  • Low-fiber diet
  • Lack of physical activity
  • Changes to your daily routine
  • Pregnancy
  • Delaying the need to have a bowel movement
  • Caffeine abuse
  • Overuse of alcohol
  • Psychological issues
  • Neurological disorders

Several underlying medical conditions lead to constipation. These are stroke, Parkinson’s disease, diabetes, irritable bowel syndrome (IBS), and an underactive thyroid gland. Your constipation may also be caused by Irritable Bowel Syndrome (IBS).

IBS has recurrent abdominal pain plus two or more of: (diagnostic criteria can change over time)

  • Pain better from defecation
  • Altered stool at the onset of pain
  • Abdominal bloating
  • Increased or decreased stools at the onset of pain
  • A ‘never empty’ sensation after passing stool
  • Passing mucus from the rectum
  • Morning cluster of motions
  • Constipation alternating with diarrhea

Other symptoms reported by patients with IBS:

  • Fatigue (some IBS patients also have Chronic Fatigue Syndrome)
  • Nausea
  • Unexplained insomnia or disturbed sleep patterns
  • Susceptibility to colds, flu, sinusitis, or post-nasal drip
  • Headaches
  • Allergic sensitivity
  • Restless leg syndrome
  • Gastric reflux

What Are the Signs and Symptoms of Constipation?

The definition of a normal bowel movement can be different for every individual. Some people go three times a day, while others go three times a week.

If you experience any of the following signs of constipation, you might need to consult a specialist:

  • Fewer than three bowel movements a week
  • Pain or straining during bowel movements
  • Dry stool
  • A feeling of fullness after a bowel movement

How Is the Condition Diagnosed?

Many people who got exposed to this health condition decide to self-treat by making modifications to their diets, using over-the-counter laxatives, or exercising more frequently. However, people tend to forget that it is prohibited to use laxatives for more than two weeks without preliminary consultation with a specialist.

Constipation diagnosis starts with a preliminary consultation with your medical practitioner. You will be asked questions about your symptoms, medical history, medications, and any underlying condition. As part of physical evaluation, your specialist can perform blood tests and a rectal exam to check your electrolytes, thyroid function, and blood count.

In more serious cases, more tests may be needed to determine the cause of your symptoms. These tests include:

  • Marker study. A test is used to determine how food is moving through your colon.
  • Anorectal manometry. A test is used to examine the muscle function of your anal sphincter.
  • Barium enema X-ray. A test designed to examine the colon.
  • Colonoscopy. A test is used to evaluate the colon.

What Does Constipation Treatment Entail?

The easiest and fastest ways to manage constipation include:

  • Dietary changes
  • Medical supervision
  • Behavioral changes
  • Normal fiber and fluid consumption
  • Increased physical activity

Laxatives represent the first-line treatment for constipation. If an adequate intake regimen is implemented, patients tend to have a symptomatic improvement. Surgical treatment of the condition is reserved for patients with refractory to medical interventions. The major goal of surgery is to produce symptom alleviation.

Surgical options may include anal procedure, colorectal resection, antegrade enemas, intestinal diversion. Most pediatric patients are treated with medical therapy, and most of them tend to get better. Although, around 30% persist in being symptomatic until adulthood.

Factors that are linked to the worse prognosis are:

  • Age
  • Female gender
  • Longer colonic transit time
  • Longer time between the first signs of the condition and the start of the treatment

In adults, constipation has a poor prognosis. This disease can have a negative impact on the quality of life, and, in many cases, treatments do not work. Even if they do, the benefits are short-term. Once the condition is confirmed, it is essential to comply with the diet and medical therapy to reverse the disorder. Although, the reoccurrence of the condition is common among many people. This is chiefly because of the lack of compliance with the diet.

Chronic constipation can make many people disabled and have a negative impact on the quality of their lives. Patients who fail to respond to medical treatment might need to undergo a total abdominal colectomy. Keep in mind that it is complicated to manage constipation if you are addicted to laxatives and are unwilling to change your lifestyle.

When To See a Doctor?

It is important to seek medical advice from our doctor if there is a change in bowel habit or new development of constipation for a complete evaluation. You will likely need to be tested for the presence of blood in the stool and may need a colonoscopy to exclude colon cancer, depending on your specific condition.   However, constipation symptoms are usually able to be managed successfully with dietary and lifestyle changes (such as adequate fiber and fluid intake and physical activity). Laxatives and prescription medications are sometimes required, and in some people with very severe constipation, further medical investigations and other treatments may be needed. Your gastroenterologist can formulate an effective constipation treatment plan for you.

Frequently Asked Questions

What Are the Risk Factors for Constipation Disease?

Major constipation risk factors are eating a poor diet and not exercising. You can also be at greater risk if you are:

  • Confined to bed. People with certain medical conditions lie spinal cord injuries, tend to have difficulties with bowel movements.
  • Pregnant. Pressure on your intestines from your baby in conjunction with hormonal changes can result in constipation.
  • 65 or older. Older people tend to be less physically active, eat poorer diets, and have underlying health conditions that contribute to the development of constipation.
  • A woman. Women have more frequent episodes of constipation than men.

Are There Any Complications or Side Effects of Constipation?

Damage that can arise as a result of severe constipation includes:

  • Hemorrhoids
  • Anal fissures
  • Damage to the pelvic floor
  • Fecal incontinence
  • Urinary retention
  • Rectal prolapse
  • Volvulus
  • Abdominal discomfort or cramps

Depression and reduced quality of life are other complications that may occur. It is crucial to seek medical advice if you are not willing to get exposed to complications of this disorder.

How To Prevent Constipation?

The following techniques can be used to help prevent constipation:

  • Drink 11/2 to 2 quarts of plain water every day to hydrate the body;
  • Minimize the consumption of alcohol and caffeine;
  • Include fiber-rich foods in your diet;
  • Limit the consumption of low-fiber foods such as milk, cheese, and processed foods;
  • Exercise for at least 30 minutes every day, five times per week;
  • Do not delay a bowel movement;
  • Consider adding fiber supplements and probiotics to your diet.

Before making use of any of the aforementioned recommendations, you should consult your healthcare provider first.

Important Reminder: This information is only intended to provide guidance, not definitive medical advice. Please consult a doctor about your specific condition. Only trained
physicians can determine an accurate diagnosis and proper treatment.

Our leading gastroenterologists in NYC have more than enough competencies to provide highly comprehensive and personalized care. For more information about constipation treatment or to schedule a consultation with one of our NYC specialists, please contact our NYC gastroenterology office.

Dr. Shawn Khodadadian has either authored or reviewed and approved this content. Manhattan Gastroenterology Locations: Manhattan Gastroenterology (Upper East Side) 983 Park Ave Ste 1D, NY 10028
(212) 427-8761
Manhattan Gastroenterology (Midtown) 51 East 25th Street Ste 407, NY 10010
(212) 533-2400
Manhattan Gastroenterology (Union Square) 55 W 17th St Ste 102, NY 10011
(212) 378-9983

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. The information on this website does NOT reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class gastroenterologist for a consultation and examination regarding ANY and ALL symptoms or signs including abdominal pain, hemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. An accurate diagnosis and treatment plan should only be made by your physician in order to exclude a serious condition.