Constipation

By Frank J. Troncale, MD, FACG and Kate Charron PA-C

What is constipation?

Constipation can be considered if you are having fewer bowel movements than usual, if your stools are hard, or if you have difficulty passing stool
The number of bowel movements per week does not necessarily diagnose constipation. For example, some people only have 3 bowel movements per week and this is normal for them.

What are some causes of constipation?

  • Dehydration
  • Low-fiber diet
  • Medications such as antihistamines (Claritin, Benadryl), antidepressants, antispasmodics (muscle relaxers), iron supplements, certain blood pressure medications,
  • and narcotics
  • Hypothyroidism (underactive thyroid)
  • Diabetes
  • Slow transit of the colon
  • Outlet delay/pelvic floor dysfunction – when the muscles used to facilitate a bowel movement do not contract appropriately to expel stool
  • Certain conditions such as multiple sclerosis and Parkinson’s disease
  • Obstruction/blockage in the colon

What are symptoms associated with constipation?

  • Straining to have a bowel movement
  • Feeling like you cannot completely empty stool from the colon
  • Abdominal discomfort
  • Bloating
  • Increased gas
  • Nausea

How is it diagnosed?

  • A detailed medical history will help determine if diet or medications are to blame
  • Blood work may be ordered to evaluate the thyroid and to look for other abnormalities
  • Abdominal x-ray can look at the distribution of stool in the colon and rule out obstruction
  • Colonoscopy, especially for anyone older than 50 or in patients with alarm symptoms (rectal bleeding, weight loss, anemia)
  • Anorectal manometry can help diagnose pelvic floor dysfunction. This test checks the pressure in the rectum to determine if it is working correctly to expel stool

What are some treatment options?

  • Increased water intake
  • High fiber diet and/or fiber supplements (Metamucil, Citrucel, etc.)
  • Avoiding medications known to cause constipation, if possible
  • Stool softeners
  • Laxatives (MiraLax, Senokot, Dulcolax)
  • Linzess and Amitiza are prescription medications that can also be tried under supervision of your gastroenterologist

The goal of treatment is to have a complete emptying bowel movement every morning, or at least 4-5 times a week.

Please contact us if you are experiencing constipation and would like to learn more. We will be happy to meet with you to discuss your symptoms and create an individualized treatment plan.

References:

American College of Gastroenterology