Constipation

What is Constipation?

A change in the frequency (less than 3 bowel movements per week) or consistency of stools (eg: passage of hard, lumpy, bumpy, "dry" stools). There are multiple reasons why constipation develops. Some of these include inadequate intake of fiber and water as well as motility disorders of the colon. These include slow transit constipation where it takes longer than normal for waste materials to go through the colon and be excreted. Occasionally stools may reach the rectum (close to the end of the colon) but cannot be expelled because of weak pelvic muscles (dyssynergic defecation).

Esophagus

Stomach

Intestine

What are symptoms of Constipation?

  • Less than three bowel movements per week
  • Passage of hard pebble-like stools
  • Gas and bloating
  • Incomplete bowel movements (the need to have several bowel movements per day)

How is the diagnosis made?

Based on symptoms reported to your medical provider. Diagnostic tests are sometimes needed and may include:

Sitz marker study – This is an x-ray study done in the radiologist’s office. The patient swallows a sitz pill which contains 24 radio-opaque rings. An abdominal x-ray is taken five days later to check for the number of remaining rings. Eighty percent or more of the rings should have been expelled, at day five, in someone with normal colon motility. Retention of more than twenty percent of the rings is suggestive of a motility disorder.

Defecography – This is a dynamic radiographic test used to evaluate the anus and rectum during simulated defecation. Barium is put into the rectum after which the patient performs simulated defecation. X-rays are taken during simulated defecation in order to diagnose abnormalities of the anus and/or rectum which may cause constipation.

Anorectal Manometry – This is a test used to evaluate the muscular and sensory function of the rectum and anus during simulated defecation. The patient is asked to expel a balloon from the rectum as the last part of the test. Anorectal manometry correlates with your ability to have a bowel movement. This test takes about 25 minutes.

How is the condition treated?

Treatment depends on the cause of your constipation. Possible treatments include a high fiber (25-30 grams/day) diet, adequate intake of water (6-8 glasses/day), stool softeners and laxatives. Do not avoid the urge to defecate.

Biofeedback or pelvic floor retraining/strengthening exercises are recommended for pelvic floor weakness.

Biofeedback is a technique used to retrain or strengthen the pelvic floor muscles. A physical therapist or a nurse teaches the patient specific exercises which will help to make it easier to have bowel movements. Exercises should also be performed at home for best results.