Constipation is a condition in which a patient has infrequent bowel movements (defined as fewer than three times per week, according to NIDDK) and/or difficulty in defecating due to hard or impacted stools.

What Are The Symptoms of Constipation?

Stools are usually hard, dry, small in size, and difficult to eliminate. Some constipated patients find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

Who Is More Likely To Have This Condition?

If you are female and over 50 years old, you may be more likely to get constipation. Pregnant women may also become constipated, and it is a particularly common problem following childbirth or surgery.

When the colon reabsorbs too much water, or if peristalsis (the normal muscular contractions of the gastrointestinal tract) is slowed, constipation often results. The most common risk factors for constipation include:

• Insufficient dietary fiber
• Sedentary lifestyle - lack of physical activity (especially in the elderly)
• Certain medications, e.g. anticholinergics.
• Irritable bowel syndrome (IBS)
• Changes in life or routine such as pregnancy, aging, and travel
• Abuse of laxatives
• Ignoring the urge to have a bowel movement
• Dehydration
• Certain diseases such as stroke (most common)
• Structural anomalies of the colon and rectum
• Obstruction caused by neoplasia and diverticulosis (growths)
• Ongoing problems with intestinal function, unknown cause (chronic idiopathic constipation)

What Does Treatment for Constipation Involve?

The appropriate treatment depends on the cause, severity, and duration of the constipation. Usually, changes in diet and lifestyle are sufficient to bring about positive results.

Dietary Modification:

Eating enough fiber (20 to 35 grams/day) helps promote normal stool formation. A “bulk-forming diet” should emphasize high-fiber foods such as beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, Brussels sprouts, cabbage, and carrots. Limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, can also be helpful. Drinking enough fluids is important as well.

Lifestyle Modification:

Engaging in daily exercise, reserving enough time for and heeding the urge to have a bowel movement are helpful.

Laxatives:

Laxatives come in different varieties:

Bulk-forming: The most commonly used type, these contain fiber such as psyllium seeds or husks (Metamucil or Citrucel).

Stimulants: These include laxatives such as Dulcolax and Senokot, and act by chemical stimulation of the colon.

Stool Softeners: These moisten the stool and prevent dehydration. Brand names include Colace and Surfak

Lubricants: As the name implies, these lubricate the colon, allowing for easier passage of stool. Chief among these are mineral-oil-based preparations.

Saline Laxatives: These laxatives, such as Milk of Magnesia, act by drawing water into the colon, allowing for better elimination.

Osmotics: This similar class of drugs works by affecting fluid balance in the colon. Examples include sorbitol, Cephulac, or Miralax.

Other treatments: More esoteric treatments have been developed in recent years to tackle constipation. These include chloride channel activators, such as Amitiza, and serotonin agonists such as Zelnorm (marketed for IBS with constipation as the predominant feature).

How Long Does Treatment for Constipation Take to Work?

This is dependent on the treatment chosen. Bulk-forming laxatives generally work within 24-48 hours. Stimulant and saline laxatives generally produce faster results (minutes to hours).

How Many Treatments Are Required?

If constipation is acute, perhaps only one treatment will be required. In chronic cases, regular administration of bulk (fiber) may be indicated. Long-term use of stimulant and saline laxatives is discouraged, as it may cause dependence.

When Will I See Results?

See “How Long Does It Take” listed above.

What Are My Alternatives?

In extraordinary cases, surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.

Will I Have Pain?

Pain may occur with constipation in straining to pass stool. Any pain induced by laxative treatment, which can cause cramps or contractions, is transient in nature.

When Can I Go Back To Work Or School?

You can usually return to work or school the same day.

Who Will Perform My Treatment?

A physician experienced in the methods of gastroenterology will prescribe the appropriate treatment.

How Much Does It Cost?

Costs of medications for this disorder are nominal.

Will My Insurance Cover Treatment for Constipation?

Insurance should cover the treatment subject to individual policy limitations.