Constipation

Constipation in general refers to the infrequent opening of the bowels beyond once every three days or the difficulty in opening the bowels with hard motions. When it is ongoing it is called chronic constipation. Constipation can be associated with bloating, passing flatus and abdominal pain. There are different classifications of chronic constipation; functional constipation and secondary constipation.

Functional chronic constipation

This is separated into three categories:

Normal-transit constipation which means the stool moves through the bowel at a “normal” rate but you have trouble opening your bowels due to other reasons such as hard stools. This type of constipation falls into the irritable bowel syndrome category and among other may be caused by different types of bacteria in the bowel. Symptom treatment is usually directed towards the bloating symptoms which are the worst symptoms for most patients and special dietary manipulations may be required.

Slow-transit constipation meaning that stool moves through the bowel very slowly occurs due to abnormal function of the bowel nervous system. This leads to slower function of the bowel wall muscles. Some people are born with this problem while others develop it during their life. In most occasions the treatment is dietary assisted with the use of medication and techniques to clear the bowel. On rare occasions when all of the above have failed removal of the segment of problematic bowel through a surgical procedure called colectomy or the formation of a stoma may be required.

Outlet obstruction occurs when the sheet of muscles helping bowel movement (pelvic floor) or the back passage muscle (sphincter) loose their coordination. This results in difficulty expelling a motion regardless if the stool is soft or hard. Another problem that may obstruct the expulsion of stool is a rectal prolapse.

Secondary chronic constipation

This type of constipation can be caused by medication or an underlying medical condition. This includes medication such as strong painkillers (opioids), blood pressure medication, medication used for epilepsy, depression and psychiatric conditions, iron and calcium supplements. Underlying conditions that can cause constipation include overactive thyroid disease, high calcium levels, diabetes and Parkinson’s disease. Problems around the lower end of the bowel may also lead to constipation. These include an anal fissure, in which pain leads to patients avoiding to go to toilet and anismus, a condition where part of the pelvic floor fails to relax to allow the bowel to empty. Both of these conditions may be treated with Botox injections.

Diagnosis

Depending on your history and examination findings further tests may be required to confirm the diagnosis and rule out other serious pathology such as narrowing of the bowel due to cancer or diverticular disease. These may include a colonoscopy, CT scan, bowel transit studies, proctogram, anorectal physiology studies and sometimes a biopsy of the lower part of your bowel (rectum) to rule out Hirchbrung’s disease.

Treatment options

Treatments will be directed towards the potential cause as already discussed. The rationale behind any investigations and proposed treatment will be discussed with you at an individual basis at the clinic.