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Constipation – Causes, Symptoms and Treatment

Constipation is a common digestive disorder characterized by infrequent bowel movements, hard stools, or difficulty passing stool. It affects people of all ages and can often be managed with lifestyle changes.

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Things worth knowing about "Constipation"

Constipation is a common digestive disorder characterized by infrequent bowel movements, hard stools, or difficulty passing stool. It affects people of all ages and can often be managed with lifestyle changes.

What is Constipation?

Constipation is a functional digestive disorder in which a person has fewer than three bowel movements per week, stools are hard and dry, or passing stool requires significant straining. It is considered chronic constipation when symptoms persist for three months or longer. Constipation is one of the most common gastrointestinal complaints worldwide and can affect people of all ages, though it is more prevalent among older adults and women.

Causes

The causes of constipation can be divided into functional and organic categories:

Common Functional Causes

Low-fiber diet
Insufficient fluid intake
Physical inactivity
Ignoring the urge to defecate
Stress and psychological factors
Irritable bowel syndrome with predominant constipation (IBS-C)

Organic and Medication-Related Causes

Underactive thyroid gland (hypothyroidism)
Diabetes mellitus with nerve involvement (diabetic neuropathy)
Neurological conditions such as Parkinson disease or multiple sclerosis
Medications including opioids, iron supplements, calcium channel blockers, and antidepressants
Intestinal obstruction or strictures
Colorectal cancer (in rare but serious cases)

Symptoms

Common signs and symptoms of constipation include:

Fewer than three bowel movements per week
Hard, lumpy, or dry stools
Straining during bowel movements
Sensation of incomplete evacuation
Bloating and abdominal discomfort or pain
Loss of appetite and a feeling of fullness

In severe cases, a fecal impaction may develop -- a hardened mass of stool that becomes lodged in the rectum and requires medical treatment.

Diagnosis

Diagnosis begins with a thorough medical history and physical examination. Further investigations may include:

Digital rectal examination: To assess for stool impaction or rectal masses
Blood tests: To rule out thyroid dysfunction, electrolyte imbalances, or diabetes
Colonoscopy: When structural causes or colorectal cancer are suspected
Imaging (X-ray or ultrasound): To evaluate for bowel obstruction
Colonic transit study: To assess how quickly contents move through the colon using marker capsules

Treatment

Lifestyle and Dietary Changes

For mild to moderate constipation, non-pharmacological approaches are recommended first:

Increase dietary fiber intake (target: 25-30 g per day through whole grains, vegetables, and legumes)
Drink adequate fluids (at least 1.5-2 liters per day)
Engage in regular physical activity
Establish a consistent toilet routine and respond promptly to the urge to defecate

Medications (Laxatives)

When lifestyle changes are insufficient, several types of laxatives are available:

Osmotic laxatives (e.g., macrogol, lactulose): Draw water into the bowel to soften stools
Stimulant laxatives (e.g., bisacodyl, sodium picosulfate): Stimulate intestinal contractions
Bulk-forming agents (e.g., psyllium husk, methylcellulose): Increase stool volume
Secretagogues and prokinetics (e.g., linaclotide, prucalopride): Used for chronic constipation unresponsive to standard laxatives

Note: Laxatives should not be used long-term without medical supervision, as dependency may develop.

Management of Chronic Constipation

Patients with chronic or refractory constipation may require specialist gastroenterological evaluation, biofeedback therapy (for pelvic floor dysfunction), or in rare cases, surgical intervention.

Prevention

Constipation can often be prevented through a healthy lifestyle that includes a high-fiber diet, adequate hydration, regular exercise, and timely response to the urge to defecate. Any persistent symptoms or blood in the stool should always be evaluated by a healthcare professional.

References

World Gastroenterology Organisation (WGO) - Global Guidelines: Constipation (2010, updated 2020). Available at: www.worldgastroenterology.org
Lacy BE, Mearin F, Chang L, et al. - Bowel Disorders. Gastroenterology. 2016;150(6):1393-1407. (Rome IV Criteria)
Bharucha AE, Dorn SD, Lembo A, Pressman A - American Gastroenterological Association Medical Position Statement on Constipation. Gastroenterology. 2013;144(1):211-217.

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