Constipation is a very common symptom that affects most people at some time in their lifetime. It has previously been defined as “fewer than 3 bowel motions per week”. New diagnostic criteria have since been developed that also take into account:

– the need to strain to pass a bowel motion

– lumpy or hard stools

– a sensation of incomplete emptying or blockage

– manoeuvres to help pass a bowel motion

What are the causes of Constipation?

There are many causes of constipation. These include:

– dietary (constipating foods, low fluid intake)

– irritable bowel syndrome

– medication side effects (e.g anti-depressants)

– thyroid disease

– neurological conditions e.g. diabetes, multiple sclerosis

– a bowel blockage e.g. tumour

– pelvic floor dysfunction

– poor muscular contractions of the bowel (slow transit)

How do you diagnose the cause of Constipation?

Depending on the duration and type of symptoms you’re experiencing, your Gastroenterologist may suggest some initial tests or proceed straight to a treatment plan.
Most patients with mild and long stranding constipation are successfully managed with lifestyle interventions, often with dietary modification and gentle laxatives.
If investigations are required, these may include:

– a colonoscopy to rule out an underlying structural problem

– bloods tests to exclude systemic conditions such as thyroid disease

– stool tests

– pelvic floor and anal muscle tests

How do you treatConstipation?

Most patients with chronic but mild symptoms are successfully treated with lifestyle interventions including:

– Dietary changes (registered dietitian)

– Regular exercise and strengthening of the pelvic floor

– Taking daily non-fermentable fiber

– Taking an osmotic laxative eg. Polyethylene glycol/PEG (Osmolax, Movicol), lactulose – these draw water into the stool resulting in a softer, more frequent, easier to pass stool.

On the other hand, stimulant laxatives increase the contractions of muscles in the intestines which help to induce bowel movements (eg Senna, Bisacodyl/Dulcolax). These are preferably used in the short term.

In a minority of patients, stronger laxatives may be prescribed. Medications that stimulate the bowel may also be required.

The function of the pelvic floor and anal muscles (sphincters) can also be impaired in some patients with constipation. Retraining these muscles may be required.

This therapy is best performed by an experienced pelvic floor physiotherapist and may involve techniques such as ano-rectal biofeedback.

Finally, surgery is very occasionally recommended if a structural problem has been identified and does not respond to initial medical treatments.

Overall, constipation is a very common symptom experienced by many people in the community. It responds well to simple interventions and should not stop you from living a happy and healthy lifestyle.