How To Improve Constipation: Unraveling the Causes of Chronic Constipation and Effective Strategies for Relief

What is constipation?

Most people suffer from constipation at some point in their lives, and many suffer in silence because they are embarrassed to talk about it. Constipation can mean a variety of things to different people: some people spend a long time in the toilet, others may have to strain, while others are primarily concerned with the number of bowel movements they have in a week.

The typical features of constipation are:

Having hard and lumpy stools that are difficult to pass out.
- Having less than 3 times of bowel motions per week.
- Feeling like you have to go to the toilet again soon after finishing a bowel movement.
- Bloating and nausea may happen in severe constipation.

We can treat the majority of constipation with a change in lifestyle habits and laxatives. Some people, however, may suffer from chronic constipation, which is constipation lasting more than 12 weeks in the last 6 months.

How does constipation develop?

Our digestive tracts are muscular tubes that contract in a rhythm, helping to move food particles through the system. When food passes through the colon (our large intestine), another process occurs: water absorption. By the time the food particles reach the end of the colon, it solidifies.

So, when the colon absorbs too much water from food waste, or when the colon’s muscle contractions are slow, the stool moves more slowly. This leads to constipation.

Constipation affects 2 – 3 out of every 10 people, and many factors can contribute to it.

Here are some common causes and risk factors where constipation is more likely to happen:

Lack of fibre: The main bulk of the stool is indigestible roughage from vegetables and fruits.

Dehydration: When we don’t drink enough fluids, the colon extracts more water from the food particles that pass through it, resulting in drier stools.

Lack of exercise: Constipation is more common in inactive people than in those who regularly exercise.

Side effects of certain medications: Some drugs, such as stronger opioid-based painkillers, iron tablets, antacids, and antidepressants, are well-known to cause constipation.

Changes in diet: A change in dietary habits to a low-fibre, or liquid-based diet can contribute to constipation.

Pregnancy: Hormonal changes during pregnancy can disrupt bowel habits in some women.

Underlying medical conditions: Medical conditions, particularly those that involve the gastrointestinal system such as inflammatory bowel disease, colorectal cancer, diabetes, or even irritable bowel syndrome can cause constipation.

Can constipation cause other health issues?

Frequent or prolonged constipation may result in the following problems:

Haemorrhoids: Straining too much can inflame blood vessels in your rectum, causing swelling and easy bleeding.

Anal fissure: Dry, hard stools may tear the anus’s delicate inner lining. Those who have been through it compare it to “passing a knife”, which is a painful experience.

Diverticulitis: Chronic constipation can cause pockets (diverticula) in the colon wall. Infection can occur if stool gets stuck in these diverticula.

Faecal impaction: This occurs when hardened faeces accumulate in the large intestine and the digestive tract’s muscles are unable to push them out.

Urinary incontinence: Your pelvic floor muscles stop urine from leaking out of your bladder. Straining too much can damage these muscles and cause urinary incontinence.

How does the doctor work out the cause of my chronic constipation?

A general physical examination by your doctor may reveal some clues to the cause of your constipation. The doctor may also perform a digital rectal examination, which involves inserting a finger into your bottom (rectum) to check for masses or abnormalities. If the doctor detects any abnormalities during the examination or suspects any illnesses that could be causing chronic constipation, they may order additional tests, such as:

Blood tests: Blood tests may detect a variety of conditions that leads to constipation, such as poorly-controlled diabetes, hypothyroidism, and hypercalcemia.

X-ray of the abdomen: X-rays are fast and widely available to help detect intestinal obstruction.

Colonoscopy: This procedure involves inserting a long, thin, flexible camera tube through your bottom into your large intestines to find the root cause of your bowel symptoms. Before the procedure, you will typically receive laxatives to help you empty your bowels.

A sigmoidoscopy is similar to a colonoscopy, but instead of checking the entire colon, it only checks the lower part of your colon.

Here are several other special tests to check for bowel movement functions:

Anorectal manometry: The anus and rectum have a special “gatekeeper”, the anal sphincter muscles. The anal sphincter muscles relax to allow proper passage of the stool, they also tighten to prevent passage of stool at the wrong time. Anorectal manometry measures the strength of the sphincter muscles and checks if they are functioning normally during bowel movements. The test helps doctors treat patients who have severe constipation or leaky stools.

Colonic transit study: This special X-ray examination can help check how fast food moves through your digestive system. You will receive and consume capsules containing differently shaped “radio-opaque” (visible on X-rays) markers for three days. Following that, you will need to go to the radiology department for an X-ray.

The position of the markers on the X-ray images will provide important information to the doctor about the function of your gut. These markers are harmless and will pass through your digestive system with your food without any problems.

Defecography: This is a “pooping study”. Defecography uses either fluoroscopic X-ray (video X-ray) or magnetic resonance imaging (MRI) to see how different muscles and organs are moving when you poop. This test is helpful, if your doctor thinks that your chronic constipation is caused by a problem with your pelvic floor or a prolapse of your organs.

Some considerations for testing in constipation:

You might begin to wonder, “Do I need to go through all of these tests for my constipation problem?”

Constipation usually comes with typical symptoms; we can address constipation with a change in lifestyle habits or a short course of medication. We only want to run additional tests to rule out other medical issues in the following scenario:

Change in bowel habit: if you’ve always had regular bowel movements and the constipation is new, with no obvious cause, such as a change in lifestyle, diet, or medication. A change in bowel patterns can sometimes indicate bowel cancer.

Severe constipation symptoms: Severe symptoms necessitate immediate medical attention and further testing.

Having new symptoms: New symptoms, such as passing blood, bouts of diarrhoea, weight loss, or other unexplained symptoms, warrant further investigations, especially if you have tried lifestyle changes and treatment.

Family history: Individuals with a family history of bowel cancer or inflammatory bowel disease may require additional testing to rule out these conditions.

How to avoid chronic constipation?

Most constipation is preventable by having good lifestyle habits. Here are some practical tips:

Stay hydrated: Drinking adequate amounts of water daily, between 6-8 glasses a day, is a good practice to prevent dehydration.
Take sufficient fibre: Foods high in fibre content include fruits, vegetables, and whole grains. Adding fibre to your diet will increase the volume of your faeces, which will help your digestive system work more efficiently.
Exercise regularly: Aside from keeping you fit, regular exercise can help food move through your colon faster. Aim for at least 30 minutes of exercise five days per week.
Toileting routine: We can train our bodies to establish a toileting routine. If your schedule or routine must change, try not to resist the urge to go to the toilet.

I am in the middle of a bad constipation, what can I take?

Here are some treatment options for dealing with constipation:

Laxatives: Laxatives come in a variety of forms, with some available over-the-counter and others requiring a doctor’s prescription. What sets them apart is how they work, how safe the treatment is, and your doctor’s preferences. These are the major categories of how laxatives work:

Bulk-forming laxatives aim to increase stool volume, making it more bulky and easier to pass. Fibre supplements are an example of a laxative that forms bulk. To avoid cramping and bloating, drink plenty of fluids while taking fibre supplements and gradually increase the dosage.
Hyperosmotic laxatives help to draw water into the bowel from surrounding organs. This in turn results in moist and softer stool, making bowel movements easier.Examples of hyperosmotic laxatives include macrogols, magnesium hydroxide, lactulose, and sorbitol syrup.
Stimulant laxatives include senna, bisacodyl, and sodium picosulfate. These laxatives speed up bowel movements by stimulating the nerves controlling the muscles lining your digestive tract.

Suppositories or enemas require manual insertion through your bottom. They are not the most pleasant form of treatment, but they work much faster to alleviate symptoms.

Biofeedback: Some people, especially women who have had a difficult childbirth, may have chronic constipation because their pelvic floor muscles don’t work together well. Biofeedback is a painless treatment that helps patients “retrain” their pelvic floor muscles, allowing them to control the right muscles during passing motion, thus alleviating constipation.

Surgery may be the answer for some cases of chronic constipation coming from intestinal blockages, such as intestinal strictures (narrowing) or rectoceles (prolapse of the rectum).

Is there a connection between chronic constipation and colorectal cancer?

Recent research has challenged the long-held belief that chronic constipation increases the risk of colorectal cancer. Constipation normally does not lead to colorectal cancer, but it can be an early symptom in some patients, especially if it occurs gradually in an otherwise healthy person who has never had constipation before.

Conclusion

Chronic constipation is a common condition that can affect anyone at any time. Most constipation is temporary and not serious; most people will find relief if they understand the causes, prevention, and treatment. Chronic constipation, on the other hand, can be debilitating in some people, necessitating additional testing.

Having said that, I advocate for people over the age of 45 to undergo screening tests for colorectal cancer if they are experiencing chronic constipation or a recent change in bowel habits because early detection can save your life.

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