Constipation is the inability to have a bowel movement and is a common medical ailment. It may be of short duration, occur suddenly, or be a chronic condition that presents intermittently over time. Constipation also affects people in different ways: some individuals may lack having a bowel movement altogether while others may have difficulty passing stools (straining) or have hard stools. In serious cases, stools can become impacted in the rectum, which requires medical intervention to remove.
The causes for constipation are many and varied, the most common being dehydration, a blockage in the intestines, the use of certain medications, pregnancy, ingesting low-bulk foods, nerve and muscle disorders within the colon and rectum, pelvic floor disorders, neurologic conditions such as Parkinson's disease, inflammatory bowel disease, diabetes, hypothyroidism and cancer. For more information or to schedule an appointment with a Virginia Mason gastroenterologist, call (206) 223-2319.
Symptoms associated with constipation include:
- Inability to have a bowel movement
- A difficult bowel movement (straining)
- Hard stools
- Abdominal pain
- Abdominal distension (bloated stomach)
Constipation that comes on suddenly (acutely) and is accompanied by rectal bleeding, abdominal pain, bloating or cramps may indicate a severe blockage in the colon and should be brought to the attention of a physician immediately.
Your gastroenterologist will take a detailed history and perform a physical exam to help determine the cause of your constipation. You will also be asked about your diet and any medications you are taking. Certain medications and supplements can cause constipation, including antidepressants, anticonvulsants, antacids, calcium channel blockers, narcotic pain medications and iron supplements.
Your gastroenterologist may then have you undergo the following tests and procedures to help in the diagnosis:
- BLOOD TESTS
A simple blood test can reveal whether constipation is being caused by an endocrine disorder, such as low thyroid levels or an increase in calcium in the body.
- ABDOMINAL X-RAYS
An x-ray of the abdomen can reveal how many stools are present within the colon.
- BARIUM ENEMA
During this procedure, barium sulfate — a contrast agent — is placed in the rectum and colon, which outlines these areas when viewed on X-rays. This procedure is performed in the Virginia Mason's Radiology Department. Your physician can determine if a physical deformity is present that is causing constipation.
- MOTILITY STUDIES
Motility or movement studies are often performed to determine if constipation is being caused by a disorder of nerves and muscles in the anus, rectum and colon. For the ano-rectal procedure, a thin flexible tube in inserted in the anus and rectum, and measurements are taken of muscular contractions.
The colonic motility study is performed as part of a colonoscopy procedure. During this exam, a thin flexible tube is passed through the colonoscope (endoscope) and measurements are taken of muscle activity in the colon. You will need to undergo a colon prep prior to this procedure.
Once the cause of your constipation has been determined, your gastroenterologist can determine the best treatment options for you, which may include:
- CHANGES IN DIET
Your gastroenterologist may recommend the addition of more fiber — fruits and vegetables — to your diet. Or he or she also may advise that you take fiber supplements (MetamucilTM). Fiber is bulk that helps move food throughout the gastrointestinal tract. When changing to a high-fiber diet, it is important to drink plenty of fluids so that the fiber does not become hardened and impacted in the bowel.
- REGULAR EXERCISE
Daily exercise, such as walking, helps to stimulate the bowel and keep you regular.
- CHANGES IN MEDICATIONS
Your gastroenterologist may suggest changes in medications that are known to cause constipation.
There are many different types of over-the-counter laxatives, including stimulants that cause muscular contractions in the colon; lubricants containing mineral oil; stool softeners that add water to stools; and those that increase the amount fluid in the colon (milk of magnesia). Your gastroenterologist can talk with you in more detail about the type of laxative best suited for you.
An enema is a common therapy for constipation and bowel cleansing. It involves introducing saline water or another solution with docusate or sodium phosphate (NOT soapsuds) into the anus and rectum, which causes contraction of muscles in the colon and rectum. An enema should be used infrequently because it can cause an imbalance in the body's electrolyte (potassium) levels.
An enema is NOT indicated in every case of constipation. Women who are pregnant, for example, and patients with intestinal obstruction or irritable bowel disease (syndrome) should NOT have an enema.
A suppository is considered a laxative but is introduced into the anus rather than taken by mouth. A suppository may contain bisacodyl, a stimulant, to help induce a bowel movement. Suppositories also should be used infrequently.
- NATURAL OR ALTERNATIVE REMEDIES
Mineral oil is a common natural agent used to treat constipation. However, its use comes with several caveats: mineral oil should only be used short term because it interferes with the body's ability to absorb vitamin K, an important component in blood clotting. For this reason it should not be used by pregnant women or by patients on blood thinners, such as warfarin (Coumadin).
Mineral oil also can cause pneumonia if it is aspirated (breathed) into the lungs. For this reason, the very elderly and patients who have had a stroke or have swallowing disorders should not use mineral oil for constipation.
- PRESCRIPTION MEDICATIONS
Your gastroenterologist may prescribe a medication, called a 5-HT4 receptor agonist, that, in effect, increases the amount of fluid in the small and large intestine. It is commonly prescribed for constipation and gastroparesis.