Constipation Causes, Diagnosis, and Treatment

Symptoms

• Having fewer than three bowel movements per week.
• Stools that are hard, dry, or lumpy.
• Difficulty or pain when passing stool.
• Stomach discomfort or cramping.
• Feeling bloated or nauseous.
• A sensation that your bowels aren’t fully emptied following a movement.

Risk Factors

Anyone can experience constipation occasionally, but some factors increase the likelihood of chronic constipation, including:

• Age: Individuals over 65 tend to be inactive, have a slower metabolism, and experience weaker muscle contractions in the digestive tract.
• Hormonal changes: Pregnancy and postpartum hormonal shifts can contribute to constipation. A growing foetus may also compress the intestines, slowing stool movement.
• Low-fibre diet: Insufficient fibre intake can slow digestion and make bowel movements more difficult.
• Medications: Certain drugs can contribute to constipation.
• Neurological and digestive conditions: Diseases affecting the brain, spinal cord, or digestive system may increase constipation risk.

Causes

Constipation can result from various factors, including lifestyle habits, medications, and health conditions.

Lifestyle factors

• Insufficient fibre intake.
• Dehydration from not drinking enough water.
• Lack of physical activity.
• Disruptions to routine, such as changes in sleep, diet, or travel.
• Consuming excessive amounts of cheese and milk.
• High levels of stress.
• Ignoring the need to have a bowel movement.

Medications

• Pain relievers. Opioids such as codeine, oxycodone (OxyContin®), and hydromorphone (Dilaudid®).
• NSAIDs. Ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
• Antidepressants. SSRIs like fluoxetine (Prozac®) and tricyclic antidepressants like amitriptyline (Elavil®).
• Antacids that contain calcium or aluminium.
• Iron supplements.
• Antihistamines such as diphenhydramine (Benadryl®).
• Blood pressure medications. Calcium channel blockers (verapamil, diltiazem, nifedipine) and beta-blockers (atenolol).
• Psychiatric drugs. Clozapine (Clozaril®) and olanzapine (Zyprexa®).
• Antiseizure drugs. Phenytoin and gabapentin.
• Antinausea medications. Ondansetron (Zofran®).

Medical conditions

Several health issues can contribute to constipation, including:

• Endocrine disorders. Hypothyroidism, uraemia, diabetes, and hypercalcaemia.
• Irritable bowel syndrome (IBS).
• Colorectal cancer.
• Diverticulitis.
• Pelvic floor dysfunction: Issues like outlet dysfunction and constipation, where muscles fail to coordinate appropriately.
• Obstructed defecation syndrome: Unexplained difficulty passing stool.
• Intestinal pseudo-obstruction: A temporary paralysis of the colon’s motor system, such as in paralytic ileus or Ogilvie syndrome.
• Neurological disorders. Spinal cord injuries, Parkinson’s disease, multiple sclerosis, and strokes.
• Lazy bowel syndrome. Poor colon contractions leading to stool retention.
• Intestinal blockage.
• Structural abnormalities in the digestive tract like colonic atresia, intussusception, volvulus, imperforate anus, and malrotation.
• Autoimmune diseases such as lupus, amyloidosis, and scleroderma.
• Pregnancy

Diagnosis

It’s important to consult your GP if you experience any of the following:

• Persistent fatigue.
• Bloody stools or significant changes in their consistency, size, and shape.
• Constipation or bloating lasting two weeks or longer.
• Severe pain while passing stools or an inability to pass stools or gas.
• Sudden constipation accompanied by stomach cramps or pain.
• Unexplained weight loss.

Diagnostic tests:

Your doctor will review your symptoms and medical history and may perform a physical examination. If necessary, they may order more tests, including:

• Stomach X-ray
• Anorectal manometry to assess rectal muscle strength.
• Blood tests to examine thyroid function and calcium levels.
• Colonoscopy. Uses a flexible tube attached to a camera to inspect your colon for blockages.
• CT scan. Done to identify digestive system obstructions.
• Transit study. Special capsules are swallowed and tracked via X-ray to determine food movement through the digestive tract.

If needed, your provider may refer you to a specialist in digestive health called gastroenterologist.

Treatment

Normally, constipation can be relieved with simple dietary and lifestyle changes. Home remedies include:

• Staying hydrated: Drink two to four additional glasses of water daily unless advised otherwise due to medical conditions or drugs. Warm fluids, especially in the morning, may also help.
• Increasing physical activity
• Establishing a routine: Try to pass stools at the same time each day without rushing. Avoid delaying bowel movements whenever you feel the need.
• Eating more fibre: Incorporate fruits (such as prunes), vegetables, and wholegrain foods like cereals, wholemeal bread, and pasta. Adding oats, wheat bran, or linseed to your diet can also be beneficial.
• Adjusting toilet posture: Slightly raising feet on a stool or a book while sitting on the toilet can help ease bowel movements.

If your constipation is caused by medication, such as opioid painkillers, speak with your GP before making any changes. Never discontinue the prescribed drug without medical advice.

In addition, you should seek medical attention if lifestyle changes and over-the-counter treatments are ineffective.

If constipation persists, your doctor may recommend laxatives or other medications. They may also refer you to a dietitian for expert guidance on managing constipation.

Conclusion

It’s important to always speak openly with your GP about your bowel movements and any concerns you may have. Pooping is a natural and necessary function. Constipation can be temporary, a chronic issue, or even a symptom of an underlying condition. Prioritize your health—seek medical advice if your bowel habits change or if constipation is significantly affecting your daily life.

For more information or to address any concerns, book an appointment with us today.