Constipation in Adults
Constipation is typically defined by physicians as having three or fewer bowel movements in a seven-day week. Constipation occurs when stool moves too slowly through the digestive system, cannot be eliminated from the rectum, or becomes difficult to pass. Any of these may cause the stool to become hard and dry over time, potentially leading to further complications. While occasional constipation is common, some individuals experience constipation over and over, which can interfere with their daily lives in many ways. Constipation can even cause extreme discomfort and pain depending on the severity of the condition.
Symptoms of Constipation in Adults
Some signs and symptoms of constipation include passing stools fewer than three times per week, having particularly hard or small stools, straining to pass stool, feeling as though your bowels cannot be completely emptied, and needing help to empty your rectum, such as pressing on your abdomen or using a finger to remove a stool from your rectum. Constipation may be considered chronic if these symptoms have been experienced consistently by an adult for three months or more.
Complications of Constipation in Adults
Chronic constipation can lead to a number of complications, any of which can affect the overall health of the individual experiencing constipation. Straining to pass a bowel movement may result in hemorrhoids, which are swollen veins in and around the anus. Hemorrhoids can bleed, and in some cases can be extremely painful. Another possible complication is an anal fissure, which can occur when a particularly large or hard stool results in small tears in the anus.
Chronic constipation may result in an accumulation of hardened stool that cannot pass through the digestive tract, a phenomenon known as fecal impaction. Fecal impaction can lead to cramping, rectal pain, and strong efforts to defecate with little stool production. In some cases, mucus or liquid stool will evacuate around the blockage, giving the patient the false impression of diarrhea. Fecal impaction is most commonly experienced by older adults, particularly those who are bedridden or have limited mobility. Fecal impaction is relatively rare but can have serious complications, such as urinary tract obstruction, perforation of the colon, dehydration, electrolyte imbalance, renal insufficiency, fecal incontinence, decubitus ulcers, stercoral ulcers, and rectal bleeding.
In addition, straining to pass a bowel movement can cause a portion of the rectum to stretch and protrude from the anus. This condition is known as rectal prolapse.
Causes of Constipation in Adults
Constipation most commonly results from decreased fiber intake, chronic dehydration, or an inactive lifestyle. Foods that contain fiber are the natural laxatives of the digestive system because fiber helps hold onto water in the stool and increases its bulk, making it easier to pass. Dehydration can lead to constipation because the body tries to conserve water in the bloodstream by removing excess water from stool.
Underlying disease processes such as Parkinson’s disease, colon cancer, or multiple sclerosis can also lead to constipation. Obstruction of the large intestine can be caused by certain types of cancer. Individuals who have previously undergone abdominal surgery may experience small bowel obstruction (resulting in abdominal pain and emesis), but not constipation, due to bands of fibrous tissue forming around the intestines and impeding normal bowel movements. People experiencing diabetes can develop nerve damage that affects nerves in the digestive tract, resulting in constipation. Injuries to the spinal cord can also interfere with nerves surrounding the intestines and result in obstruction of the bowels.
Constipation can also result from changes in diet or activity, consuming an excess of dairy products, resisting the urge to empty the bowels, the overuse of laxatives, stress, certain medications, eating disorders, pregnancy, irritable bowel syndrome, an underactive thyroid, pelvic dyssynergia, and poor bowel habits.
Constipation can also occur during a period of prolonged bed rest with a lack of physical activity preventing stool from moving throughout the digestive tract. A decrease in food intake, as well as the use of drugs with constipation as a known side effect, can also result in constipation.
Constipation Prevention for Adults
There are a number of factors that can help to avoid the onset of constipation. Having a diet that is high in fiber including beans, fruits and vegetables, whole grain cereals, and bran, can help prevent constipation. In addition, consuming plenty of fluids, maintaining an active lifestyle, and managing stress can all contribute to healthy bowel movements. Developing healthy bowel habits can also be necessary for avoiding constipation. It is important to never resist the urge to pass stool and to create a regular schedule for bowel movements, especially after consuming meals.
Diagnosis of Constipation
In addition to a general physical examination and a digital rectal examination, doctors can use blood tests to identify and diagnose constipation. In a blood test, a doctor will look for a systemic condition such as hypothyroidism or high calcium levels to diagnose constipation.
When needed, constipation can be further worked up with the help of a Sitzmark Study. This X-RAY evaluation is an outpatient procedure that helps us determine if the Constipation is resulting from dysfunction of the colon (Slow Transit Constipation), or from the inability of the rectum to coordinate with the pelvic floor to successfully evacuate its contents (Obstructed Defecation Syndrome).
In the setting of Obstructed Defecation Syndrome, some patients may benefit from a study called Dynamic Pelvic MRI Defecography to further help guide treatment.
NOTE: You may have come across an outdated method of diagnosing constipation (or several other structural or functional abnormalities of the large intestine) known as a barium enema. This is an x-ray examination of the lower gastrointestinal tract. This method should be avoided owing to too high a risk of perforation. The use of barium sulfate would allow the large intestine to be made visible on the x-ray because it highlights certain areas of the internal organs to help medical professionals identify any abnormalities that may be present.
Treatments for Constipation in Adults
While medications exist that can provide short-term symptomatic relief for constipation, they do not address the underlying disorder. When the etiology of the constipation is not adequately addressed, the symptoms tend to worsen over time, eventually requiring the use of even stronger medication than what would have been used initially.
While intervention at the earliest stages of symptom onset is ideal, often adults experiencing constipation will not seek evaluation from a proctologist until they are already dependent on medication to manage the condition or more alarming symptoms present themselves, such as hemorrhoids, rectal prolapses, fecal impaction, and fecal incontinence. After addressing any acute processes, a tailored evaluation allows RS Surgical to understand the pathophysiology of the individual. Many patients see significant improvement in their constipation with dietary changes, behavioral modifications, and guided exercises. The response is augmented by optimizing the selective use of supplements and medications that are most effective for the individual patient. Surgery for constipation is rarely required.
RS Surgical empowers patients by educating them on the underlying cause(s) of their symptoms and related management and treatment options so that they can minimize reliance on medications, prevent future disorders, and improve their overall quality of life. With effective intervention, constipation can be managed and the patient can typically move forward with minimal, if any, complications from treatment.