Constipation is the most common digestive complaint in the United States. Approximately 80% of people will suffer from constipation at some point during their life. Constipation is a symptom that has different meaning to different individuals. Normal bowel function can range from three times per week to three times per day. Constipation most commonly refers to infrequent bowel movements on an ongoing basis, greater than 3 weeks. Constipation is also defined as the need to strain to have a movement or incomplete rectal evacuation. The need for enemas, suppositories or laxatives in order to maintain regularity is common in patients who have severe prolonged constipation.
There are numerous causes for constipation. Identifying the cause of constipation is essential to successful treatment. Common causes include but are not limited to:
- Sedentary (inactive) lifestyle
- Chronic laxative use
- Ignoring the urge to have a bowel movement
- Narrowing of the colon
- Pelvic floor dysfunction
- Some medical diseases
Testing and Diagnosis
History and Physical: After discussing your symptoms, medical history and bowel habits, your physician may perform a physical exam of the anal area to rule out any obvious conditions causing your constipation
Colonoscopy: Visual examination of the intestine using a flexible lighted instrument. This test is performed in an outpatient setting with the patient under IV sedation. (see colonoscopy)
Colonic Transit Studies: Transit studies measure the rate at which stool moves through the colon. The test, commonly referred to as a Sitz marker test, involves swallowing a capsule that contains tiny rings visible on X-ray. The patient has X-rays taken three and five days later, the rings are identified and their location documented. The rate at which the rings move through the colon defines the patient’s colonic transit time.
Defecography: X-ray pictures and video demonstrate how the rectum empties and determines if any other organs are involved. Barium contrast medium is introduced into the patient’s rectum, and the patient is asked to evacuate the barium as if having a bowel movement. Video X-rays are also taken while the patient is asked to cough, strain and bare down while sitting on a radiology commode.
Surface Electromyography (EMG): This is a test, performed in the office, to measure the activity of the nerves going to the anal muscles. Small sensors are used to record the nerve activity while the patient relaxes and tightens the muscles.
Anal Manometry: This is a test, performed in the office, to measure the strength of the anal muscles. A small flexible tube is placed in the anus and records muscle strength while the patient relaxes and tightens the muscles.
A large number of patients can be successfully treated with dietary changes. Fiber therapy includes adding fiber to the diet through food as well as including an oral fiber supplement, to reach the recommended 25-30 grams daily. Fluid intake should equal 8-10 glasses daily.
Some patients may benefit from establishing a daily bowel routine with laxatives, suppositories or enemas. Physical therapy may be used to retrain the anal sphincter muscles.
In extreme cases, some patients may require surgery. Your physician will determine if surgery is indicated.