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Chronic Constipation

Constipation, what is it?  This means that a person has three or fewer bowel movements in a week.  The stool may be dry and hard, often painful to pass.  This is very common but in most cases it only lasts a short time and is not serious.  Chronic constipation can mean infrequent bowel movements for weeks at a time or having difficulty passing stools.  It can be described as having the feeling that you need to have a bowel movement but, no matter what, the stool does not move out of the body.  Your stools may be formed, hard, small balls or a combination of them.

What’s normal and what’s not?

Chronic Constipation Myth:  It is abnormal if I don’t have a bowel movement every day. Fewer than 5 or 6 bowel movements a week is considered to be chronic constipation.

Truth:  Less than 50% of people have one bowel movement each day.  The majority of adults have between 3 and 21 bowel movements each week.  Even just having 3 bowel movements in a week’s time is normal.

What are the causes of constipation?  

  • Slow movement of stool through the colon

  • Delayed emptying of the colon due to pelvic disorders

  • Lack of physical activity

  • Certain medications

  • Ignoring the urge to have a bowel movement

  • Other medical conditions

There are things you can do to help prevent constipation and these include:

  • Eating foods that are high in fiber (fruits, vegetables and grains)

  • Drinking 8-10 glasses of water a day

  • Routine exercise

  • Ask your provider for alternative medications that do not cause constipation

Diagnosing constipation:

Your provider will start with a medical history, perform a physical exam and perform diagnostic tests.  

  • The physical exam may include a digital rectal exam where your provider will have you lie on your side with your knees close to your chest.  The provider will insert a gloved lubricated finger into the anus to check for tenderness, blood and muscles functionality.

  • If a diagnostic test is indicated, this may be simply be a blood test to check for other contributing conditions or you may be ordered a flexible sigmoidoscopy or colonoscopy in order to view the rectum and entire colon and biopsy if needed.  Other tests may include a transit study, anal manometry, x-ray, MRI or CT scan depending on what your provider suspects is the cause.

Treating constipation:

Your provider will order a treatment depending on the cause of your constipation, the severity of your constipation and the duration of your constipation.  Treatments include:  Dietary changes, nutritional education, exercise and lifestyle changes, over-the-counter medications and bulk-forming agents.  It also may be necessary to prescribe a medication.