Chronic Constipation – Symptoms, Diagnosis, Treatment and

Constipation, in medical terms is defined as less than three bowel movements per week. Less than a single bowel movement per week is considered to be severe constipation. Constipation can lead to physical discomfort, cramps, nausea, vomiting, abdominal pain, rectal bleeding, bloating and sometimes fecal impaction (hardening of stool inside the rectum thus blocking the further passage of stool).

Constipation can be acute constipation (recent onset) or chronic constipation (long duration). Acute constipation may be due to a serious medical cause and hence immediate treatment is required. There are several treatments for constipation. However it is essential to determine the underlying cause before deciding on a treatment method. A few of the treatment methods for constipation are described below.

Dietary fiber (bulk-forming laxatives) – Fiber is one of the basic elements in the treatment of constipation. Ensuring adequate intake of fibers can help to provide considerable relief from constipation. Fruits and vegetables are rich in fibers and therefore a minimum of five servings of fruits or vegetables should be eaten daily. For those who have difficulty taking fruits and vegetables, fiber supplements are available. Fiber works by binding to water and maintaining the water inside the intestine. The water helps to soften the stool and the fiber increases the volume of the stool.

There are different sources of fiber, the most common ones being:

-        Fruits and vegetables

-        Wheat or oat bran

-        polycarbophil (for example, Equilactin, Konsyl Fiber).

-        psyllium seed (for example, Metamucil, Konsyl),

-        synthetic methyl cellulose (for example, Citrucel)

-        Malt extract (for example, Maltsupex)

Flatulence or increased gas is a side effect of high fiber diets. While taking fibers, it should be started with a low dose and gradually increased every one to two weeks till relief from constipation is achieved or flatulence occurs. If flatulence develops, then the dosage can be reduced for a few weeks and then increased dose can be tried again. If flatulence persists, then try a different source of fiber. With higher doses of fiber, it is recommended to drink greater amounts of water to prevent hardening of the fiber and possible blockage of the intestine. People with strictures or adhesions should not use fiber without consulting a doctor.

Emollient laxatives – These laxatives, also known as stool softeners contain a wetting agent called docusate that allows water within the colon to enter and mix with stool thus softening the stool. These laxatives are commonly used to soften the stool temporarily and relieve constipation (e.g. childbirth, after surgery, or heart attacks). They are also used given to people with hemorrhoids or anal fissures.

Lubricant laxatives – The use of lubricant laxatives is used for the short term treatment of constipation.  These laxatives contain mineral oil as such or a combination of oil with water. The oil coats the contents in the intestine and helps to retain the water in the stool resulting in softer stool. This however is not suitable for the long term treatment because of certain disadvantages. The oil sometimes causes the absorption of fat soluble vitamins leading to their deficiencies in the long run. It may also lead to lipid pneumonia in very young children or elderly people.

Saline laxatives – These laxatives contain ions such as magnesium, phosphate, sulfate, and citrate that are non-absorbable. These ions remain in the colon and cause the retaining of water within the colon. This again leads to softening of the stool. The effect of saline laxatives takes place within a few hours.

Hyperosmolar laxatives – These are compounds which cannot be digested or absorbed. They stay within the intestine and retain the water that is already present in the colon resulting in softer stool. These laxatives are safe for long-term use and are associated with few side effects.

Stimulant laxatives – Stimulant laxatives works by increasing the amount of water in the stool and causing the speedy movement of stool by the muscles of the small intestine and colon. These laxatives are found to be very effective but are likely to produce certain side effects such as severe diarrhea, dehydration, loss of electrolytes and intestinal cramping.

Lubiprostone (Amitiza) – This is another drug that is used in the treatment of chronic constipation by increasing the production of chloride ions and produces a chloride rich fluid secretion that softens the stool, increase motility and help in spontaneous bowel movements. Mild to moderate nausea has been reported as a possible side effect of this drug.

Tegaserod (Zelnorm) – This is a medication used in the treatment of chronic constipation. The contractions of the intestinal muscles are controlled by chemical called serotonin. When Serotonin binds to 5-HT4 receptors on the muscle cells, contractions are prevented. What Tegaserod does is that it blocks the 5-HT4 receptors so that serotonin is prevented from binding to it. This results in increased contractions of the intestinal muscles and the rapid removal of the contents of the intestine. Side effect of this medication includes mild diarrhea.

Colchicine – This drug primarily used for the treatment of gout (a type of arthritis caused by the deposition of uric acid crystals in the joints) has been found to loosen stool and relieve constipation.

Enemas – Enemas stimulate the contraction of the colon and allow the easy elimination of stool. This type of treatment is highly beneficial when the stool has hardened in the rectum. Elimination of stool usually occurs between a few minutes and one hour after the enema is given. Enemas are not suitable to be used regularly as they can cause fluid and electrolyte imbalance in the body.

Suppositories – Laxative suppositories are available which are drugs inserted into the rectum to stimulate bowel movements. There are many different types of suppositories and each has different mechanism of action.

Surgery – Surgical removal of a part of the colon is the only treatment for individuals who do not respond to all other therapies or for those suffering from chronic constipation caused by diseases of the colon or laxative abuse.

In majority of the cases, a change in lifestyle and diet can help relieve constipation. A high fiber diet, regular exercise, and adequate fluid intake are a few of the changes that can bring about a tremendous relief to constipation.