Chronic constipation is infrequent or difficult bowel movements lasting more than a few weeks.

Constipation is commonly described when a person has less than 3 bowel movements per week.

Occasional constipation is very common, but some people suffer from chronic constipation and it can affect their ability to carry out their daily tasks. Chronic constipation also causes people to have bowel movements which causes one to become nervous.

Treatment of chronic constipation depends in part on the underlying cause. However, in some cases no cause can be found.

Symptoms Of Constipation

Symptoms of chronic constipation include:

• Fewer than 3 bowel movements per week

• have lumpy or hard stools

• straining for defecation

• Feels like your rectum is blocked and is preventing you from having a bowel movement

• A feeling that the stool cannot be completely expelled from the rectum. 

Constipation can be considered chronic if one has had 2 or more of these symptoms in the last 3 months.

Causes Of Constipation

Constipation usually occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which can cause stools to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

• Tiny tears in the skin around the anus (anal fissure)

• A blockage in the intestines (bowel obstruction)

• Colon cancer

• Narrowing of the colon (bowel stricture)

• Other abdominal cancer that presses on the colon

• Rectal cancer

• Rectum bulge through the back wall of the vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

• Damage to the nerves that control bodily functions (autonomic neuropathy)

• Multiple sclerosis

• Parkinson's disease

• Spinal cord injury

• Stroke

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• The inability to relax the pelvic muscles to allow for a bowel movement (anismus)

• Pelvic muscles that don't coordinate relaxation and contraction correctly (dyssynergia)

• Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. 

Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes

• Overactive parathyroid gland (hyperparathyroidism)

• Pregnancy

• Underactive thyroid (hypothyroidism)

Risk factors Of Constipation

Factors that may increase your risk of chronic constipation include:

• Being an older adult

• Being a woman

• Being dehydrated

• Eating a diet that's low in fiber

• Getting little or no physical activity

• Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure

• Having a mental health condition such as depression or an eating disorder

Prevention Of Constipation

The following can help you avoid developing chronic constipation.

• Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.

• Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.

• Drink plenty of fluids.

• Stay as active as possible and try to get regular exercise.

• Try to manage stress.

• Don't ignore the urge to pass stool.

• Try to create a regular schedule for bowel movements, especially after a meal.

• Make sure children who begin to eat solid foods get plenty of fiber in their diets.

Diagnosis Of Constipation

In addition to a physical exam and digital rectal exam, doctors use the following tests and procedures to diagnose chronic constipation and try to find the cause:

• Blood tests: Your doctor will look for a systemic condition such as low thyroid (hypothyroidism) or high calcium levels.

• X-ray: X-rays can help doctors determine if our intestines are blocked and if there is stool in the colon.

• Examination of the rectum and lower colon or sigmoid colon (sigmoidoscopy): During this procedure, your doctor inserts a flexible, lighted tube into your anus to examine your rectum and lower part of your colon.

• Examination of the rectum and entire colon (colonoscopy): This diagnostic procedure allows the doctor to examine the entire colon using a flexible tube with a camera attached.

• Evaluation of anal sphincter function (anorectal manometry): During this procedure, your doctor inserts a narrow, flexible tube through your anus and rectum, then inflates a small balloon at the end of the tube. The device is then pulled back through the sphincter. This procedure allows your doctor to measure the coordination of the muscles you use to have a bowel movement.

• Evaluation of anal sphincter muscle speed (balloon expulsion test). Often used along with anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.

• X-ray of the rectum during defecation (defecography): During this procedure, your doctor inserts a soft patch made of barium into your rectum. You then pass the barium mixture out in the same way that you have a bowel movement. Barium shows up on X-rays and can reveal prolapse or problems with muscle function and coordination.

• MRI defecography: During this procedure, as in barium defecography, your doctor inserts a contrast gel into your rectum. Then you pass the gel. An MRI scanner can visualize and evaluate the function of the defecation muscles. This test can also diagnose problems that can cause constipation, such as rectal prolapse or rectal prolapse.

Treatment For Constipation

Treatment for chronic constipation usually begins with dietary and lifestyle changes that increase the speed at which stool moves through your intestines. If these changes don't help, your doctor may recommend medication or surgery.

Diet and lifestyle changes

Your doctor may recommend the following changes to relieve your constipation:

• Increase your fiber intake. Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.
  Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.
  A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.

• Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.

• Don't ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.

Laxatives

Several types of laxatives exist. Each works slightly differently to make bowel movements easier. The following products are available over the counter:

• Fiber Supplements: Fiber supplements add bulk to your stool. Bulky stools are softer and easier to pass. Fiber supplements include psyllium (Metamucil, Konsyl, others), calcium polycarbophil (FiberCon, Equalactin, others), and methylcellulose (Citrucel).

• Stimulant: Stimulants like bisacodyl (Correctol, Dulcolax, others) and sennosides (Senokot, Ex-Lax, Perdiem) cause your intestines to contract.

• Osmotics: Osmotic laxatives help stool move through the colon by increasing fluid secretion from the intestines and helping to stimulate bowel movements. Examples include oral magnesium hydroxide (Phillips' Milk of Magnesia, Dulcolax Milk of Magnesia, others), magnesium citrate, lactulose (Cholac, Constilac, others), polyethylene glycol (Miralax, Glycolax).

• Lubricant: Lubricants like mineral oil allow stool to move more easily through your colon.

• Stool softener: Stool softeners such as docusate sodium (Colace) and docusate calcium (Surfak) moisten stool by drawing water from the intestines. 

• Enemas and suppositories: Douching with tap water with or without soap bubbles can be helpful in softening stools and creating stools. Glycerin or bisacodyl suppositories also help remove stool from the body by lubricating and stimulating.

Surgery

Surgery may be an option if you've tried other treatments and your chronic constipation is caused by a blockage, rectal prolapse, or stricture.

For people who have tried other treatments without success and stools move unusually slowly through the colon, surgical removal of part of the colon may be an option. Total colectomy is rarely needed.

When to see a doctor

Make an appointment with your doctor if you experience unexplained and persistent changes in your bowel habits.