What is constipation?
Constipation is defined as having fewer than three bowel movements per week with straining to pass a bowel movement, passage of small hard stools, or having a sense of incomplete evacuation of the stool. One may also find passing a stool painful or feeling like the rectum is blocked. Constipation has many causes, but often occurs when the stool that forms after food is digested moves too slowly through the colon. When this happens, too much water is absorbed across the colon and the stool becomes hard and dry. Causes of constipation may include dehydration; certain prescribed or over-the-counter medications thyroid disease; changes in diet, like a low-fiber diet; or a bowel obstruction. Constipation can also be related to age-related decreases in motility (speed of the GI tract), from certain systemic diseases and a loss of enteric neurons. Chronic idiopathic constipation (CIC) is a common cause of constipation in which there is no single identifiable factor that has resulted in this condition.
What are the symptoms of constipation?
Constipation is common, and symptoms include infrequent bowel movements or difficulty with having a bowel movement, lower abdominal pain, bloating and fullness.
If constipation is associated with rectal bleeding, weight loss, or severe abdominal pain, or the symptoms have a very sudden onset, please seek urgent medical attention.
How is constipation diagnosed?
A careful history and physical exam are important parts to the diagnosis of constipation, and a good history alone can often help make the diagnosis. It is important, however, to consult a medical professional if symptoms have happened acutely/abruptly, or symptoms are worsening. Structural evaluation with imaging (CT, Sitz marker studies, ultrasounds) and endoscopy (colonoscopy or sigmoidoscopy) are warranted to exclude an anatomical cause for the new or worsening symptoms. Other pelvic diseases including uterine fibroids, endometriosis and malignancy/cancer are important to exclude as causes of new onset constipation.
Pelvic floor dysfunction is another common reason for constipation. This is a broad condition that describes the decline in function of various muscles of the pelvis and lower abdomen, and can result or contribute to constipation. Tests to evaluate this include an anorectal manometry, or MR defecography. Another recommendation may be to undergo a Smart Pill exam. This test can determine how fast or slow the stomach, small bowel and colon are moving.
How is constipation treated?
A combination of adequate fluid intake, a high fiber diet and exercise may be sufficient to improve or resolve constipation. Depending on the cause, a physician or advanced practice provider may recommend medication changes, both adding and eliminating. There are various prescription and over-the-counter products that can help improve symptoms of constipation and improve quality of life. Pelvic floor physical therapy is often very helpful for constipation related to pelvic floor dysfunction.
Our experienced team of physicians and advanced practice providers at Associates in Gastroenterology can help you with your concerns, questions and management of all aspects of gastrointestinal and liver disease. We would love to be your gastroenterology practice.lease schedule an appointment either by calling us (719-635-7321) or by clicking here.
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