CONSTIPATION IN ADULTS

Thomas Peller, MD, FACP
Gastroenterology
Eau Claire GI Associates
Eau Claire

Constipation in the United States is common. Up to 25% of the population suffers from constipation and over 2.5 million people visit their physician each year because of this complaint.

Most physicians define constipation as infrequent bowel movements (studies have shown that normal bowel frequency can be anywhere from 3 times per day to 3 times per week). Patients, on the other hand, define constipation as a disturbance in their bowel function. Frequently patients will equate constipation with the need to strain to have a bowel movement. Some feel they are constipated when they have hard stools or have the urge, but without results. Others feel they are constipated because they have infrequent movements and the feeling of incomplete evacuation after a movement.

Constipation itself is not a disease but rather a symptom. A symptom implies that there has been a departure from normal function. Before discussing causes for constipation, some knowledge of normal bowel function will be helpful. The digestion process removes nutrients from the food we have ingested as the food (or chyme) moves through the small intestine (small bowel). The “waste” that is left over after the nutrients have been removed then moves into the colon (large intestine).  This “waste” includes more than a quart of water. The colon’s job is to absorb most of this water so that the stool that is formed is soft without being watery. If the passage through the colon is too slow, too much water will be absorbed resulting in a drier harder stool that is difficult to pass.

Once the stool has moved into the rectum, a series of events will trigger an “urge” to have a bowel movement. By acting on this “urge” the normal relaxation of the anal sphincters and muscles will occur and the rectum will pass out the stool.

The causes of constipation include problems that affect:

• water absorption in the colon
• bowel motility and
• relaxation of the anal sphincters and muscles

A common cause is a poor diet. Animal fats and refined sugars tend to slow down intestinal motion resulting in more water absorption from the colon. Fiber, on the other hand improves intestinal motility, allowing more water to stay in the stool. This retention of water in the intestine results in larger stools, which the intestine can then “move” easier. However, in order for fiber to work, one also needs to increase water consumption.

Pregnancy, hormonal disturbances such as thyroid dysfunction, inactivity (as happens with illness, aging and travel), hemorrhoids and anal fissures can all slow down bowel motility or affect the normal relaxation of anal muscles, resulting in constipation.

Some people develop constipation by ignoring the urge to have a bowel movement. They may ignore the urge because of a busy schedule or fear of public restrooms.  If this urge is constantly ignored, the body can become desensitized to this feeling resulting in progressive constipation.

Another common cause is imaginary constipation. This results from the misunderstanding of what constitutes a normal or abnormal bowel movement. Some people have been falsely taught that if you don’t have a bowel movement every day,  waste products will accumulate in their intestinal tract causing excessive weight gain and poisoning their blood with toxins. This is not true.

An overlooked cause of constipation can be medications, especially those that slow down intestinal motility. These may include pain medications (especially narcotic pain medications), antidepressants, iron supplements, and certain drugs for high blood pressure and Parkinson’s disease.

Testing is sometimes necessary to rule out more complicated causes of constipation. These can be routine blood tests to check for electrolyte imbalance, anemia and thyroid dysfunction. More complex testing might include inserting an endoscope into the lower colon to check for obstruction of the bowel, inflammation, diverticular disease or tumors. Testing might be needed to assess whether or not the muscles in the rectum and anus can contract and relax normally.

Most of the time constipation is not related to serious disease and easily remedied through dietary adjustments, exercise, education and reviewing medications.

Your doctor should be notified if you develop:

• Severe or prolonged constipation
• Constipation associated with bleeding, rectal pain, or soiling of undergarments
• Significant and prolonged change in your normal bowel habits

For more information or to schedule an appointment with Dr. Thomas Peller, Eau Claire GI Associates, call  715.552-7303.  Dr. Peller also sees patients in Chippewa Falls