Chronic constipation affects almost 15% of all adults and 30% of those over age 60. Fortunately, there are many effective treatments for long-term constipation.
What defines chronic constipation
Constipation can be defined in many ways, as bowel movement frequency can vary among healthy individuals — from three movements a day to three a week. However, constipation should be considered when more than three days pass between bowel movements. It’s one of the most frequent gastrointestinal problems in the United States, with over 2 million physician visits each year.
When constipation continues for more than a few months, it’s known as long-term or chronic constipation. Chronic constipation affects almost 15% of all adults and 30% of those over age 60. It’s characterized by difficult, infrequent, or incomplete bowel movements. Chronic constipation is defined as having two of the six following symptoms for more than three months: straining, hard stools, less than three bowel movements per week, use of manual maneuvers to help evacuate stool, sensation of incomplete bowel evacuation, or sensation of anorectal blockage. Complications due to excessive straining, such as hemorrhoids, anal tears or fissures, impacted stools and rectal prolapse, can result from constant constipation. Chronic constipation can significantly decrease quality of life, as sufferers can experience abdominal and rectal discomfort and feel sluggish or bloated, causing interference with their daily lives. A small minority of patients with chronic constipation have disorders of the gut nervous system resulting in slow transit constipation.
Fortunately, there are a number of effective treatment options for long-term constipation. Here are some of the possible actions to take, ranging from lifestyle modifications to prescribed medications, if you do have chronic constipation.
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Increase water intake
Drinking more water — at least eight 8-ounce glasses (8 x 8 rule) a day — can help move material through your digestive system and help keep stool soft.
Caffeine can be dehydrating; too much caffeine, coupled with not enough water, can slow the movement of material through your digestive system.
Increase fiber intake
Foods that are high in fiber —like whole grains, fruits, vegetables, beans, and bran — help improve gastrointestinal function. Low-fiber foods — like processed foods and dairy and meat products have the opposite effect. A daily diet that contains 20 to 30 grams of fiber aids in the formation of softer stool. If you find that adding more fiber to your diet causes bloating or gas, try adding it gradually.
Get more exercise
A sedentary lifestyle or lack of physical activity can contribute to the development of constipation. Exercising regularly stimulates intestinal activity and decreases the risk of constipation.
Get up and go
Don’t ignore the urge to pass stool. Get up and go. Putting it off can lead to a backup of stool that may harden and become impacted. It’s also wise to try to create and maintain a regular schedule for bowel movements, particularly after a meal.
Check your medications
Several medications can cause chronic constipation. Antacids that contain aluminum or calcium, anticonvulsants, antispasmodics, anticholinergics, antiparkinson drugs, antidepressants, calcium channel blockers, diuretics, iron supplements, and pain medications (particularly narcotics / opioids) can be at fault. Check with you doctor to see if your medications can be changed or eliminated.
When chronic constipation is caused by anorectal dysfunction, biofeedback can sometimes be helpful. It works by retraining the pelvic muscles that control the release of bowel movements. Learning how to relax and tighten these muscles can ease the evacuation of stool. Biofeedback has also been effective for some individuals with slow transit constipation.
Nutrition and dietary supplements
Consuming additional fiber through the use of supplements (along with adequate water) can have a positive effect on long-term constipation. It’s best, however, to check with your doctor before adding any supplements to your daily diet. Psyllium, a soluble fiber that comes from the shrub-like herb Plantago ovata, can help relieve constipation. The reaction between the psyllium husk and water forms a gelatin-like mass that helps move stool through the intestines. Another soluble fiber, glucomannan, is derived from the root of Amorphophallus konjac. Some studies have shown that it, too, can be helpful with resolving chronic constipation. Although probiotics help to keep the intestines healthy and in good working order, studies using them to treat constipation have yielded mixed results. Some of the most common types of probiotics include Lactobacillus, Bifidobacteria, and Saccharomyces boulardii.
Check with your doctor before adding herbs to your diet to treat long-term constipation as they can unwanted side effects as well as interact with other herbs, supplements, or medications. Herbs used to treat constipation are either bulk-forming or stimulant laxatives. Flaxseed, Linum usitatissimum, which is a bulk-forming laxative, contains soluble fiber and can be mixed with water. Herbs that are stimulant laxatives can cause pain, dehydration, and electrolyte imbalances and are only for short-term use.
Stool softeners work by increasing the water content of stool, thus helping ease its way through the intestines. Check with your doctor before embarking on a stool softener course to treat constant constipation.
There are different types of laxatives that are available without a prescription. However, all should be used under a doctor’s supervision because of the possible side effects and drug interactions. Bulk laxatives, also known as fiber supplements, must be taken with water. They work by helping retain water in the intestines, which helps form softer and bulkier stool that is easier to evacuate. Stimulant laxatives cause regular contractions in the intestinal muscles, which help move stool along. Osmotics cause fluids to move through the intestines in such a way as to cause distention or swelling. They may be useful for people with idiopathic constipation (constipation without any known cause). Lubricants, such as mineral oil or glycerin suppositories, can help stimulate bowel movements, making it easier to evacuate stool.
For some people, prescription medications are the only solution to chronic constipation. Two of them, lubiprostone and linaclotide, attract water into the intestines, which softens and speeds up the movement of stool. Consultation with your doctor will yield the best choice to treat your chronic constipation.
Underlying medical disorders
Sometimes underlying health problems can cause long-term constipation by slowing the passage of stool through your intestines, rectum, or anus. These include spinal cord or brain injuries or disorders (such as Parkinson’s disease), diabetes, or thyroid disorders. Treating the underlying medical disorder — like prescribed thyroid hormone replacement therapy for an underactive thyroid — can help resolve the chronic constipation.
Fecal microbiota transplantation
Also known as fecal bacteriotherapy or fecal infusion, this process refers to the transplantation of functional bacteria from the stool of a healthy donor to the gastrointestinal tract of the recipient suffering from chronic constipation. Studies to date on FMT are few in number though patients with slow transit constipation may benefit.
If all nonsurgical options have failed to control your chronic constipation and the cause is a blockage, fissure, stricture or rare cases of slow transit constipation, surgery may be an option to correct the underlying problem by removing part of the intestines. Your doctor can refer you to the proper surgeon who specializes in these procedures.