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Chronic Constipation

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Constipation is technically defined as having less than three bowel movements in a week. Many people have bowel movements several times a day, while others have them only once or twice a week. If you don’t stray too far from your regular pattern, whatever your bowel movement pattern is, it’s unique and normal for you.

Other key features that usually define constipation include:

  • Your stools are dry and hard.
  • You have a feeling that you have not fully emptied your bowels.
  • Your bowel movement is painful and stools are difficult to pass.

Causes of Chronic Constipation

The most common cause of constipation is slow digestion or an inability to eliminate waste from the rectum, resulting in the hard and dry stool. Chronic constipation has many possible causes.

  • Blockages in the colon or rectum
  • Problems with the nerves around the colon and rectum
  • Difficulty with the muscles involved in the elimination
  • Conditions that affect hormones in the body such as underactive thyroid, pregnancy, overactive parathyroid gland, and diabetes

Symptoms of Chronic Constipation

Need help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

  • Feeling as though you can’t empty the stool from your rectum
  • Feeling as though there’s a blockage in your rectum that prevents bowel movements
  • Straining to have bowel movements
  • Having lumpy or hard stools
  • Passing fewer than three stools a week
  • Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

Risk Factors of Chronic Constipation

Factors that may increase your risk of chronic constipation include:

  • Being a woman
  • Being an older adult
  • Being dehydrated
  • Getting little or no physical activity
  • Eating a diet that’s low in fiber
  • Having a mental health condition such as depression or an eating disorder
  • Taking certain medications, including opioid pain medications, sedatives, some antidepressants or medications to lower blood pressure

Diagnosis for Chronic Constipation

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

  • An x-ray
  • Blood tests
  • Colonoscopy
  • Sigmoidoscopy
  • Balloon expulsion test
  • Anorectal manometry
  • Colonic transit study
  • Defecography
  • MRI defecography

Treatment and Medications for Chronic Constipation

Constipation is generally treated by making dietary and lifestyle changes that will increase stool passage speed. You may need to see a doctor if those changes do not help.

  • Diet and lifestyle changes
  • Laxatives
  • Over-the-counter medications

If over-the-counter medications don’t help your chronic constipation, your doctor may recommend prescription medication, especially if you have irritable bowel syndrome:

  • Lubiprostone (Amitiza)
  • Plecanatide (Trulance)
  • Linaclotide (Linzess)
  • Prucalopride (Motegrity)
  • Naloxegol (Movantik)
  • Methylnaltrexone (Relistor)

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