Complications

Complications of chronic constipation include:

  • Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
  • Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
  • Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
  • Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

Prevention

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

In addition to 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:

  • Blood tests. Your doctor will look for a systemic condition such as low thyroid (hypothyroidism) or high calcium levels.
  • An X-ray. An X-ray can help your doctor determine whether our intestines are blocked and whether there is stool present throughout the colon.
  • Rectal biopsy sometimes.

Treatment

Treatment for chronic constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through your intestines. If those changes don’t help, your doctor may recommend medications 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. Laxatives Several types of laxatives exist. Each works somewhat differently to make it easier to have a bowel movement. The following 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).
  • Stimulants: Stimulants including 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 secretion of fluid 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).
  • Lubricants: Lubricants such as mineral oil enable stool to move through your colon more easily.
  • Stool softeners: Stool softeners such as docusate sodium (Colace) and docusate calcium (Surfak) moisten the stool by drawing water from the intestines.
  • PEG powder is used mainly in children Regular follow up is necessary with your health care provider.

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC