2015-10-29 17:03:32 UTC

Constipation 107: Managing Chronic Constipation

Learn more about managing chronic constipation in this patient companion, based on the AGA Clinical Guideline.

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: AGA Medical Position Statement on Constipation

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

Contents:

What Is Chronic Constipation?

A Gastroenterologist Can Help

Testing For Chronic Constipation

Treatments for Chronic Constipation

Questions For Your Doctor

 


What is chronic constipation?

  • Constipation is defined as having less than three bowel movements per week. When this lasts for three weeks or longer, is it considered chronic constipation. 
  • Chronic constipation is a common health issue that has a number of possible causes.
  • In many cases, the root cause is unknown. Working with your doctor to get an accurate diagnosis will help him or her give the best path of treatment.
  • Around 16 percent of American adults, and one-third of adults over the age of 60, have had chronic constipation.
  • Symptoms can differ from one person to another. Common symptoms of chronic constipation are:
    • Straining during a bowel movement.
    • Feeling that a bowel movement is incomplete.
    • Taking a long time to pass a bowel movement.
    • Passing hard, lumpy stools.
    • Anal fissures, or small, painful tears in the lining of the anus.
    • Belly pain, bloating (swelling) and/or discomfort.
  • Short bouts of constipation are common. Simple changes to your diet and lifestyle can help resolve constipation without the need to see a doctor or take medication. Try these tips:
    • Include more high-fiber foods, such as whole grains, fruits and veggies, into your diet.
    • Make time for moderate exercise, such as brisk walking, riding a bike or mowing the lawn. Experts recommend getting at least two-and-a-half hours of exercise per week.
    • Drink plenty of fluids. Women should drink at least nine cups of liquid per day, and men should drink at least 13.
    • Set aside some time for a trip to the toilet after a meal, when a bowel movement is more likely to happen.
    • Don’t ignore the urge to have a bowel movement.

A Gastroenterologist Can Help

For constipation that doesn’t go away with small changes, a gastroenterologist can help.

  • If your constipation gets worse or does not go away within three weeks, see a gastroenterologist. You can find a doctor near you using the AGA GI Locator Service. You can also read more about constipation, why it occurs and when to see a doctor.
  • If you visit the doctor with constipation, he or she should first take your medical history and complete a physical exam.
  • If you have a family history of colon cancer or other digestive issues, tell your doctor.
  • Before figuring out the cause of your constipation, your doctor should suggest fiber and/or over-the-counter (OTC) laxatives to see whether one of these easy remedies can help your issues.
  • Based on your history, he or she may decide to run some tests to rule out these disorders. If the test comes back normal, your doctor will diagnose you with functional constipation, meaning the root cause is unknown.
  • Functional constipation is broken down into three types: 
    • Defecatory disorders.
      • This is when a patient gets constipation because the muscles responsible for passing a bowel movement — the pelvic floor muscles — do not work the right way.
      • For instance, they may not be relaxed enough to let a bowel movement easily leave the body.
      • In other cases, they may not be tense enough to move the stool through the bowel.
      • A patient with a defecatory disorder may have to strain very hard or may take a long time to pass a bowel movement.
    • Slow-transit constipation(STC).
      • In this type, a patient’s digestive tract processes food more slowly than normal.
      • This means it takes longer for the body to digest and dispose of a meal.
      • Most of the patients with STC are women.
      • About half of patients with defecatory disorders also have STC.
    • Normal-transit constipation(NTC).
      • If both defecatory disorders and STC are ruled out, a patient is considered to have NTC.
      • Not very much is known about this type of constipation.

Testing

Routine tests can help find the cause of your functional constipation

  • If neither fiber nor laxatives seem to work, your doctor will then do a test to find out which of the three types of functional constipation you have.
  • He or she will test for a defecatory disorder first.
    • Based on where you live, this may involve a balloon expulsion test.
      • In this test, your doctor will insert a small balloon into your rectum and fill it with water.
      • Your doctor will then ask you to go to the bathroom to pass the balloon.
      • Taking longer than one minute to pass the balloon is a sign of a defecatory disorder.
  • If the balloon expulsion test comes back normal, your doctor will move on to testing for slow-transit constipation (STC).
  • STC is diagnosed with a colon transit time test.
    • In this test, your doctor will ask you to swallow a small pill.
    • Your doctor will then track and time the movement of the pill through your digestive tract.
    • If it takes longer than three days for the pill to pass through the body, your doctor may diagnose you with STC.
  • If your doctor rules out both a defecatory disorder and STC with these tests, he or she will diagnose you with normal-transit constipation (NTC).
    • In this case, talk to your doctor about the symptoms you most often have with your constipation. Certain symptoms may point to an underlying digestive disorder.
    • For instance, bloating, pain and fatigue are signs of irritable bowel syndrome (IBS), which can be treated with medication.

Treatments

Depending on your diagnosis, there are many ways to treat your constipation. Talk to your doctor about your options so you can get started on your path to feeling better. A clear diagnosis can start the path to successful treatment.

Defecatory disorders

  • Most patients with this type of constipation see improvement after learning how to correctly relax and contract the pelvic floor muscles. This is known as pelvic floor retraining.
  • Your doctor can work with you to learn how to control your pelvic floor so that you can pass stool more quickly and easily.
  • Your doctor may use a technique called biofeedback therapy to help with pelvic floor retraining.
    • In biofeedback therapy, a patient is hooked up to sensors and a screen that shows what is going on inside the body.
    • Using this technique, you can see what happens when you tense or relax certain muscles.
    • This helps form a better brain-body connection, which will help you learn what changes you need to make to have a more successful bowel movement.
  • Your doctor may also refer you to a dietitian or a psychologist. These health professionals can help you tackle any underlying issues that may be at the root of your functional constipation.

Slow-transit constipation (STC) and normal-transit constipation (NTC)

  • Both STC and NTC can be resolved with similar treatments.
  • Laxative drugs are an effective way to make bowel movements more frequent and less difficult to pass.
    • These drugs are often taken 30 minutes after a meal to help your body process and pass the food.
    • They are also very affordable.
    • Most types of laxatives cost $1 or less per day.
  • If your constipation does not get better while taking laxatives, your doctor may suggest a newer type of drug, such as lubiprostone or linaclotide. These drugs often cost more than laxatives and may have side effects. 
  • In rare cases of STC, if drugs do not work to reduce your symptoms, your doctor may consider surgery.
    • This procedure involves the removal of the whole colon.
    • Any surgery comes with risks, and it is important to talk about these potential risks with your doctor. 

Questions to ask your doctor

  • What changes can I make to my diet or lifestyle to help my constipation?
  • What is the cause of my constipation? If it is unknown, how can we figure it out?
  • Are there any side effects of the drugs or laxatives you are prescribing that I should know about?

 

 

Updated March 2016

©AGA, July 2016

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