Constipation

constipationThere are several different factors that define constipation. Most people who have constipation meet one or all criteria for constipation. In this section,
I will be specifically describing chronic constipation, or constipation that has been there for many years. If constipation is acute one should consult a physician.

Here are a few criteria to define chronic constipation:

  1. Stool frequency– There is no golden rule to follow in regards to the number of bowel movements one should have per day or per week. It largely depends on the diet. A 250 pound body builder, who eats 4 large meals per day, will most likely have more bowel movements than a 100 pound woman who barely eats 1200 calories per day. Of course the amount of fiber in the diet is also an important determining factor. However, less than three bowel movements per week can be abnormal.
  2. Stool consistency– A normal stool should be formed; not hard or pebble like, and not loose or watery. A formed stool looks like a sausage, and should have a smooth surface without cracks.
  3. Straining– When you have a sensation to have a bowel movement, the stool should evacuate with minimal effort without the need to strain too much. If you have a sensation to have a bowel movement, but can’t evacuate the stool, that may be pathologic.
  4. Incomplete evacuation– This is when you have a bowel movement and able to evacuate some stool, but have a feeling of incomplete evacuation, where there is more stool in the rectum and you just can’t completely evacuate despite straining. This is very frustrating, and some people report using their finger to dig the stool out.

stoolchart

 

Consuming a lot of vegetables and fruits with high levels of fiber can help improve constipation in some people. Of course the typical American diet consists mostly of meat and potato without much fiber. A lot of times I hear people start high protein diets for weight loss or fitness purposes and become constipated, because they give up vegetables in their diet.

There are two main causes of chronic constipation:

1) Delayed colonic transit constipation is when the stool travels very slowly through the colon.

2) Impediment to defecation at the level of anus or rectum. This is the inability to allow the sphincter to relax and allow for proper defecation.

For proper diagnosis, your physician will likely do the following:

  1. Obtain a detailed history and perform a detailed physical exam
  2. Exclude metabolic causes such as hypothyroidism and rheumatologic disorders
  3. Exclude obstruction depending on your age and “alarm symptoms” by performing a colonoscopy.
  4. Trial of fiber therapy and laxatives
  5. If inadequate response, further testing such as colonic transit testing and anorectal testing