Constipation: Diagnosis, Prevention and Treatment

Constipation generally occurs when stools remain in the colon or large intestine for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry.

Updated: June 16, 2022

Constipation generally occurs when stools remain in the colon or large intestine for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry.

Diagnosis of Constipation:

Diagnosis is done depending on the type of constipation whether it is acute (days to weeks) or chronic (months to years). Three or fewer bowel movements per week can be considered as constipation.  Symptoms related to constipation can include bloating, distension, headaches, abdominal pain, a feeling of fatigue and nervous exhaustion, or a sense of incomplete stomach emptying.
Chronic constipation is associated with abdominal discomfort and often diagnosed as irritable bowel syndrome (IBS).

Physical Examination:

An abdominal examination along with rectal examination can be done as a physical examination. Abdominal examination can disclose an abdominal mass if there is significant stool burden and abdominal discomfort. Rectal examination gives an image of the anal sphincter tone and whether the lower rectum contains any feces or not. Rectal examination also gives information on the consistency of the stool, the presence of hemorrhoids, blood and whether any perineal irregularities are present including skin tags, fissures, anal warts.

Diagnostic Tests:

If any underlying cause of the constipation is suspected ,few laboratory tests can be performed. Tests may include CBC (complete blood count), thyroid function tests, serum calcium and serum potassium.
If bowel obstruction is suspected, abdominal X-rays are generally performed. This can disclose extensive impacted fecal matter in the colon, and may confirm or rule out other causes of similar symptoms.
If an abnormality in the colon such as a tumor is suspected, colonoscopy can be done. Anorectal manometry, anal sphincter electromyography, and defecography are some test which can be done in very rare condition.

Prevention of Constipation:

Prevention can be done by lifestyle changes which include adequate exercise, increasing fluid intake, and high-fiber diet .

Treatments for Constipation:

In most of the cases, constipation resolves itself without any treatment or risk to health.  The treatment of recurring constipation can include lifestyle changes such as doing more exercise, eating more fiber, and drinking more water.
Constipation can be treated with the use of laxatives. But it should be used with care and only when necessary. This is because when you become dependent on them, there is a significant risk of constipation when they are stopped. In more severe cases, the person may need a prescription medication.
The underlying illness or condition should be found out inorder to treat the specific reason.  Enough time should be given to allow your toilet visit to be unstressed and uninterrupted, and do not ignore an urge to have a bowel movement.

OTC laxatives:

The following laxatives can be used when constipation can not be resolved by other treatments.

  • Lubricants such as mineral oil and fleet helps the stool move down the colon more easily.
  • Stool softeners such as colace and surfak can rehydrate (moisten) the stool.
  • Stimulants which include correctol, dulcolax, and senokot can make the muscles in the intestines contract rhythmically.
  • Osmotics which include cephulac, sorbitol and miralax helps the movement of fluids through the colon.
  • Fiber supplements are  the safest laxatives. They are also called bulk laxatives which include fibercon, serutan, metamucil, konsyl and citrucel and should be taken with plenty of water.
  • Chloride channel activators which include lubiprostone require a prescription.
  • 5-HT-4 agonists include prucalopride which helps in increasing the secretion of fluid in the intestines and speed up the rate at which food passes through the colon.
  • Saline laxatives include milk of magnesia that help in drawing water into the colon.

Surgery:

A surgery can be done to remove the portion of anal sphincter or rectum which are responsible for the problem only when constipation does not respond to any treatment.


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