Chronic Constipation and Treatment

Constipation is a very common complaint and affects about 15% of the US population. It has a negative effect on the quality of life especially in patients over 65. One only has to watch the proliferation  of TV advertisements for cures for constipation to appreciate the economic impact of the disorder.

It is a root cause for many anorectal problems. It may be simply chronic constipation or be a sign of irritable bowel syndrome (IBS). Bowel patterns have been classified in the literature are porting to be Rome classifications and the Rome lll definition of IBS-C or irritable bowel syndrome with constipation includes the following:

  • symptoms present for at least six months prior to diagnosis
  • presence of symptoms for the last three months
  • loose stools rarely present without the use of laxatives
  • bloating and cramping relieved with a movement
  • a sense of incomplete evacuation

*Symptoms include greater than two of the following jury at least 25% of movements:

  • straining
  • lumpy or hard stools
  • sensation of incomplete evacuation
  • sensation of anorectal obstruction or blockade
  • manual maneuvers to facilitate evacuation
  • fewer than three bowel movements per week

IBS-D is irritable bowel syndrome with diarrhea as the dominate sign. Both diarrhea and constipation can be present as well.

Recent underatanding of the syndrome and its cause have led to more effective diagnosis and treatment.

*From Longstreth GF, et al. Gastroenterology. 2006;130:1480-1491.

Patients, however, may be less likely to define constipation using the criterion of stool frequency; data have shown patient definitions of constipation agreed with physician definitions only 50% of the time, with stool frequency used as a measure only 32% of the time. Patients were more likely to report constipation if they experienced straining (52%), hard stools (44%), the urge but inability to pass stool (34%), or abdominal discomfort (20%). Analysis of 10,875 subjects from the National Health Interview Survey showed straining and hard bowel movements were most strongly associated with self-reported.

Some secondary causes of constipation can be related to and from problems including diabetes and hypothyroidism and high calcium levels, neurologic disease like Parkinson's, mechanical obstruction, medications especially narcotic medications and antidepressants, anatomic disorders including prolapse and rectocele,  severe depression and anorexia, and dietary or lifestyle causes including low fiber intake and ignoring the need for a bowel movement. Prior surgery can also create constipation.

Constipation, or the absence of a daily BM causes a larger volume, dehydrated and therefore hard stool. Straining is needed to pass the stool. This increases the pressure in the ano rectal plexus of veins and hemorrhoids are the result. In addition, injury can occur to the fragile skin of the anal canal resulting in a painful fissure in ano.

Only after a thorough evaluation can recommendations be made for the treatment of constipation. Those treatments may range from over-the-counter laxatives and softeners to prescription medications but only after it has been determined that no mechanical blockage or another lesion is the cause.

Dr. Shapiro, as a board-certified surgeon, is familiar with the evaluation and treatment of chronic constipation and its associated anorectal complications. He treats patients throughout the Tampa Bay area, including Clearwater, Tampa, St. Petersburg, and nearby areas.

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