Understanding Chronic Constipation

The digestive system helps break down the foods we eat so our bodies can absorb the proper nutrients. During digestion, the unnecessary particles of these foods are turned into waste that becomes stool, which is excreted from the body during a bowel movement.

When the digestive system isn’t working as it should, a person can become constipated. Constipation occurs when the body does not pass stool regularly. It and can cause symptoms like abdominal pain, bloating, and difficult bowel movements.

Everyone experiences constipation at some point in their life, especially as a result of dietary changes or eating certain foods. However, chronic constipation can have other causes and may be a sign of an underlying health condition.

This article will explore chronic constipation, including common causes, treatment options, and when to visit a healthcare professional.

What Is Chronic Constipation?

Chronic constipation is defined as bouts of constipation that occur for three months or more. Certain criteria need to be met to diagnose chronic constipation, such as:

• A reduced frequency in healthy bowel movements
• How easily the stool is passed and if a person must strain during bowel movements
  

Causes of Constipation

Various factors such as diet, exercise, medication use, and certain health conditions may cause chronic constipation.

Lifestyle Factors

A lack of exercise or eating the wrong foods can disrupt how your digestive process works. Specific factors are more commonly associated with chronic constipation, such as:

• Diet: Eating large amounts of meat, sugary foods, and processed foods can slow down the digestive tract. Lack of sufficient water, fluids, and fiber can also contribute.
• Exercise: Exercise is good for many areas of your health, and not getting enough of it can also cause a person to become constipated. Studies show that a lack of regular physical activity and engaging in sedentary activities can lead to slower-moving digestion.

Structural Issues

Constipation can also be caused by structural issues in the gastrointestinal tract, such as:

• Anal fissures: Small tears in the tissue that lines the anus
• Thrombosed hemorrhoids: Painful lumps that develop when blood pools in an external hemorrhoid, which is an inflamed and swollen blood vessel in the lower rectum or around the anus
• Colonic strictures: A narrowing of part of the colon
• Obstructing tumors: A tumor that develops somewhere in the gastrointestinal tract, making it hard for stool to pass through properly
• Rectocele: Tissue between the vagina and rectum that weakens, causing the rectum to sag into the vagina or push into the coccyx region
• Anorectal blockage: A blockage in the gastrointestinal tract
• Pelvic floor dysfunction: Pelvic floor dysfunction affecting the pelvic floor muscles (a group of muscles located at the base of the pelvis) that, when not able to properly relax, make bowel movements difficult
• Dyssynergic defecation: A condition that occurs when the pelvic floor muscles cannot properly coordinate with muscles and nerves around them, causing a person to have irregular or abnormal bowel movements

Medication Usage

There are several medications that can cause a person to experience chronic constipation, such as:

• Pain-relieving opiates and opioids such as morphine, codeine, and tramadol
• Antispasmodics used to treat muscle spasms
• Antiparkinsonian medications used to treat Parkinson’s disease
• Drugs designed to stop epileptic seizures from occurring
• Tricyclic antidepressants and antipsychotics used to treat mental health disorders
• Food supplements such as iron or calcium
• Antacids used to treat heartburn
• Diuretics, which are used to reduce the amount of salt and water in the body
• Medications that are used to treat diarrhea
• Chemotherapy drugs
• Birth control pills
• Antihistamines used to treat allergies

Bowel Diseases

Bowel diseases can cause a person to develop chronic constipation. Some common bowel diseases include:

• Irritable bowel syndrome (IBS, common disorder of the large instestine)
• Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis
• Hirschsprung's disease (condition affecting the large intestine)
• Diverticulitis (infection or inflammation of small, bulging pouches that can form on the lining of the digestive tract)

Mental Health Issues

In some cases, chronic constipation can be caused by mental health disorders. Some conditions that can cause constipation include:

• Anxiety
• Depression
• Schizophrenia and other psychotic disorders
• Bipolar disorder and other mood disorders
• Personality disorders such as borderline personality disorder
• Addiction

Underlying Conditions

Chronic constipation can also arise because of other underlying health disorders such as:

• Neurological disorders, including Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury, paraplegia, spina bifida, and autonomic neuropathy (nerve damage)
• Cancer
• Endocrine and metabolic conditions, such as diabetes, hypercalcemia, porphyria, hypothyroidism, hyperthyroidism, and pregnancy
• Myopathic disorders such as amyloidosis and scleroderma
• Lupus

How Is Chronic Constipation Diagnosed?

Diagnosing chronic constipation is based on certain criteria.

The criteria used to diagnose functional constipation is having at least two of the following six symptoms for at least three months of a six-month period:

• Fewer than three bowel movements in a week
• Straining for more than 25% of bowel movements
• Having hard or lumpy stools during more than 25% of bowel movements
• Feeling as though something is stopping you from having a bowel movement more than 25% of the time
• Feeling as though you have not fully emptied your bowels for more than 25% of bowel movements
• Using manual aids to help defecate for more than 25% of bowel movements

In addition, stools are rarely loose unless you use laxatives and you don't meet the criteria for irritable bowel syndrome.

Tests will be done following a collection of your health history so that your healthcare provider can rule out other causes. These tests may include:

• Blood labs to check for underlying health conditions
• A stool sample to check for infection or inflammation
• Urine tests to check for diseases such as diabetes
• A colonoscopy or endoscopy, which involves a scope that can look for structural problems within the color, rectum, and anus
• A physical exam
• A trial run using fiber supplementation and laxatives to determine if your diet is playing a role in your chronic constipation
• Anorectal manometry, which is designed to test pressure in the anus and rectum to see how well it is functioning
• Balloon expulsion, which is a test that inserts a balloon into the rectum to assess how the patient's digestive system is functioning when having bowel movements
• Tests that involve eating a meal with radioactive substances to help track how food passes through your gastrointestinal tract
• X-rays
• Fluoroscopic defecogram or MR defecography to look for anterior or posterior rectocele

Treatment for Chronic Constipation

Treating constipation relies heavily on the cause. If an underlying health condition is diagnosed, constipation will likely subside with treatment targeting the root cause. Other treatment options include dietary changes, laxatives, pelvic muscle exercises, and in rare cases, surgery.

Dietary Changes

In many cases, chronic constipation can be due to a poor diet, and dietary changes can help alleviate constipation, including:

• Adding more fiber to your diet
• Increasing your fluid intake, especially water

Laxatives

Laxatives can help the gastrointestinal tract move waste more easily. Different types of laxatives may be used, such as bulk laxatives, which are essentially fiber supplements, or polyethylene glycol, which is a chemical solution that works by holding water in the stool to soften it as it moves through the gastrointestinal tract.

Pelvic Muscle Training

Pelvic muscle training is a type of training exercise that aims to strengthen pelvic muscles. It can be used to support the rectum and proper bowel function.

A type of therapy to help retrain the muscles is called biofeedback. This therapy involves being hooked up to electrical sensors that are designed to help a person control their bodily functions.

For chronic constipation, the hope is that biofeedback can essentially give a person the ability to control and change how their muscles work to encourage more regular defecation.

Surgery

In the event that a structural issue is causing constipation, surgery may be required. Surgery involves removing any blockages that are making it difficult to pass stool through the gastrointestinal tract.

When to Seek Medical Attention

Although chronic constipation isn’t always serious, it’s important that you see your doctor if you are experiencing it for three or more weeks. You should go to your nearest emergency department if you are experiencing any of the following symptoms along with your chronic constipation:

• Severe abdominal pain that does not go away
• Bloating that continues to worsen
• Blood in your stool
• Bleeding from your rectum
• Fever
• Pain in your lower back
• Unintentional weight loss
• Vomiting
• The inability to pass gas

Summary

Chronic constipation is characterized as constipation that occurs more than three times a week for a period of roughly three to six months. Being constipated is often associated with straining to have a bowel movement, abdominal pain, and feeling sluggish.

There are many things that can lead to chronic constipation such as certain medications, underlying health conditions, a lack of exercise, poor diet, and structural issues within the gastrointestinal tract. Since there are a myriad of possible causes, you should always seek out the proper medical care if you experience chronic constipation for any length of time.

Plenty of treatment options are available depending on the cause.

A Word From Verywell

Chronic constipation is uncomfortable, but it’s not always something to worry about. Since there are so many causes, from something as simple as your diet to something as serious as cancer, it's important that you see your healthcare provider. They can provide you with the right treatment so you can overcome chronic constipation.