Constipation affects roughly 15% of the global population and can have a significant impact on quality of life, yet it remains underdiagnosed and undertreated.
Darren M. Brenner, M.D., AGAF, FACG
Associate Professor; Director, Neurogastromobility Program, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Constipation is a common disorder affecting approximately 1 in 6-7 people worldwide. People can experience short-term constipation because of medication use, dietary changes, or even travel. However, most cases of constipation are chronic or long-lasting. It can be quite debilitating and significantly impact a person’s quality of life. It can lead to social isolation, reduced participation in social activities, and decreased productivity or increased absences from school and work. The overall impact of constipation should neither be minimized nor ignored.
Chronic constipation is a cluster of symptoms that can vary from person to person. Symptoms include:
- Reduced number of bowel movements (BMs) (fewer than three per week is considered low; however, people have different ranges of normal)
- Passage of hard or pellet-like BMs
- Having to strain or excessively push to start or complete a BM
- Feeling as though you did not empty completely after a BM
- Needing to change positions on the toilet, push around the groin, or manually remove BMs from the rectum
Abdominal symptoms are also common in individuals with constipation. These symptoms include:
- Abdominal pain: pain varying from dull to sharp that occurs in the belly area
- Abdominal discomfort: discomfort varying from dull to sharp that occurs in the belly area
- Bloating: a buildup of gas or a swollen feeling in the stomach or intestines
- Distension: an uncomfortable swelling in the intestines that causes the abdominal area to visibly expand
- Nausea, often including an urge to vomit
- Vomiting
Tracking your symptoms
Given the various symptoms associated with chronic constipation, it can be helpful to keep a bowel movement diary before your visit with a healthcare provider. Recording how often you have bowel movements, their texture, and other associated symptoms can be beneficial for making an accurate diagnosis and deciding on further diagnostic and treatment plans.
Treatment options
Effective treatment for constipation depends upon an accurate diagnosis. Unfortunately, no specific symptom or set of symptoms can be used to differentiate one cause from another, and symptoms sometimes overlap. Generally, the initial treatment for mild chronic constipation involves a recommendation of diet changes, including increased fiber intake, or over-the-counter medications. Some healthcare providers may recommend increased hydration and exercise.
Laxatives are commonly recommended. Osmotic laxatives work by increasing the amount of fluid in the intestinal tract, which softens bowel movements and speeds up their movement through the colon. Stimulant laxatives improve constipation by increasing colon movement and/or changing colon fluid secretion.
There are also prescription medications available. Your healthcare provider can work with you to decide the best options for you.
Working with your healthcare provider
Chronic constipation is a complex, symptoms-based disorder that may occur because of multiple factors. Working closely with a healthcare provider and discussing all symptoms thoroughly will help you find the best treatment plan for you.
While chronic constipation can drastically affect your life, there are many options for treatment, and many people can find relief through effective management.
