What Are The Symptoms Of Chronic Constipation?
- hard and/or lumpy stools, or small pellets
- failed or lengthy attempts to pass stool
- the need to strain excessively at stool
- a sense of incomplete evacuation of stool, unsatisfactory stool
- decreased frequency of stool (some define as less than 3 per week)
- constipation for more than 3 months is classified as chronic constipation
Additional Symptoms of Constipation:
- abdominal distension (your tummy protrudes)
- bloating (sensation of fullness in abdomen)
- increased incidence of trapped gas, or very odorous gas
Who Gets Constipation?
Close to 30% of adults in North America report having experienced chronic constipation symptoms. Constipation is more than twice as common in women, and about twice as common in those of African descent. As we age we are more likely to experience symptoms of constipation, and pregnant women also have a higher likelihood of it. Those with inadequate caloric intake (restricted intake, disordered eating) may also be more likely to develop constipation.
Those who have other gastrointestinal motility disorders (like IBS, dyspepsia and acid reflux) may be more likely to experience constipation. In my practice, I frequently see patients who come in complaining of acid reflux, and then reveal that they’ve had a long history of constipation. While the relationship is not completely understood, in these cases, I’ve found that relieving chronic constipation symptoms and improving bowel function often serves to aid in resolving my patients’ dyspepsia and reflux.
TYPES: Primary Vs Secondary Constipation
Primary constipation refers to a problem in the gut itself – vs. secondary constipation, which arises as the result of another condition or substance.
Why Does It Matter Which Type Of Constipation You Have?!
It matters because the treatment approach to each (especially from a naturopathic perspective) is different!
While I tend to start with the same initial dietary & lifestyle treatment measures for most patients, if you don’t get results within 6-8 weeks, we would further assess, and depending on which type of constipation is most likely, determine which treatment approach will be most effective. Sometimes, this becomes clear in the first visit, and these measures can be initiated more quickly to conquer chronic constipation symptoms.
Related Reading: Constipation Assessment & Diagnosis
Primary constipation occurs as the result of dysfunction of the nerves and/or muscles of the gut. Primary constipation may be caused by:
- Dyssynergic Defecation: inappropriate or inadequate contraction and relaxation of the pelvic floor muscles (failed expulsion of stool)
- Slow Transit Time: inadequate intestinal tone or “peristalsis” – the downwards muscular propulsion of material through the intestines
- Functional Disorders like Constipation-Predominant Irritable Bowel Syndrome (IBS-C).
Do You Have Dyssenergic Defecation?
If you meet the definition for constipation, and initial treatment measures are ineffective after 6 to 8 weeks, the diagnosis of Dyssynergic Defecation should be considered – especially in patients with:
- A sensation of anal blockage
- Frequent straining
- A need to manually assist defecation
Again, Dyssynergic Defecation is the inappropriate or inadequate contraction and relaxation of the pelvic floor muscles, resulting in the failed expulsion of stool. Dyssenergia may be responsible for as much as 40% of chronic constipation – but often goes undiagnosed. If dyssynergia is the cause, physiotherapy of the pelvic floor along with biofeedback have been shown to be very effective for many people.
Do You Have Slow Transit Time?
Transit time is the length of time it takes for ingested food to go from your mouth to your passed stool. Some people will have a sense of this. Foods like beets can be a good indicator – as they are typically visible in stool. Alternatively you could ingest a charcoal pill and watch for its passage in your stool, or you could get a Lactulose Breath Test (LBT). The LBT is touted as a test for SIBO (Small Intestinal Bacterial Overgrowth) – but is actually NOT an effective tool in this regard. However, it IS a good measure of transit time.
Do You Have IBS-C?
Your constipation may be due to IBS-C, if your symptoms have existed for at least 6 months, AND for the last 3 months in a row (or more) you’ve had recurrent abdominal pain or discomfort (uncomfortable sensation) at least 3 days/month, AND at LEAST 2 of the following symptoms:
- Abdominal pain/discomfort is relieved after passing stool
- Since symptoms began you’ve had a change in frequency of stool
- Since symptoms began you’ve had a change in form (appearance/texture/size) of stool
People with IBS-C have hard or lumpy stools or pellets at least 25% of time, and loose, mushy or water stools less than 25% of time. (Other subtypes of IBS may be diarrhea predominant, or a mixed type with similar amounts of diarrhea AND constipation.)
Keep in mind that IBS is a diagnosis of exclusion – which means that other likely causes must be ruled out first. If physiologic testing is normal, and initial dietary & lifestyle measures (see treatment below) are insufficient, IBS-C should be considered; especially if abdominal pain is a predominant symptom.
This refers to constipation that is secondary to another condition, medication or behaviour, such as: diet, recreational drugs, certain medications, endocrine, metabolic, or neurologic conditions (i.e. hypothyroidism, hyperparathyroidism, diabetes and primary diseases of the colon (stricture, cancer, anal fissure, proctitis). Successful treatment of secondary constipation MUST address the cause.
What Type Of Diet Is Associated With Secondary Constipation?
A diet that is deficient in fibre and/or water is likely to cause constipation. Fibre is found in plant foods: vegetables, fruits, whole grains, legumes (beans, lentils & peas), nuts & seeds. Water may include water itself, or water content of fruits & vegetables, soups, or other beverages. This type of diet is often referred to as a Whole Food Diet (eating foods in their whole, natural state as much as possible), and is effective at preventing constipation.
Conversely, a diet high in refined flour & sugar (bread, baked goods, crackers, sweets, white pasta), fried or fatty foods (fast food, doughnuts, ice cream, cream sauces, etc), or alcohol, are associated with constipation. Caffeine may stimulate bowel movements, but it also acts as a diuretic (pulls water from the body), which can in turn contribute to constipation.
What Medications May Cause Secondary Constipation?
While the list is not comprehensive, some of the most common contributors include:
- Opiates/narcotics for pain (i.e. codeine, morphine, etc)
- Antihistamines (i.e. in allergy or cold medications)
- Calcium channel blockers (i.e. used for high blood pressure or irregular heartbeat)
- Antipsychotics (i.e. tranquilizers used in the treatment of bipolar disorder, schizophrenia, psychosis)
- Tricyclic antidepressants (i.e. amitriptyline – used for depression especially with pain)
- Calcium or iron supplements
What to do if you are on one of these medications and experiencing constipation?
Do NOT simply discontinue a prescription medication (some may require guidance on how to safely wean off without ill effects). Speak to your MD and/or ND about alternatives that may be available to you.
What Conditions May Cause Secondary Constipation?
Hypercalcemia means the calcium level in your blood is too high, and is most commonly associated with overactive parathyroid glands. An imbalance in calcium levels can impact the ability of smooth muscle in the intestines to contract normally.
Hypothyroid symptoms are highly variable, but because it’s largely responsible for our metabolism, when it’s under active, things tend to slow down – including digestion and elimination.
Nervous System Impairment
The Autonomic Nervous System (ANS) is responsible for control of digestive function. Constipation may be associated with damage to the nervous system seen in spinal cord injury or Parkinson’s Disease.
A disorder of blood sugar regulation, diabetes has profound long term consequences throughout the body. Diabetes may damage nerves in the autonomic nervous system, which may result in altered bowel function, including constipation, diarrhea, or alternations between the two. High blood sugar may also contribute to dehydration, which in turn may cause constipation.
Proctitis, Anal Fissure, Hemorrhaids, Stricture of Colon, Volvulus, Diverticulitis or Colorectal Cancer
These may be conditions or symptoms of conditions that affect the structure of the colon – making it difficult to pass stool.
Get more details here on all of the conditions associated with secondary constipation, along with their symptoms, and what tests are most useful in assessing for and diagnosing them.
Chronic Constipation Assessment & Diagnosis (How to screen for and diagnose different types of constipation)
Alarm Features of Chronic Constipation (When to visit the ER or get a referral for colonoscopy)
Constipation Treatment: A Comprehensive Guide To Conventional & Naturopathic Constipation Cure