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.

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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

What Does Constipation Feel Like?

A person who is constipated experiences hard, dry stool during bowel movements that only occur three or fewer times per week. Constipation may be accompanied by pain in the abdomen and stool that is difficult to pass, which causes a person to strain while trying to have a bowel movement.

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, dairy products, sugary foods, and processed foods can slow down the digestive tract. Lacking water, fluids, and fiber can also contribute. Drinking too much alcohol or beverages with caffeine can also lead to slower-moving bowels.
  • 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.

Can Holding Your Bowels Cause Constipation?

Holding in your bowels now and again isn’t likely to cause any issues, however, if you do it on a regular basis, it can lead to chronic constipation.

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
  • 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:

Medication Use and Constipation

Do not stop taking a medication to avoid constipation. If you experience constipation, speak to your healthcare provider about possible treatment options.

Bowel Diseases

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

Mental Health Issues

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

Underlying Conditions

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

Underlying Conditions and Constipation

While constipation can occur in all of the aforementioned disorders and conditions, it will likely be one of many symptoms. If you experience constipation with other symptoms and believe that you may have an underlying health condition, speak to your doctor.

How Is Chronic Constipation Diagnosed?

Diagnosing chronic constipation is based on certain criteria. The criteria used to diagnose the condition are:

  • 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 at least 25% of bowel movements
  • Using manual aids to help defecate for more than 25% of bowel movements

A medical professional will also assess other digestive symptoms, such as loose stools without the use of laxatives, which may indicate IBS.

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

The Goal of Testing

The main goal of testing is to get a clear picture of what’s going on inside the gastrointestinal tract . Since there are so many causes, various tests such as the ones mentioned above may all be performed.

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.

Stimulant Laxatives for Chronic Constipation

Stimulant laxatives work by encouraging the contraction of intestinal muscles to stimulate a bowel movement. While they are effective, they should only be used in special cases because they are often associated with unwanted side effects such as cramping.  

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.

Frequently Asked Questions

  • Can chronic constipation damage your intestines?

    While damage to the intestines isn’t likely to occur, chronic constipation can lead to several long-term complications. These include inflammation of the veins in the rectum, tears in the lining of the anus, and infection in pouches of the colon wall. You can also damage your pelvic floor muscles from straining too much.

  • Can constipation make you feel tired and weak?

    Feeling tired and weak is a common symptom of constipation. When your body is holding on to too much waste, it is not absorbing nutrients from food. This can cause malnutrition, which can lead to fatigue. Tiredness and weakness may also be a sign that an underlying medical issue is to blame for your constipation.

  • Can constipation lead to a buildup of toxins in the body?

    It is unlikely that toxins will build up in your body if you’re constipated since your colon can expand to continue to hold the waste. That being said, there are rare cases in which a bacterial infection has occurred when waste entered a wound in the colon or rectum caused by straining during bowel movements.

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