Learn About Constipation

Constipation is defined as having fewer than three bowel movements a week, or bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass. Everybody gets constipated sometimes; but constipation can be chronic, which means lasting a long time, even years.

Gastroenterology concerns the health of the organs that make up the gastrointestinal (GI) tract: Mouth, esophagus, stomach, small intestine, large intestine, and the anus. The intestines are sometimes collectively referred to as the bowel. The last part of the GI tract—called the lower GI tract—consists of the large intestine and anus, and are the gut organs involved in constipation.

The large intestine absorbs water and any remaining nutrients from partially digested food delivered from the small intestine. The large intestine then changes waste from liquid to a semi-solid matter called stool, which passes from the colon to the rectum. The rectum is where stool is stored prior to a bowel movement. During a bowel movement, stool moves from the rectum to the anus, and on out of the body.

Constipation is caused by stool getting dried out in the colon. The colon absorbs too much water from the stool, making it hard and dry, and thus more difficult for the muscles of the rectum to push out of the body. Factors predisposing to constipation include insufficient dietary fiber (fiber helps the stool retain water), lack of activity, certain medications, lifestyle or daily routine changes, some illnesses, and finally GI tract problems, particularly those GI disorders that are not caused by an alteration of the anatomy of the GI organs – the so-called functional GI disorders.

Functional GI disorders are problems caused by changes in how the GI tract operates. Functional constipation often results from problems with muscle activity, or motility, in the colon or anus, which delays stool movement. When the constipation is accompanied by abdominal pain or discomfort, the diagnosis of Irritable Bowel Syndrome (IBS) may be appropriate. Otherwise, the condition of chronic idiopathic (meaning having no known cause) constipation is likely.

In order to settle on the diagnosis of a functional bowel disorder such as chronic idiopathic constipation, it is necessary to ensure that the bowel is essentially normal. To that end, a colonoscopy is the definitive investigation. A colonoscopy is used to view the rectum and entire colon from the inside. A colonoscopy is performed at an outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. A health care provider will give written “bowel prep” instructions to follow at home. The usual bowel prep involves a clear liquid diet for 1 to 3 days before the test; the night before, a laxative may be administered. Finally, one or more enemas may also be required the night before the test. In most cases, light anesthesia, and possibly pain medication, is used. The patient will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera in the tube sends a video image of the intestinal lining to a computer screen. The test can show signs of problems in the lower GI tract.

While dietary and lifestyle changes are sometimes sufficient to manage functional constipation, medication is often needed. Many over-the-counter remedies are available. Increasingly, medication that causes the small intestine to deliver a more fluid stool to the colon is prescribed, such as Amitiza (lubiprostone) and Linzess (linaclotide); and prokinetic agents that improve bowel motility by their action on serotonin receptors in the gut are being researched. One of these, Biotonus (mosapride) is already available in many non-US markets.

In summary, irritable bowel syndrome and chronic idiopathic constipation are functional disorders that are defined by signs and symptoms in the absence of identifiable structural or biochemical explanations. Colonoscopy is the “gold standard” diagnostic approach to ensure the illness is indeed functional. New medications are available or being researched to improve constipation by delivering more fluid stool to the colon and/or promoting gut motility. These newer medications are particularly helpful for people with functional constipation whose symptoms persist despite added dietary fiber, lifestyle changes, or the use of over-the-counter remedies.

Bibliography: National Digestive Diseases Information Clearinghouse (NDDIC)

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