Constipation is one of the most common gastrointestinal complaints in the United States, resulting in about 2 million annual visits each year to a doctor. “Constipation” means different things to different patients. Often, it includes infrequent bowel movements, straining with bowel movements, hard “pellet-like” stools and a feeling of incomplete evacuation after going to the bathroom. Patients can suffer from symptoms associated with constipation such as bloating, abdominal pain, nausea, and even loss of appetite. Many patients use stool softeners, fiber products, laxatives, suppositories, enemas and even manual assistance in order to evacuate.
The causes of constipation span a wide range. Common causes include a change in diet or daily routine, thyroid disorders, medication side effects, inadequate fiber and/or fluid intake, and lack of exercise or activity. Specific gastrointestinal diseases that can cause constipation include irritable bowel syndrome, diverticular disease, laxative abuse, colorectal cancer, and colon inertia. Women who have carried pregnancies or undergone pelvic surgery can develop rectocele, enterocele, and intussusception, all of which may cause difficulty with constipation.
Evaluation of constipation requires a physician with an expertise in colon and rectal disease. Any patient with new or persistent constipation (i.e., more than a few weeks) should seek evaluation. A thorough history and physical examination will assist in directing the work-up of the patient. Blood tests and simple X-rays may be helpful. Often a colon evaluation (i.e., colonoscopy or barium enema) will be recommended to rule-out any physical blockages. Other tests helpful in examining the function of the colon include defocography (barium study of rectum), colon transit studies, and anal manometry.
The work-up of constipation should lead to a specific diagnosis. Depending on the issue, different treatments can be recommended and implemented. Some patients benefit from changes in diet, an increase in fluid intake or increasing activity level. Others achieve significant improvement with biofeedback (physical therapy for the pelvis). Less commonly, patients will be recommended to undergo surgery to fix the underlying issue with the colon or the rectum. Newer surgical techniques such as laparoscopic colon resection offer patients minimally invasive surgical options with excellent outcomes.