Constipation
Chronic constipation affects up to 20% of adults and significantly impacts quality of life. Understanding the underlying cause is key to effective, lasting treatment.
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Understanding Constipation
Constipation is defined as infrequent bowel movements (typically fewer than three per week) or difficulty passing stool. It can be acute (short-term) or chronic (lasting more than three months). While often related to diet and lifestyle, persistent constipation may indicate an underlying condition requiring evaluation.
Common Symptoms
Common Causes
Lifestyle Factors
- Low dietary fibre intake
- Inadequate fluid consumption
- Sedentary lifestyle
- Ignoring urge to defecate
- Changes in routine or travel
Medications
- Opioid pain medications
- Calcium channel blockers
- Iron supplements
- Antidepressants
- Antacids containing aluminium
Medical Conditions
- Irritable bowel syndrome (IBS-C)
- Hypothyroidism
- Diabetes mellitus
- Parkinson's disease
- Pelvic floor dysfunction
When to Seek Help
While constipation is usually benign, certain symptoms require prompt medical evaluation to exclude serious underlying conditions.
Rectal Bleeding
Blood in stool or on toilet paper requires prompt evaluation.
Unexplained Weight Loss
Unintentional weight loss may indicate underlying disease.
New Onset After Age 45
New constipation in older adults warrants investigation.
Severe Abdominal Pain
Significant pain or distension needs urgent assessment.
Investigations
Evaluation may include tests to exclude structural causes and assess bowel function.
Colonoscopy
Recommended to exclude structural causes, particularly in patients with alarm symptoms or new-onset constipation over age 45.
- Rules out colorectal cancer or polyps
- Identifies strictures or narrowing
- Detects inflammatory conditions
- Essential for age-appropriate screening
Additional Tests
Blood Tests
Thyroid function, glucose, calcium, and full blood count to identify metabolic causes.
Transit Study
Measures how quickly stool moves through the colon to identify slow transit constipation.
Anorectal Manometry
Assesses pelvic floor function and coordination for suspected defecatory disorders.
Defecography
Imaging study to evaluate pelvic floor anatomy and function during evacuation.
Treatment Approach
Lifestyle Modifications
- Increase dietary fibre (25-30g daily)
- Adequate fluid intake (1.5-2L daily)
- Regular physical activity
- Establish regular toileting routine
- Respond promptly to urge to defecate
Medical Treatments
Fibre Supplements
Psyllium, methylcellulose, or other bulk-forming agents to increase stool volume.
Osmotic Laxatives
Polyethylene glycol (PEG), lactulose - draw water into the bowel to soften stool.
Stimulant Laxatives
Bisacodyl, senna - for short-term use when other measures are insufficient.
Prescription Medications
Prucalopride, linaclotide - for refractory cases when standard treatments fail.
Biofeedback Therapy
Pelvic floor retraining for patients with defecatory disorders.
Don't Suffer in Silence
Chronic constipation can significantly impact your quality of life. Dr. Prem provides comprehensive evaluation and personalised treatment plans to help you find lasting relief.
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