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Chronic Constipation

What is Chronic Constipation?

Chronic constipation, is a widespread and often debilitating disorder which if not treated can dominate a patients’ life causing a significant impact on their quality of life both socially and psychologically[1].

There is no widely accepted definition of chronic constipation in use in clinical practice. Doctors often define constipation on stool frequency, however patients define constipation as a multisymptom disorder that includes infrequent bowel movements, hard lumpy stools, straining, bloating, feeling of incomplete evacuation after a bowel movement and abdominal discomfort[1].

The disease has been defined by the Rome III criteria developed to classify functional gastrointestinal disorders based on the type and duration of symptoms.

Diagnostic criteria* for functional constipation must include 2 or more of the following[2]:

  • Straining during at least 25% of defecations
  • Lumpy or hard stools in at least 25% of defecations
  • Sensation of incomplete evacuation for at least 25% of defecations
  • Sensation of anorectal obstruction / blockage for at least 25% of defecations
  • Manual maneuvers to facilitate at least 25% of defecations (eg, digital evacuation, support of the pelvic floor)
  • Fewer than 3 defecations per week
  • Loose stools are rarely present without the use of laxatives
  • There are insufficient criteria for IBS
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

What are the treatment options?

Some patients with chronic constipation can be successfully treated with lifestyle modification, dietary changes and increased fluid and fibre intake, and these treatments are generally tried first. For patients who fail to respond to this approach, physicians typically recommend laxatives, most of which are available over-the-counter. Most types of laxatives draw water into the intestine and the colon, or modify stool consistency .Most patients will respond to laxatives, however they do not always address the underlying symptoms nor address the underlying causes[1].

If laxatives fail to provide you with adequate relief other alternative therapies are available, these include medicines which work in a different way by acting upon the guts nervous system to restore propulsion, biofeedback therapy and in some cases surgery.

References:
1. Johanson J et al. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther 2007;25:599-608.
2. Longstreth GF et al. Functional bowel disorders. Gastroenterology 2006;130:1480-91.