Definition

Chronic constipation is a stool frequency of less than three per week that lasts several months associated with straining, lumpy or hard stools, bloating, and the sensation of incomplete defecation.

Causes

The causes of chronic constipation are multifactorial.  They typically fall into one of two broad categories:

Colonic Inertia

Colonic inertia is the inability of the colon to naturally push fecal matter through the bowel; the stool remains within the colon leading to very infrequent stools.

Pelvic Floor Dysfunction

Pelvic floor dysfunction includes a variety of diagnoses that involve problems at, or just above, the rectal opening which prevent the stool from being eliminated easily.

Symptoms

Abdominal bloating, cramps and discomfort; the need to endlessly push and strain to get the stools to pass; requiring digitation to pull out feces.

Diagnosis & Treatment

Treatment will depend on results from the examination and tests. For patients where an identifiable cause is not found, the treatment focuses on improving diet, increasing exercise and utilizing fiber supplements/laxatives/enemas as directed by their doctor.

Patients who are found to have colonic inertia will be managed with a variety of laxatives and diet adjustments to improve function. However, if the patient’s constipation continues to impact their life significantly, a surgical option is available.

For patients with pelvic floor dysfunction, the majority of these abnormalities can be treated non-operatively, but a few will require an operation (such as a rectocele repair). For the non-operative treatments, many patients are candidates for a course of Anorectal Biofeedback Training, which teaches the patient how to better control their pelvic floor and relax the appropriate muscles to permit easier elimination.

Visit the American Society of Colon & Rectal Surgeons website for more information