Chronic Constipation

Chronic constipation can range from mild to severe. It’s typically diagnosed if you’ve had 2 or more of the symptoms below for at least 3 months:

• straining to empty your bowels

• hard or lumpy stools 

• needing a longer time to empty your bowels

• a feeling of incomplete bowel evacuation

• abdominal pain 

• abdominal bloating

• having to press your abdomen and/or use a finger to remove stool from your bottom

Several factors can cause chronic constipation. 

The most common causes of chronic constipation include:

• not eating enough fibre, such as fruit, vegetables, and cereals

• ignoring the urge to pass stools

• lack of exercise

• not drinking enough fluids

• being underweight or overweight

• muscle or structural abnormalities

• changes to your daily routine

• anxiety or depression

• pregnancy

• certain medications, including those for high blood pressure, depression, and epilepsy

• certain supplements, including iron supplements 

In rare cases, chronic constipation can be a sign of a more serious medical condition. In adults, these can include:

• colon or rectal cancer

• inflammatory bowel disease (IBD)

• irritable bowel syndrome (IBS)

• parkinson’s disease

• diabetes

• hypercalcaemia

• underactive thyroid

• muscular dystrophy

• multiple sclerosis (MS)

• spinal cord injury

Around 1 in 3 cases of chronic constipation are caused by a condition called dyssynergic defecation. This is also called pelvic floor dysfunction or anismus.

Dyssynergic defecation is thought to be caused when the muscles and nerves within your pelvic floor aren’t functioning normally. Pelvic floor muscles are the layer of muscles that support your pelvic organs and span the bottom of your pelvis.

To confirm a diagnosis of severe constipation, your consultant will start by asking you about your medical history and your symptoms. 

In some cases, no tests or procedures are needed. In others, you may need chronic constipation tests, such as:

• physical examination of your rectum

• blood tests

• colonoscopy: an examination of your colon

• flexible sigmoidoscopy: an examination of your bottom and lower colon

• anorectal manometry: to measure how well the muscles and nerves in and around your rectum function

• balloon expulsion test: to measure your anal sphincter muscle speed

• anorectal motility studies: to assess the function of the muscles and nerves of your rectum 

• colonic transit study: to measure how well food moves through your colon

• defecography: an X-ray of your rectum during a bowel movement

• MRI defecography: a test to assess the function of your defecation muscle during a bowel movement

You may be able to prevent chronic constipation or improve your symptoms by making tweaks to your diet, lifestyle, and toilet habits. 

You can try:

• increasing the fibre in your diet by eating more fresh fruits, vegetables, whole grain breads, and cereals 

• exercising most days of the week

• not ignoring the urge to move your bowels

• drinking plenty of fluids

• avoiding alcohol

• keeping to a regular toilet routine

• resting your feet on a low stool while going to the toilet

• reducing stress

• trying abdominal massage to help move stool through your bowels

Most cases of constipation aren’t serious and go away on their own or with treatment.

However, complications can occur if your constipation is severe, persistent, or lasts for a long time and you don’t seek treatment. Complications include:

• distension of your rectum and loss of sensory and motor function

• haemorrhoids

• anal fissure (a tear in the lining of your anus)

• faecal incontinence

• chronic dilatation of your colon

• an obstruction, hole, or ulcer in your bowel

• recurrent urinary tract infections (UTIs)

• rectal bleeding

• rectal prolapse

Once your specialist has diagnosed chronic constipation and the causes of your condition, they will usually start treatment by recommending changes to your diet and lifestyle. 

If those changes don’t help, they may recommend the use of medicines or surgery.

Laxatives and supplements

If diet and lifestyle don’t relieve your condition, your consultant may prescribe 1 or more of these medicines:

• bulking agents, such as fibre supplements

• osmotic laxatives

• stimulant laxatives

• faecal softener laxatives

• lubricant laxatives

If your severe constipation is caused by IBS or chronic idiopathic constipation (where the cause is unknown), your consultant may prescribe various prescription medicines.

If oral laxatives and supplements don’t work, your specialist may suggest treatments, such as a suppository or a mini enema.

Pelvic floor biofeedback

Biofeedback training exercises are a non-surgical, non-invasive therapy option that has been shown to reduce symptoms and causes of some bowel problems, such as constipation, incontinence, dyssynergic defecation, and IBS.

It involves working with a specialist consultant, nurse, or physiotherapist. They can use various devices to help you learn to relax and tighten the muscles in your pelvis to help you pass your stools more easily.

At Welbeck, our gastroenterologists and colorectal specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.