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Constipation

When It Becomes a Problem

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Updated March 13, 2012

Probably every person reading this has been constipated at some point in his or her life. About 2.5 million annual doctor visits are due to a complaint of constipation, according to the Digestive Diseases Information Clearinghouse. Although it's not especially comfortable, this symptom is usually a benign reflection of dietary or fluid level changes in your body, and is usually not related to colon cancer. However, worsening constipation over a time span of weeks to months can be categorized as a bowel habit change, which you will want to discuss with your doctor.

What is Constipation?

It's important to remember that constipation is a symptom of another problem in your body -– not a disease by itself. Constipation is the inability to freely pass a bowel movement. Your bowel movements may be very hard, small, and painful to pass. You should not need to take up residence on the toilet and force your bowels to move. Actually, your bowels should move with little or no straining whatsoever. Although every person has their own "normal" bowel frequency, having less than three or four bowel movements per week is too infrequent and can indicate constipation.

What Causes It?

Under normal circumstances, the occasional episode of constipation should not be a cause for concern. Many things can make you constipated, most of which are benign (non-life-threatening).

  • Dehydration
  • Fever
  • Diet low in fiber
  • Sedentary lifestyle
  • Advancing age
  • High-fat diet
  • Diseases or injuries affecting the colon (stroke, irritable bowel syndrome, diabetes, Parkinson's, multiple sclerosis, spinal cord injuries)
  • A tumor partially blocking the colon
  • Prescription medications (especially pain medications)
  • Dietary choices (dehydrated or salty foods)

Decrease the Risk of Constipation

If you suffer occasional "functional" constipation, or the type that is not related to any diseases, injuries or cancer, a few simple lifestyle changes may lessen your episodes and severity:

  • Increasing the liquids you drink daily (avoid caffeine and alcohol, as they dehydrate you further)
  • Increase your physical activity
  • Increase the amount of fiber you eat (aim for the recommended 20 to 35 grams daily)
  • Decrease fat in your diet
  • Talk to your doctor if you are dependent on laxatives

Laxatives and Over-the-Counter Treatments

A word of warning: you can become dependent on laxatives. Talk to your doctor before you purchase or use any over-the-counter product. Saline and osmotic laxatives can cause electrolyte imbalances and should not be used for the elderly, diabetics, or young children. Likewise, stool-bulking laxatives and stimulants can cause serious problems if you are constipated from an intestinal blockage. Your doctor will be able to help you choose an over-the-counter product safely.

There are many different types of over-the-counter laxatives, including:

  • Stool-bulking -– fiber supplements that add volume to the stool
  • Stimulants –- make the colon contract, pushing stool through quickly
  • Softeners -– add liquid back into the stool
  • Lubricants -– lubricate stool and facilitate passage
  • Saline and osmotic -– get water back into stool

Chronic Complications

Constipation is defined as "chronic" when it occurs at least 12 weeks out of the year. The episodes can be spread out over a 12-month period, such as having trouble moving your bowels at least once a month, and the problem will still be defined as chronic.

Hemorrhoids are an uncomfortable side effect of chronic constipation and can be quite a nuisance. Although most hemorrhoids will resolve on their own, surgery is sometimes needed to remove them once they become chronic or painful. To decrease your risk of developing hemorrhoids:

  • Avoid straining to pass bowel movements
  • Increase dietary fiber intake
  • Do not sit on the toilet for extended periods of time
  • Increase fluids
  • Exercise to improve circulation
  • Schedule a visit with your doctor if they are painful or recurring

Other less common complications of chronic constipation include anal fissures and fecal impaction. Anal fissures are microscopic tears in your anus, which are painful and may bleed when you wipe. They should resolve on their own when the constipation is relieved. Fecal impaction occurs when stool becomes so hard and solid that it cannot be passed naturally. You will need a healthcare provider to help manually break up the blockage so that you can begin passing stools again. Fecal impaction can be very painful and is more common in the elderly and women.

Bowel Habit Changes and Cancer

Diarrhea can be a symptom of colon cancer more frequently than constipation. Certain types of colon polyps have mucous excretions that water down the bowel movements, causing frequent, runny stools. Your doctor will consider your bowel habits during your appointment, but diarrhea usually has another, less benign cause than colon polyps.

One of the most common symptoms of rectal cancer is a feeling of "fullness" or "pressure" in your rectum. This may feel as if you have to pass a stool, and could potentially be confused for constipation. Talk to your doctor if you have this symptom, especially if it is paired with a feeling of "urgency," or an intense feeling of needing to use the bathroom.

The bottom line? Chronic constipation can be very uncomfortable, but it is rarely life-threatening or an indication of colon cancer. If you are having persistent bowel problems, make an appointment to see your doctor. He or she can evaluate you and order tests or consults, as needed.

Sources:

American Cancer Society. (2006). American Cancer Society's Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.

Harvard Women’s Health Watch. (July 2004). Hemorrhoids and What To Do About Them. Accessed March 9, 2012.

National Digestive Diseases Information Clearinghouse. (n.d.). Constipation. Accessed March 12, 2012.

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