Chronic constipation is usually a benign condition that affects about 20% of the world’s population, it is found more frequently in women and the elderly. Studies indicate from 12% to 27.2% of people in North American are afflicted with this condition.
Chronic constipation is characterized by 12 weeks in a year in which you experience difficult or infrequent passage of stool (less than 3 per week), hardness of stool, prolonged time to complete an evacuation, or feelings of incomplete evacuation.
Practically everyone experiences constipation at some point, but chronic constipation can cause serious difficulties including hemorrhoids, bleeding, fecal impaction, bowel perforation, incontinence and an overall decreased quality of life. Serious effects of chronic constipation include blood in the stool (hematochezia) and weight loss of 10 pounds or more.
Constipation may be caused by many factors including increased stress in life or a change in diet. However, that may be underlying organic disorders causing the constipation. Actual physical disorders may be diagnosed by tests or procedures such as a complete blood count, measuring serum calcium, thyroid function tests, flexible sigmoidoscopy, and a colonoscopy.
Chronic constipation is closely related to other gastrointestinal disorders such as irritable bowel syndrome, dyspepsia and GERD. For example, in one study 29% of GERD patients reported chronic constipation.
Treating chronic constipation usually involves both rapid constipation relief and then long term constipation management.
The long term management of constipation typically involves bulking agents, water and exerciser that helps stimulate movement through the intestines.
Bulking agents are intended to increase the water content of the stool. These agents add water and bulk to the stool and are effective at increasing the stool frequency and consistency. Bulking agents can begin working in 12-24 hours but it takes 2-3 days to be fully effective.
- Psyllium husks are the outer coat of the psyllium seed (e.g., Metamucil, Konsyl)
- Calcium polycarbophil (e.g., Perdiem Fiber Therapy, Fibercon)
- Methylcellulose (e.g., Citrucel)
- Bran (e.g., wheat or corn bran)
Stool softeners act on the surface and function like detergents, allowing water to penetrate and interact with the stool to soften it.
- Docusate sodium (e.g., Colace)
- Docusate calcium (e.g., Surfak).
Osmotic laxatives help the inner layers of the intestine (intestinal lumen) retain water, thereby allowing more water to contact the stool to soften it. This improves stool frequency and stool consistency. These laxatives often take 2-3 days to be effects and are not recommended for rapid relief of constipation.
- Polyethylene glycol (e.g., Miralax)
- Lactulose (e.g., Kristalose)
- Magnesium hydroxide (e.g., Milk of magnesia)
These agents stimulate the sensory nerve endings of the colon to help increase contractions of the intestines to move the stool along. Stimulant laxatives often work within 6-12 hours.
- Senna (e.g., Senokot, Ex-lax)
- Bisacodyl (e.g., Dulcolax, Correctol, Carter’s Pills)
Other Constipation Remedies
Enemas for constipation are often the last resort for people anxious about their slow elimination. If you go to the hospital because of constipation you will probably get an enema. Enemas typically try to soften the stool, lubricate the colon, and stimulate muscles to help elimination. Sodium phosphate is sometimes used (e.g., Fleet) to keep water in the intestines to break apart and soften the stool.
Homemade enemas often contain mineral oil to help lubrication and common table salt with lukewarm water.
Other remedies typically include herbal remedies and biofeedback. Herbs such as aloe and mineral oil or biofeedback are sometimes touted as remedies for constipation. Most information about their effectiveness is anecdotal and no rigorous clinical trials have been reported.
Chronic Constipation Conclusions You Can Use
Long term relief to prevent the repeated occurrence of constipation requires getting enough fiber and water. If you cannot change your diet to include more fruits and vegetables, then add one or more of the above bulking agents to your daily food intake.
For more immediate relief of constipation some combination of stimulant laxatives and stool softeners will probably work for you. As a last resort, try an enema.
References About Chronic Constipation
- Chronic Constipation as published in the New England Journal of Medicine
- An Evidence-Based Approach to the Management of Chronic Constipation in North America as published in the American Journal of Gastroenterology
- Systematic Review on the Management of Chronic Constipation in North America as published in the American Journal of Gastroenterology