Most people experience occassional constipation. Constipation isn’t just the inability to have a bowel movement, and includes the difficulty associated with bowel movements. Travel, inactivity, illness, and certain over the counter medications taken “as needed” commonly result in short-term or acute constipation. Constipation lasting longer than three months is considered chronic constipation. Chronic constipation should be treated by a doctor to prevent health complications. 

Chronic Constipation: Are you and your healthcare practitioner talking about the same thing? 

Clear communication is essential to working with doctors, but the general public often has only a rudimentary understanding of medical terms - including constipation. There is often a gap between the physician and the patient’s perception of constipation which can lead to confusion. ^{(1, 2, 7, 10)} A study of people who thought they had constipation showed that only a third actually fit the criteria for constipation, while the rest actually had Irritable Bowel Syndrome or other gastrointestinal disorders. ⁽⁹⁾ So what are the criteria for constipation? 

If you have two or more of these symptoms, you may have constipation: ^{(Rome IV)} 

• Fewer than 3 bowel movements per week 
• During at least 25% of bowel movements do you experience any:
• Straining
• Hard or lumpy stools
• Sensation of incomplete evacuation
• Sensation of blockage at the level of the anus and rectum
• The need to use fingers or other manual maneuvers to have a bowel movement

If these symptoms last three consecutive months, your constipation may classified as chronic constipation. 

How often should I have a bowel movement? 

You don’t need to have a daily bowel movement to be healthy. Normal bowel function is different for everyone. Normal stool elimination varies from three times daily to three times weekly. This means that some people have a bowel movement every day or multiple times per day while others can skip an entire day, and both cases are considered normal.  Even if you normally have a bowel movement every day and miss a day, that’s normal. If you find yourself going more than three times per day or less than three times per week, then you should see your doctor. ^{(7, 10)}  

What does normal stool look and feel like? 

Ideal stools are “like a sausage or snake, smooth and soft,” or “like a sausage but with cracks on its surface.”  Ideal stools are easy to pass and don’t require any straining or pushing. ⁽¹¹⁾ 

What causes constipation? 

There are a wide variety of reasons you might become constipated. Diets low in fiber and with low fluid intake can cause constipation, as can a sedentary lifestyle. Constipation is also a side effect of medications including opiates, antacids, and some antidepressants or blood pressure medications. You can become constipated from prolonged use of laxatives or ignoring the urge to have a bowel movement. You might become constipated if certain pelvic floor or abdominal muscles aren’t able to relax or work together properly. Even health conditions including diabetes, Parkinson’s disease, anorexia, and hypothyroidism can cause constipation. Changes in life or daily routine including aging, pregnancy, and travel can all cause constipation, too. Problems with the colon and rectum including scar tissue and diverticulosis. Problems with intestinal function such as Irritable Bowel Syndrome, idiopathic (of unknown origin) constipation, and functional constipation. Poor dietary habits and lifestyle can lead to functional constipation, when the bowel is healthy but not working properly. In short, constipation can come from many different sources, and your doctor can help you find or rule out what might be causing it. ^(5,7,8) 

Why should I care about constipation?  

Besides being uncomfortable, complications of chronic constipation can be very serious, even requiring surgery: 

• Swollen veins in your anus, also known as hemorrhoids. Straining to have a bowel movement can cause swelling in the blood vessels in and around your anus. ^(7,12)
• Stool that are stuck and can’t be passed, known as fecal impaction. Chronic constipation can cause buildup of hardened stool that gets lodged in your intestines, leading to further difficulty passing bowel movements. ⁽⁷⁾
• Ripped or torn skin in your anus, otherwise known as an anal fissure. Large or hard stool can cause little tears in the anus. You may feel a burning or tearing sensation with an anal fissure. Pain can last for days to years and spread or radiate down the legs, even after the bleeding stops. ^(3,7,12)
• Intestine that stick out or protrude from the anus, in other words, rectal prolapse. Straining to have a bowel movement can cause part of the rectum to stretch and bulge out from the anus. Rectal prolapse may require surgery. ^(7,12)

When should I see my doctor?  

You should see your doctor if you experience any of the following: ^{(4, 6, 7)} 

• Your symptoms last longer than three weeks
• Your symptoms are really bad or disabling, affecting your daily life
• You have bad stomach pain when you pass stool
• Your bowel habits change suddenly
• You notice that your stools are consistently thinner
• You notice rectal bleeding, blood on the toilet paper, that does not go away or comes back often
• You see blood in your stool, particularly if it is mixed with stool
• Your stools are black
• You are found to have anemia, caused by lack of iron
• Fiber and exercise haven’t helped
• Family history of colon cancer or inflammatory bowel disease in addition to other symptoms
• You’re losing weight without trying

Constipation is often an embarrassing problem that is hard to discuss with friends and family, but your doctor is there for you and can offer a variety of treatments and solutions that work for you. The first step is to gain a better understanding of the problem, and I hope this article has helped you do just that. At Fusion Wellness Therapy we can offer support and treatment for constipation as well as a wide variety of pelvic floor issues and concerns.  

Check back soon for upcoming articles on identifying the cause of constipation, treatments and self-care for constipation. 

Sources 

1. Bellini M, Gambaccini D, Usai-Satta P, et al. Irritable bowel syndrome and chronic constipation: Fact and fiction. World Journal of Gastroenterology : WJG. 2015;21(40):11362-11370. doi:10.3748/wjg.v21.i40.11362.
2. Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association Medical Position Statement on Constipation. Gastroenterology.144(1):211-217.
3. Chang J, McLemore E, Tejirian T. Anal Health Care Basics. Perm J. 2016;20(4):74-80.
4. Concerned about constipation? National Institute on Aging, National Institutes of Health. https://www.nia.nih.gov/health/concerned-about-constipation. Published December, 2013. Updated April 28, 2017. Accessed July 1st, 2017.
5. Constipation. National Digestive Diseases Information Clearinghouse. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation. 
6. Constipation 103: When to call your doctor. American Gastroenterological Association. https://www.gastro.org/info_for_patients/constipation-103-when-to-call-your-doctor. Published July, 2016. Accessed July 5th, 2017.
7. Costilla VC, Foxx-Orenstein AE. Constipation, Understanding Mechanisms and Management. Clin Geriatr Med. 2014;30(1):107–115.
8. Dahl WJ, Stewart ML. Position of the Academy of Nutrition and Dietetics: Health Implications of Dietary Fiber. Journal of the Academy of Nutrition and Dietetics. 2015;115(11):1861-1870.
9. Ferrazzi S, Thompson GW, Irvine EJ, Pare P, Rance L. Diagnosis of constipation in family practice. Can J Gastroenterol 2002;16:159-64. 
10. Pinto Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Canadian Journal of Gastroenterology. 2011;25(Suppl B):11B-15B.
11. Raker J, Blake M, Whelan K. PTH-246 Can we trust reports of stool consistency? the validity and reliability of the bristol stool form scale. Gut. 2015;64(Suppl 1):A518-A519.
12. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG Clinical Guideline: Management of Benign Anorectal Disorders. Am J Gastroenterol. 2014;109(8):1141-1157.