Irritable Bowel Syndrome

Understanding IBS with Constipation (IBS-C)

An Overview of Constipation

Odds are that at some point or another every person will experience the discomfort of constipation. So it's important to learn what to do for it, whether it is something you or your child have just started to experience, or it is something that has been a problem for quite some time.

What Is Constipation?

Constipation is a state in which bowel movements become more difficult. Typically this means that stools are hard and challenging to pass.

Although the frequency of bowel movements can be very different from one person to the next, constipation is generally defined as bowel movements that occur less than two or three times per week. Alongside constipation, you might also experience abdominal pain and/or bloating.

Causes of Constipation

Although constipation is a common phenomenon for people of all ages, it is more likely to be an issue for older adults, pregnant and post-partum women, and people who have lower income levels.

You are also more likely to experience constipation if you are taking certain kinds of medication or if you are recovering from surgery.

There is a wide variety of causes behind constipation. These can include lifestyle factors and habits, other medical conditions, and some classes of medications taken for different health problems. 

Lifestyle Factors

Often constipation occurs due to behavioral habits, for example:

  • Not eating enough fiber-containing foods
  • Not drinking enough water throughout the day
  • Not engaging in enough physical activity
  • Traveling or changes in routine
  • Eating too much dairy
  • Being stressed
  • Ignoring urges to use the bathroom for a bowel movement

Other Health Conditions

There are many health conditions in which constipation may be a symptom, including:

(It is important to note that colon cancer also typically presents itself with symptoms of weight loss, fatigue, and signs of blood in the stool.)

Medication Side Effects

Many medications used to treat other health conditions may cause constipation as a side effect, including:

  • Antacids containing calcium or aluminum
  • Anticholinergic medications (antispasmodics)
  • Antidepressants
  • Antihistamines (allergy medications)
  • Calcium channel blockers (for high blood pressure)
  • Diuretics
  • Iron supplements
  • Narcotic pain medications
  • Some seizure medications
  • Some blood pressure medications
  • Some herbal supplements

Preventing Constipation

By identifying what lifestyle factors can contribute to constipation, it is easier to figure out what you can do to try to prevent it from happening.

 Here are five tips:

  1. Be sure to add lots of dietary fiber into your diet, including vegetables, legumes, fruits, and whole grain products.
  2. Drink lots of water throughout your day.
  3. Stay active!
  4. Respond promptly to any urges for a bowel movement.
  5. If necessary, use a fiber supplement.

When to See Your Doctor

You should call your doctor if your constipation persists for longer than three weeks and/or you  experience any of the following symptoms:

  • Blood in your stool
  • Unexplained weight loss
  • Severe pain in the abdomen

Your doctor will take your medical history, perform a physical exam, and perhaps order blood work. Based on your clinical picture, further tests may be recommended. If you are over the age of 50, it is likely that you will be sent for a colonoscopy. A flexible sigmoidoscopy is another possible option.

Should the need arise, your doctor might send you for more specialized testing to try to gather information as to what is behind your constipation. Such tests include those that measure colonic transit time (how long it takes for stool to move through your colon) and anorectal manometry which measures the tone and strength of the muscles in your anus and rectum.

Less frequently used tests are X-ray defecography and MRI defecography, both of which identify any functional or structural problems relating to having bowel movements.

Treatment for Acute Constipation

If you are experiencing a new onset of constipation without any of the symptoms listed above, try to increase your fluid intake and your physical activity level. Also, gradually increase the amount of dietary fiber you are consuming.

Additionally, there are numerous over-the-counter options for you to look into or talk to your doctor about, including:

  • Osmotic laxatives: These products work by increasing the fluid level in your colon, thus softening stool and triggering more regular urges to have a bowel movement.
  • Stimulant laxatives: These products speed up the muscles in your large intestine, thus triggering the urge for a bowel movement.
  • Herbal stimulant laxatives: These products contain herbs that have properties for increasing the fluid volume and the speed of muscle movement within the large intestine.
  • Stool softeners: These do exactly what their name implies—soften stool. However, they don't necessarily ease the problem of constipation and thus a laxative may be the preferred choice.

Your doctor may also decide to switch or adjust the dosage of a medication that you are taking for a different health issue if it is believed to be contributing to your constipation.

When Constipation Is Chronic

Chronic constipation should not be ignored. And there are some associated complications that you will want to try to prevent, including:

Although research does not show a strong correlation between chronic constipation and colon cancer, there are some concerns. Therefore it is important that you work with your doctor on devising a treatment plan.  Your doctor can offer several medications to address your chronic symptoms, like:

  • Amitiza: This targets specific cells within your digestive tract to stimulate the release of more fluids, thus softening stool and speeding up your system. Unfortunately, approximately one out of every four or five people who take Amitiza experience nausea.
  • Miralax: This medication is classified as an osmotic laxative and is now available over-the-counter. It has good research support for easing constipation, but may not be effective in reducing symptoms of abdominal pain. So, it might not be a good option if such pain is part of your symptom picture.
  • Linzess: Known as Constella in Europe, Linzess targets specific receptor cells in the digestive tract. This results in increased fluid within the intestines which helps ease constipation and abdominal pain.

Other treatments for chronic constipation include biofeedback and/or physical therapy to retrain the muscles in your pelvic floor. This might be especially helpful if you have been diagnosed with dyssynergic defecation. In very, very rare cases, a surgical procedure might be indicated.

When Your Child Is Constipated

Constipation in children is fairly common, with symptoms of hard, dry, difficult-to-pass stools and bowel movements that occur less than two or three times per week. In the vast majority of cases, such constipation is short-lived and does not indicate a more serious illness.

In rare cases, such constipation may lead to the same problems that adults experience, i.e. anal fissures, hemorrhoids, and rectal prolapse. Rarely will a doctor recommend a diagnostic test for constipation in children, but will rather rely on medical history and a physical examination to diagnose and provide treatment.

Children that are constipated may show some behaviors not necessarily seen in adults. They may actively balk at using the toilet, clench their buttocks, or rock in an unusual way as if to hold in stool. You may also notice signs of stool in diapers or underwear. (A large stool mass may even trigger daytime urinary accidents or bedwetting in a child who has been previously toilet trained and/or dry through the night.)

You should contact your child's pediatrician if constipation lasts longer than two weeks or immediately if you see any signs of fever, vomiting, blood in the stool, swollen belly, or unexplained weight loss.

For cases in which constipation is not indicative of a serious health issue, your child's doctor will work with you on a treatment plan to address their symptoms. This may include addressing any fear behaviors associated with using the toilet or having a bowel movement and changing your child's diet.

A Word From Verywell

Constipation is a relatively common human experience and rarely indicates a serious health concern. Working with your doctor and tweaking your self-care is often all that is needed to ease symptoms. Should symptoms persist, your doctor has options for developing an optimal symptom management plan for you or your child.

Sources:

"ConstipationNational Institute of Diabetes and Digestive and Kidney Diseases Website accessed July 26, 2016.

"Constipation in Children" Accessed July 26, 2016.

Lee, Y. "What’s New in the Toolbox for Constipation and Fecal Incontinence?" Frontiers in Medicine 2014 1:5.

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