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Comprehensive Overview of Constipation: William E. Whitehead, PHD Center Co-Director

Constipation is caused by slow movement of waste through the colon or difficulty passing stool, with common symptoms including straining, hard stool, and less than 3 bowel movements per week, and it affects 3-10% of people, with treatments including fiber supplements, laxatives, diet and exercise changes, and in severe cases surgery. The document provides an overview of constipation causes, who is affected, testing and treatment options, and information on a research study being conducted at UNC.

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97 views3 pages

Comprehensive Overview of Constipation: William E. Whitehead, PHD Center Co-Director

Constipation is caused by slow movement of waste through the colon or difficulty passing stool, with common symptoms including straining, hard stool, and less than 3 bowel movements per week, and it affects 3-10% of people, with treatments including fiber supplements, laxatives, diet and exercise changes, and in severe cases surgery. The document provides an overview of constipation causes, who is affected, testing and treatment options, and information on a research study being conducted at UNC.

Uploaded by

neha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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COMPREHENSIVE OVERVIEW OF CONSTIPATION

William E. Whitehead, PhD


Center Co-Director

WHAT CAUSES CONSTIPATION?


Constipation can refer to either very slow movement of food residues through the colon (slow
transit constipation) or difficulty passing bowel movements after they reach the rectum (outlet
dysfunction). The specific symptoms of constipation are listed below. Doctors often diagnose
constipation if patients have at least two of these symptoms more than a fourth of the time:

• Straining
• Hard or lumpy stools
• Feeling that there is a blockage in the rectum that prevents bowel movements from passing
• Having to press around the anal opening
• Less than three bowel movements per week

The large intestine is a tube-shaped muscle, and short segments of this muscle can squeeze together
(contract) to close off the inside. Most of the contractions are not coordinated with each other; they
just move food residues back and forth so water can be absorbed. However, about 6 times per day,
strong contractions begin in the right side of the large intestine and move progressively
downstream pushing food residues towards the rectum; this is called a High Amplitude
Propagating Contraction. If these strong contractions fail to occur, food residues can't move
downstream and slow transit constipation results.

WHO HAS CONSTIPATION?


From 3% to 10% of people in surveys say they are constipated, and a higher number, about 30%,
report that they take laxatives at least once a month. More women than men say they have
constipation, and more African Americans than Caucasians. As people grow older, they report
more constipation. However, in most large surveys, older people have as many bowel movements
as younger people. This suggests that as people age, they have more trouble passing a bowel
movement (need to strain more), but the frequency of bowel movements does not change. Many of
the drugs people take for pain, high blood pressure, or depression cause constipation. Talk with
your doctor about your medications; he or she may be able to change the drugs you take for these
health problems to ones that are less constipating. Because constipation is a very common problem,
and it is not life-threatening, most doctors will start treatment without doing tests. It is only when
the treatment is not successful that patients need to be tested to identify exactly what causes it.
TESTING FOR CONSTIPATION:
• Sitzmark test is the most
helpful test to find the cause of
constipation. This test
measures how long it takes
food residues to travel
through the gut. This is done
by having you swallow tiny
soft rubber rings in a capsule
about 1/2 inch across and then
taking an x-ray 5 days later to
see how many of the rings are
left. In some clinics the rubber
rings are given for 3-5 days
instead of just once.
• Anorectal Manometry is a test used to measure the pressure in the anal canal when you
strain to have a bowel movement to see if your sphincter muscles relax as they should.
• Pelvic Floor Electromyographic
• [EMG] stands for activity. This is used to test the failure of the sphincter muscles to relax
(outlet dysfunction) Small sensors are used to record the electrical potentials your sphincter
muscles generate when they squeeze.
• Balloon Defecation is a test in which a small
tube with a balloon on the tip is inserted into
your rectum, filled with water or air, to see if
you can pass it like a bowel movement
• Evacuation Defecography is an alternative
test used to inject a thick paste made from
barium and Metamucil into your rectum (this
behaves like a soft bowel movement) and uses
an x-ray to see how well you can pass it out.

HOW IS CONSTIPATION TREATED?


Laxatives are used when food residues move slowly
through the large intestine. There are several types:
• Fiber supplements or high fiber foods,
combined with drinking more liquids, may
cause you to have larger and softer stools.
This can eliminate mild constipation.
• Stimulant laxatives usually contain senna or cascara (laxatives that occur naturally in some
plants) or bisacodyl (the ingredient in Dulcolax).
• These are effective laxatives if used occasionally, but they may stop working if they are used
every day.
• Osmotic laxatives stimulate the small intestine to secrete more water to make bowel
movement softer. Examples are milk of magnesia, magnesium citrate, lactose, and sorbitol.
• Polyethylene glycol (the ingredient in Miralax) is a liquid which your body can't absorb, so it
flushes food residues out of the intestines.

WHAT ABOUT DIET AND EXERCISE?


A diet high in fiber can reduce constipation by making your bowel movements larger and softer.
Breakfast cereals are often fortified with extra fiber. Prunes are a natural laxative. Drinking plenty
of water may also help. Foods that can make constipation worse include cheese and bananas.
Surveys show that people who exercise most days, even with mild exercise such as walking, have
less constipation.

Surgery. When slow transit constipation is very severe, your doctor may recommend removing
your large intestine and connecting your small intestine to your rectum. However, this surgery
often has sideeffects including fecal incontinence; it is used only as a last resort.

Biofeedback is a method for teaching people how to properly relax the sphincter muscles when
they are straining to have a bowel movement.

Muscle relaxing drugs are drugs that relax the sphincter muscles as well as other muscles of the
body.

Research Study at UNC


UNC has a grant from the National Institute of Health to test different methods of treating
constipation that is related to difficulty passing bowel movements. Patients who qualify will receive
one of three experimental treatments, which are free and which last for three months.

How to make an appointment at UNC


The UNC Center for Functional GI and Motility Disorders accepts referrals from doctors or patients
to test for the causes of constipation and to make treatment recommendations. You can schedule an
appointment by contacting (910) 966-5563.

To enroll in our research study, you or your doctor should telephone Mr. Steve Heymen at (910) 966
2515.

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