Constipation

What is constipation?
Patients and doctors differ greatly in their understanding and use of the word constipation. For many people, it is used for the infrequent passage of stools. For others it can refer to the passage of very hard stools. There is huge variation in bowel habits and many patients go several days without opening their bowels. This is not necessarily abnormal.

What causes constipation?
There are a number of causes of constipation, including problems like an underactive thyroid and Parkinson’s disease. Constipation may be due to other causes and these can often be considered to be a “transit” problem or an “evacuatory” problem (obstructed defaecation syndrome). Patients with a transit problem have a slow or lazy colon that does not propel food through the bowel at the proper speed. Patients with an evacuatory problem may have difficulty with the actual process of emptying the bowels.

What symptoms do patients get?
Patients with constipation often complain of hard or infrequent stools. Sometimes they also have symptoms of obstructed defaecation syndrome.

What tests will I need?
A flexible sigmoidoscopy or colonoscopy will excluded serious disease. A combination of a proctogram and transit studies distinguishes between a transit and a defaecatory problem.

Which treatments might be offered?
Simple treatments will treat most patients with constipation and we will often recommend regular use of appropriate laxatives as surgery has been beset by poor results. However sacral nerve stimulation improves some patients’ symptoms. In those with evacuatory problems, treatment of the structural abnormality (ie the prolapse, the rectocoele or the enterocoele) may relieve the constipation. Patients with anismus will often benefit from biofeedback or botulinum toxin injection.