What Are the Symptoms of Chronic Constipation?

Chronic constipation is a condition where bowel movements are infrequent or difficult for more than 3 months.

It involves at least 2 of the following Rome IV diagnostic criteria:

 

• Fewer than 3 bowel movements per week
• Hard or pellet-like stools in more than 25% of defecations
• Straining during more than 25% of defecations
• Sensation of incomplete evacuation in more than 25% of defecations
• Sensation of anorectal blockage in more than 25% of defecations
• Manual maneuvers (e.g., pressing abdomen or inserting fingers) in more than 25% of defecations

 

Symptoms persist despite not using laxatives and must not meet criteria for Irritable Bowel Syndrome (IBS).

 

What Causes Chronic Constipation?

1. Primary Constipation (Functional Constipation)

Most common causes include:

 

• Slow transit constipation
• Dyssynergic defecation (impaired pelvic floor muscle coordination)
• Normal transit constipation or IBS-C (constipation-predominant IBS)

2. Secondary Constipation

Caused by:

 

• Behavioral factors: low fluid intake, low-fiber diet, sedentary lifestyle
• Medical conditions: diabetes, hypothyroidism, hypercalcemia, Parkinson’s, neuropathy, spinal injury, tumors, bowel obstruction, depression, or anxiety
• Medications: opioids, antidepressants, calcium, iron supplements, anticonvulsants

 

When Should You See a Doctor?

If you experience chronic constipation with these warning signs, seek medical evaluation promptly:

 

• Blood in stool or black stools
• Unexplained weight loss
• Loss of appetite, chronic fatigue
• Pale skin or anemia
• Frequent or severe abdominal pain
• Fecal incontinence
• Numbness in the buttocks or legs
• Palpable mass in the abdomen or rectum
• History of abdominal or spinal surgery
• First-time constipation after age 50
• Pre-existing conditions like diabetes, hypothyroidism, or neurological disease
• Family history of colon cancer or chronic inflammatory bowel disease
• Constipation lasting over 3 weeks without improvement despite self-treatment

 

How Is Chronic Constipation Diagnosed?

1. Medical History & Physical Exam includes underlying conditions, bowel habits, medications, associated symptoms, rectal exam to check for muscle tone and stool mass

2. Laboratory Tests for anemia, hypothyroidism, electrolyte imbalances, blood glucose

3. Additional Tests:

• Abdominal X-ray: to assess bowel dilation or obstruction
• Colonoscopy: to detect tumors or strictures
• Anorectal manometry: evaluates anal sphincter and pelvic floor function
• Balloon expulsion test: evaluates defecation ability
• Colonic transit study: measures bowel movement speed
• Defecography: imaging test during defecation to assess pelvic function

 

How Is Chronic Constipation Treated?

Treatment involves identifying underlying causes, adjusting bowel habits, diet, pelvic floor training, medications, or in severe cases, surgical removal of part of the colon for slow-transit cases unresponsive to other treatments.

 

How to Prevent Chronic Constipation?

• Establish a regular toilet routine and allow enough time for bowel movements
• Avoid holding in bowel movements
• Consume a high-fiber diet including vegetables, fruits, and whole grains; avoid processed foods
• Drink enough water to soften stools
• Exercise regularly to stimulate bowel movement
• Manage stress and practice relaxation techniques