Chronic Constipation: The gift that keeps on giving!

As a Gastroenterology nurse practitioner, I can easily say that constipation is the most common issue my colleagues and I face. Even when patients come in with complaints like acid reflux, diarrhea, and fatigue, constipation is always on my mind.

Most often, patients associate constipation with reduced stool frequency, less than 3 x per week, however many other symptoms are associated with constipation. Hard stools, excessive straining, feelings of incomplete bowel evacuation, having a need to go but unable, abdominal pain or bloating, and even nausea and vomiting can be associated with constipation. Loose stools are another complaint that most people would not associate with constipation, but may indicate hard stool retention with overflow of fluids in the colon. Patients see many other providers about these complaints before being evaluated by GI, only to find out that they have been constipated all along.

Constipation can be categorized as acute or chronic. Acute constipation typically occurs transiently, such as during traveling and eating new foods, getting sick, after having surgery, or temporarily taking a medication that slows down the bowels. Acute constipation can have a sudden onset and indicate a bigger issue, like bowel obstruction, in rare circumstances.

Chronic constipation is generally a persistent problem that will last for more than 3 months and require long-term management or more aggressive interventions to improve bowel evacuation. Chronic constipation may be due to other chronic diseases such as neurological disorders, thyroid disease, or GI conditions such as IBS, and IBD (Crohn’s disease and ulcerative colitis). Medications such as narcotics and antidepressants are often big contributors to constipation.

Chronic constipation may be due to normal or slow colon transit time and/or defecatory abnormalities (pelvic floor weakness and anatomical abnormalities within the rectum). Chronic idiopathic constipation (CIC) is the diagnosis often given to people that are chronically constipated without an obvious, identifiable cause. About 15% of the global population can carry this diagnosis.

Why are so many people diagnosed with CIC? I believe the answer lies in our modern world. The same reasons that chronic disease is so prevalent, our lifestyle and dietary choices do not support good bowel habits. High stress, poor sleep, dehydration, poor dietary habits, and inactivity can all affect bowel evacuation. Changes in various hormones due to an unhealthy lifestyle can contribute to CIC as well. Patients tell me that they were doing fine until a specific timeframe but what they fail to realize is that chronic constipation was developing over the course of years. By the time you started having symptoms, the mechanisms that facilitated constipation were already in play for a long time. Most people want a quick fix but they want to do it “naturally,” which is impossible. To “naturally” reverse the damage caused by a modern, unnatural lifestyle will take years, and significant changes to your life, and may not be completely reversible for some people.

So what options do you have? Fiber is often the go to recommendation for constipation. I find that fiber can be helpful up to a point. Many people overdo it on fiber intake. They attempt to consume high fiber diets and add fiber supplementation but this can be counterproductive, resulting in bloating, abdominal pain, and harder stools due to the bulking activity of fiber. I don’t generally recommend a set amount of fiber, because each individual can have different tolerances.

There are various over the counter and prescription laxative options available to help with constipation. Some are safe for temporary use while others can be used long-term, if needed. 

If you would like to receive a plan tailored to your specific constipation needs, please join us a VNPS. Medication options and recommendations on lifestyle and dietary changes are available to help get constipation under control. Improving bowel evacuation can make a big difference in your overall health and well-being.

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