treatment of chronic constipation

Chronic constipation refers to infrequent bowel movements or difficulties in evacuating stools that last several weeks or more. Constipation is usually characterized by a number of bowel movements, rough and small, less than three per week. Although occasional constipation is very common, some people develop chronic constipation that can interfere with their ability to perform daily tasks.

Generally, the doctor uses a treatment of chronic constipation through laxatives. Moreover, this does not prevent that in some cases, surgery is required.

Chronic constipation

Definition of chronic constipation

Unlike occasional constipation, chronic constipation persists for more than six months. It is characterized by the difficulty of evacuating hard and small stools, accompanied by a reduction in the number of stools up to at least three per week.
Chronic constipation is frequently due to several external or internal factors:
• poor living hygiene.
• a diet that is not high in fiber and low in calorie intake.
• stress.
• lack of physical activity.
• physical or sexual abuse
• side effects of some medications on antidepressants and antacids…
• Some conditions such as hypothyroidism, bowel obstruction, etc.

Symptoms of chronic constipation

In addition to the difficulties of stool evacuation, chronic constipation leads to the appearance of certain disorders and digestive discomfort accompanied by different symptoms depending on the patient’s case:

• Bloating

• Flatulence

• Hemorrhoids

• Abdominal pain

Relieving these symptoms is necessary to improve quality of life. These symptoms are due to hormonal changes that can disrupt the functioning of the digestive tract and cause constipation whether occasional or at worst chronic constipation. Women are more affected than men because they suffer more hormonal upheavals.

Patient Exam

The interrogation of the patient

In the face of constipation, dialogue between doctors and patients is essential. Sometimes taboo, this subject is at the origin of multiple apprehensions (even if in most cases, constipation does not necessarily symbolize a risk for health). The doctor will first determine whether it is constipation or not (less than 3 bowel movements per week). It will then assess its impact on quality of life. Medical and surgical history, medications, eating habits and physical activity levels will also be studied.

Clinical Review

Medical examination of the rectal area can detect the presence of stool accumulations, hemorrhoidal lesions or possible abnormalities (cracks, tumours, etc.). It will also evaluate the tone of the anal sphincter.

Blood tests and colonoscopy are primary examinations prescribed under well-defined conditions to rule out probable pathologies that can lead to constipation.

If constipation persists even after the follow-up of medication and a healthy and well-balanced diet, a special test for ano-rectal manometry, colon transit time or intestinal MRI) is performed. These tests will help determine an accurate mechanism to provide the appropriate treatment for chronic constipation.

Treatment of chronic constipation

Improving your eating habits is recommended as a treatment of chronic constipation or occasional constipation, starting with fiber intake (between 20 and 40 grams).

Once the fiber intake is checked according to standard standards, a daily treatment with laxatives is usually sufficient: analgesic laxatives (mucilages) and osmotic laxatives that allow the hydration of stool, and paraffin-based lubricating laxatives (emollients) are beneficial for softening and sliding stools.

In case of failure, stimulant laxatives may be prescribed. These laxatives stimulate the motor of the colon and the secretion of water in the colic mucosa, but often cause abdominal pain and diarrhea. The use of an enema or in some cases a rehabilitation by push is more appropriate with regard to ano-rectal constipation.

Finally, in special cases, we can mention a subtotal colectomy, that is to say the resection of almost the entire colon can be performed. In the case of constipation of anorectal origin, surgery can restore an anatomical abnormality in the case of rectal prolapse or rectocele.

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