Our bowel movement and adventures in toilet are not commonly discussed topics among family and friends. Do you know that it is quite common for some people not to pass stools once a day? In the medical literature, we define a normal stool passage as once in 3 days to three times a day, so long as the person does not have any pain during stool passage or need to strain very hard to pass the stools. However, if someone has infrequent passage of stools associated with abdominal bloating, pain or a need to strain excessively to pass stools, he/she is likely to have constipation.
Are there different types of constipation?
While there are many causes of constipation, your doctor should firstly decide whether you are suffering from primary or secondary constipation. Primary constipation is when the cause of the constipation is directly related to the colon (large intestine). Secondary constipation happens when you are suffering from a disease that causes your colon to slow down, leading to constipation. Secondary constipation can usually be excluded by some simple blood tests. One example of secondary constipation is hypothyroidism (a condition when your body produces too little thyroid hormone). Replacement of the thyroid hormone will quickly resolve the constipation.
After excluding secondary constipation, your doctor will try to determine if you have chronic constipation. Patients suffering from at least two of the following symptoms over a period of three months or more are considered to have chronic constipation:
• Frequency of less than 3 bowel movements per week
• Excessive straining during defaecation for at least 25 % of bowel movement
• Lumpy or hard stools
• Sensation of anorectal obstruction
• Sensation of incomplete defecation
• Manual maneuvering required to defecate
Can my chronic constipation be cured?
Chronic constipation can be readily controlled and some patients can be cured of the condition. It is important to know that the aim of treatment is to normalize your stool passage so that you do not suffer any discomfort/pain from going to toilet.
A normal person’s bowel movement is affected by the following factors:
• Diet content – diet low in fruit and vegetable fiber tends to cause constipation
• Psychological stress – the more stressed you feel, the more constipated you become
• Physical stress – if you are sick or have trouble sleeping (insomnia), you become constipated
• Medications – some medications for other health conditions may cause constipation
• Hormones – your general hormone levels can affect your bowel movement
• Physical activity – low general physical activity is associated with constipation
• Brain/ nerve control – nerves stimulate the colonic muscle which lead to bowel movement
On average, an adult will pass stools roughly once a day. A change in any of the factors can lead to constipation. Your doctor can identify which factors are abnormal and this can help treat your constipation.
What are the treatment options?
While further investigation and assessment are required to determine the best suited treatment option for each patient, the options below are widely accepted as reasonable first-line therapy:
• Dietary modification
• Lifestyle modification
• Regular exercise
• Oral medication
Is laxative use bad for me? Will I become dependent on laxatives?
It is a myth that laxative use will damage your colon. Your doctor can use one or more laxative to regulate your bowel movement. Many patients can gradually reduce or stop their laxatives when their lifestyle/ diet modifications have improved to control their bowel movement. Unfortunately, some patients have more severe constipation and require long term use of laxatives. You should not worry if this happens because the aim is to regulate your bowel movement to avoid complications of constipation. Most of the common laxatives have very few risks with long term use.
Can surgery cure me of constipation?
Surgery is very rarely used today in treatment of constipation as dietary modifications, exercise and medications have been very effective in treatment of chronic constipation. If your doctor recommends surgery before exhausting all the non-surgical options, you should seek a second opinion.