Constipation: Causes, Symptoms, and Treatment Options by Dr. Shravan Bohra

Hello, I am Dr. Shravan Bohra, a liver disease specialist and gastroenterologist at Apollo Hospital, Ahmedabad. Today, I want to talk to you about an issue that affects many people worldwide — constipation, also known as "kabzi" in Hindi.

What is Constipation?

Constipation, or "kabzi," is a common digestive disorder that affects people of all ages, whether it's children, adults, or the elderly. Regardless of gender, almost everyone experiences constipation at some point in their life. But what exactly does constipation mean?

Constipation occurs when:

• You go to the toilet less frequently, sometimes only once every two or three days.
• You need to strain during bowel movements.
• Your stool is hard, dry, or lumpy.
• After a bowel movement, you still feel like your bowel hasn't fully emptied.

These symptoms indicate that you may be suffering from constipation.

Types of Constipation

Constipation can generally be classified into two types: chronic and acute.

Chronic Constipation

Chronic constipation is a long-standing issue. Many patients who visit me have been suffering from constipation for years, sometimes even 10 or 20 years. Some individuals may have been dealing with it since childhood. This long-term constipation is referred to as chronic constipation, and it typically requires persistent medical intervention. Despite treatment, the problem often persists, making it one of the most prevalent forms of constipation.

Acute Constipation

Acute constipation, on the other hand, is a sudden occurrence. This means the person is experiencing constipation for the first time in their life, and it may last for a few days to a week. Acute constipation can lead to symptoms like bloating, a constant urge to have a bowel movement, and loss of appetite. While this form of constipation can be alarming, it’s often temporary.

Common Causes of Constipation

Understanding the underlying causes of constipation is crucial for effective treatment. Some of the most common causes include:

1. Age

Age plays a significant role in the likelihood of developing constipation. Constipation is more commonly seen in individuals over the age of 50, and its prevalence increases as people grow older. By the time a person reaches their 70s, approximately 30% of them experience regular bouts of constipation.

2. Pregnancy

Pregnant women are more prone to constipation due to hormonal changes and the pressure of the growing uterus on the intestines. This can slow down the passage of stool.

3. Dietary Habits

Poor dietary choices are one of the leading causes of constipation. Many people consume diets low in fiber, which is essential for regular bowel movements. Fiber adds bulk to the stool, making it easier to pass. A diet lacking in fiber can result in hard, difficult-to-pass stools, leading to constipation.

4. Dehydration

Drinking insufficient amounts of water can also lead to constipation. On average, an adult should consume at least eight glasses of water a day, and even more during hot weather. When you don’t drink enough water, your stool becomes dry and hard, making it more difficult to pass.

5. Changes in Routine

Traveling, skipping meals, or sudden changes in your daily routine can disrupt your bowel habits. For instance, traveling long distances or skipping your usual breakfast or lunch can throw off your digestive system and result in constipation.

6. Sedentary Lifestyle

Leading a sedentary lifestyle with little to no physical activity is another major cause of constipation. People who work in offices or have jobs that require them to sit for long periods without exercising may be at a higher risk of developing constipation.

7. Ignoring the Urge to Go

Ignoring the natural urge to have a bowel movement can lead to constipation. Over time, your body may stop sending signals, resulting in more severe constipation. It’s essential to go when you feel the need to avoid complications.

8. Genetic Predisposition

Some individuals may have a genetic predisposition to constipation. If constipation runs in your family, there’s a chance you might experience it more frequently than others.

Health Conditions Associated with Constipation

Constipation can also be a symptom of underlying health issues. Some of these conditions include:

1. Neurological Problems

Neurological disorders like Parkinson’s disease, diabetes, or hypothyroidism (underactive thyroid) can cause constipation. These conditions affect the nerves and muscles responsible for bowel movements, slowing down the process.

2. High Calcium Levels

Elevated calcium levels in the blood or conditions like hypercalcemia can lead to constipation.

3. Kidney Failure

Chronic kidney disease or kidney failure can result in constipation as the body's waste management system becomes less efficient.

4. Intestinal Obstruction

Intestinal blockages caused by hernias, tumors, or other conditions can lead to severe constipation. For instance, colon cancer or inflammatory bowel disease (IBD) can cause a blockage that results in constipation.

5. Irritable Bowel Syndrome (IBS)

IBS is a condition that affects the large intestine, causing symptoms such as abdominal pain, bloating, and changes in bowel habits. There are several types of IBS, and one of them is IBS with constipation (IBS-C), where the primary symptom is difficulty passing stool.

Medications That Can Cause Constipation

Certain medications can also lead to constipation. These include:

• Antacids containing calcium.
• Diuretics used to treat high blood pressure or heart conditions, which can cause dehydration.
• Pain medications such as codeine or morphine.
• Antidepressants or medications used for mental health conditions.
• Calcium channel blockers used to treat high blood pressure, such as amlodipine or nifedipine.

In some cases, long-term use of laxatives can worsen constipation. When you rely on laxatives for too long, your body may become dependent on them, making it difficult to have a natural bowel movement.

When to See a Doctor for Constipation

While constipation is a common issue, there are times when it may be necessary to consult a healthcare professional. You should consider seeing a doctor if:

• Your constipation persists for more than two weeks, despite home remedies.
• You notice blood in your stool.
• Your constipation is accompanied by unexplained weight loss, fever, or fatigue.
• You feel constant bloating or have severe abdominal pain.
• You have anemia (low blood levels) alongside constipation.

These could be signs of a more serious underlying condition, such as colon cancer or another gastrointestinal issue, and warrant prompt medical attention.

Diagnostic Procedures for Constipation

When patients visit me with constipation, my primary objective is to identify the root cause of the problem. This typically involves several diagnostic tests, such as:

• Blood Tests: To check for thyroid issues, elevated calcium levels, or other metabolic abnormalities.
• Stool Tests: To look for blood in the stool, which can indicate conditions like colon cancer or polyps.
• Colonoscopy: A crucial test, particularly for individuals over 50, which involves using a camera to inspect the colon for blockages or abnormalities. This helps us detect conditions like colon cancer or inflammatory diseases.
• Colonic Transit Study: In this test, the patient swallows a capsule containing tiny markers that are visible on X-rays. After five days, an X-ray is taken to check how far these markers have traveled through the colon. This helps in understanding whether there is a delay in stool movement through the intestines.

Conclusion

Constipation is a widespread issue that can impact your quality of life, but it is usually treatable with proper lifestyle changes and medical intervention. By understanding the causes and symptoms, you can take steps to prevent or manage constipation effectively. However, if the problem persists or worsens, consulting a doctor is essential to rule out any serious health conditions.

If you or someone you know is struggling with long-term constipation, don't hesitate to seek medical advice. Proper diagnosis and treatment can provide relief and prevent further complications.

Feel free to reach out if you have any questions or need further clarification.