Constipation (Part 2)

Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I am going to talk some more about poop. Specifically, I am going to be talking more about constipation. In the first part, I talked about what constipation is and why it is important to prevent it or to treat it when prevention is unsuccessful. In this, second part, I want to talk about chronic constipation..

Chronic constipation is different than occasional or recurrent constipation. It is considered normal for a person to occasionally experience episodes of constipation and these occasional episodes are not associated with the previously discussed health risks. Recurrent constipation is when you have short bouts of constipation that become a pattern over time. This is more common in conditions like irritable bowel syndrome with constipation. Chronic constipation is when you present with consistent symptoms of constipation for a duration of 6 months or more.

Chronic constipation is common, effecting about 15% of the population. Having a mental health diagnosis, being older then aged 65, being female and living in a care facility are factors strongly associated with chronic constipation. Those who are experiencing chronic constipation are more likely to report symptoms of having a difficult time passing stool or an inability to completely empty the bowel rather then a reduced frequency of stool. When looking at quality of life indicators, having chronic constipation has scored comparable with patients suffering from asthma, rheumatoid arthritis and psoriatic arthritis. Thus, this diagnosis not only carries increased risks for adverse health outcomes, it also carries the very real risk of having a significant impact on a person’s daily life.

There are 3 types of chronic constipation which include: normal transit constipation, slow transit constipation and defecation disorder. It is possible for a person to have a defecation disorder in addition to slow transit constipation. The symptoms of constipation are the same for all 3 types of constipation. About half of all chronic constipation cases are normal transit constipation. In these cases, diagnostic testing shows no abnormalities in the gut motility or the way that stuff moves through the gut. In 15% of cases, diagnostic testing shows decreased motility and is given the diagnosis of slow transit constipation. Gastroparesis is a common comorbidity of this type of constipation which is not surprising since both are conditions of decreased motility.

25% of chronic constipation is caused by defecation disorders and the remaining 10% are those who have both a defecation disorder and slow transit constipation. Defecation disorders are a group of diagnoses that describe conditions that cause a person to have an impaired ability to pass stool from the rectum (the final portion of the colon) out the anus. There are numerous diagnoses beneath this umbrella which include pelvic floor dysfunction, anatomical abnormalities (such as prolapse or rectocele), neurogenic bowel (nerve damage) and others.

It is worth mentioning irritable bowel syndrome with constipation (IBS-C) since it is a type of chronic constipation. However, it does not fall under the umbrella of chronic constipation (also called functional constipation) as it is classified as being a type of irritable bowel syndrome. Having IBS-C precludes the diagnosis of having either normal or slow transit constipation, but does not preclude the possibility of being diagnosed with a defecation disorder. The diagnostic distinction between IBS-C and normal transit constipation or slow transit constipation is that IBS-C has regular bouts of loose stools not associated with the use of laxatives.

Hopefully, the preceding discussion has made it clear that the diagnosis of having constipation is complex and nuanced. Because of this complexity, it often requires extensive testing to determine the type of constipation that a person is experiencing. Since the type of constipation will determine the best treatment approaches, it is important to determine the type of constipation that the person is experiencing. This testing often includes x-rays, lab work, CT, MRI, colonoscopy, colorectal transit studies, defecography or anorectal manometry. However, these tests are not always performed. If you have been receiving treatment for constipation without relief for several months without this kind of work up, I would recommend advocating for this differential diagnosis. Getting a second opinion might become necessary. It is also important to have gastroenterologist evaluate your case.

Keeping a medical journal is very valuable. If you are suffering chronic constipation but are not having effective treatment or don’t know which type of constipation you have, I would strongly recommend that you start a medical journal. Include a daily record of every bowel movement that you have. Document the type of stool you pass by the Bristol stool scale rating system. Also document any symptoms that you have when passing those stools such as pain, bleeding, nausea, cramping etc. It is also useful to document what you eat and drink every day. This information can help you and your provider find patterns or trends in your bowel habits.

Having type 1 or type 2 stools per the Bristol stool scale is highly indicative of slow transit constipation while normal transit constipation generally has type 3 or type 4 stools. Needing to use manual maneuvers such as using the fingers to remove stool from the rectum or applying pressure to the lower abdomen is highly indicative of a defecation disorder. Having bouts of loose stools not associated with the use of laxatives is considered to be IBS-C. Abdominal pain while having a bowel movement that is better after the stool is evacuated is also indicative of IBS-C. Rectal pain is more likely functional constipation rather then IBS-C, but this is not as clear a distinction statistically. Having frequently varying types of stools per the Bristol stool scale is indicative of IBS-C. And these kinds of trends are best noted when a person is keeping a medical journal of their stools.

Including your food and fluid intake as part of your journal can be helpful for both the diagnostic process and the treatment phase. If you only have loose stools after you have eaten a particular food it becomes less likely that it is IBS-C and more likely that you have constipation and a food allergy or food intolerance. When you begin the treatment phase for your constipation, having a dietician or nutritionist review your food log can be helpful in considering ways that you can modify your diet to help prevent constipation.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!

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