What is Constipation?

Constipation is a very common condition – almost everyone gets constipated at some time or other. Constipation means different things to different people. Some consider the passage of hard stools to be constipation, whilst others consider it to be the infrequency of bowel movement. Some people believe it is essential to have one bowel action every day. The normal range of bowel frequency varies from individual to individual, with some having three motions per day, whilst others have only one every three days.

When should I consult my GP?

Constipation becomes an abnormal symptom when:

  • There is a persistent change in your normal bowel habit.
  • It is associated with bloating and/or crampy abdominal pain.
  • There is bleeding from the back passage.
  • You find yourself spending long periods of time straining on the toilet.
  • You need to use your fingers in the back passage, or even the front passage in women to get your bowels working.
  • You have the feeling that there is a “ball” blocking the passage of motion in the back passage.
  • There is absolute constipation when you do not pass any motion or wind over several days.

If you have any of these symptoms, contact your GP who may order some tests or refer you to a Colorectal Surgeon.

What are the causes of constipation?

Most causes of constipation relate to lifestyle issues:

  • Low fibre / high fat diet
  • Low fluid intake
  • Little or no exercise
  • Change in daily routine
  • Stress and anxiety

Other factors that can aggravate constipation are:

  • Pregnancy
  • Overuse of laxatives
  • Side effects of medication especially strong pain killers.

Causes of persisting constipation, often associated with other symptoms are:

  • Blockage in the bowel by a growth or narrowing (bowel obstruction)
  • A muscle problem – either the large bowel muscle is sluggish (slow transit constipation) or the anal sphincter muscle (at the back passage) does not relax when you are having a bowel motion (obstructed defecation).
  • Non-specific or functional problem where no immediate cause is obvious.

What tests may I need to have?

Your GP may arrange these tests or refer you to a Colorectal Surgeon.

  • Examining the back passage and the inside of the bowel. This is done to determine if there is a blockage.
  • You may need to have internal examination of the anus with the doctor’s finger and a rigid telescope (a sigmoidoscope);
  • An internal examination of the whole large bowel with a flexible telescope (a flexible sigmoidoscopy or colonoscopy),
  • An X-ray examination of the large bowel – a barium enema.
  • Tests to determine if there is a muscle problem.
  • A whole gut transit time. This is performed either by you taking a table containing markers, then having a series of x-rays or having a nuclear medicine scan after taking a combined liquid and solid meal (containing Radio Isotope) and scans are then taken. These tests require x-rays or scans over a period of 5-6 days.
  • Muscle test on the back passage (Ano-rectal manometry). A catheter is placed in the anus and measurements of your muscles made including a balloon test.
  • Electrical tests on the muscle (EMG). These tests may be uncomfortable but they are occasionally necessary.

How is constipation treated?

Constipation is best treated by maintaining a healthy diet and lifestyle –

  • Low fat/high fibre diet
  • Regular fluid intake
  • Regular exercise

What is fibre?

Fibre is in the cell walls of plants and remains undigested in the bowel. It acts like a sponge soaking up water into the bowel, adding bulk to the bowel content and increasing the passage of digested food through the bowel.

How much fibre do we need?

Most Australians each about 20 grams of fibre per day, but the recommended daily intake to remain healthy and have a regular bowel habit is 30 grams per day.

Which foods are high in fibre?

Breads, cereals, vegetables, fruit, nuts, seeds, legumes (lentils/beans). Foods that are high in fibre are generally low in fat. A high fibre/low fat diet is ideal.

What else can I do to help avoid constipation?

  • Fluids – drink plenty of water (2 litres per day). This increases the sponge effect of the fibre.
  • Fitness – have regular exercise. 20 minutes, three times per week. Walking is best. This stimulates bowel function.
  • Fibre supplement. Many natural fibre products are available at your pharmacy to add extra fibre.

A formula for fighting constipation – the 5 Fs:

  • High Fibre
  • Low Fat diet
  • Fluid
  • Fitness
  • Fibre supplement

What can be done to treat constipation?

  • Blockage or bowel obstruction: Surgery may be required to remove the affected part of the bowel causing the blockage.
  • Bowel Muscle Problem (Slow transit constipation). The majority of patients can be treated by a combination of dietary manipulation and laxatives. Occasionally surgery may be required to remove the large bowel and join the small bowel to the rectum. A stoma bag is very rarely required.
  • Sphincter Muscle Problem (Obstructed defecation). Treatment is a combination of diet, laxatives and bio feedback – exercises involving pelvic floor rehabilitation (retraining the sphincters to relax).

Non-specific. Often, despite all investigations, no specific cause can be found for constipation, although symptoms persist. This can be frustrating both for the patient and the doctor, but usually a combination of change in lifestyle, diet and laxatives will improve the situation.