Constipation: Causes, Symptoms, and Treatment Options

Constipation issues?

Hello, doctor.
In the past, I used to have a bowel movement every 1 to 1.5 days, and it was always smooth; I would go whenever I felt the urge.
However, around mid-February of this year, I suddenly experienced constipation (I hadn’t traveled anywhere and maintained a normal routine), going 3 to 4 days without any urge to defecate.
I felt abdominal bloating and extreme discomfort, so I consulted a colorectal surgeon.
Before the appointment, I suddenly passed some unformed, deep brown soft stool.
I underwent a digital rectal examination, X-rays, and a CT scan, and finally had a colonoscopy in early March, all of which came back normal.

I then visited a traditional Chinese medicine practitioner who diagnosed me with "excess cold in the intestines" and prescribed some herbs.
I started paying attention to my fruit and water intake, and I began to have bowel movements again, but only in the mornings.
This continued for three months, and the amount I passed daily was still minimal.
The stool was mostly banana-shaped and soft, with occasional pellet-like stools, and sometimes I would have two bowel movements within two hours in the morning.
After defecation, I always felt a bloated sensation in my abdomen, as if I hadn’t completely emptied my bowels.
Sometimes, no matter how hard I tried, I couldn’t pass any more stool, but changing positions or wiping would sometimes result in a small amount of residual stool being expelled.
I also noticed yellow, transparent mucus around the anal area when I couldn’t pass stool.
In the past two weeks, my bowel movement frequency has decreased again, accompanied by abdominal bloating, particularly in the upper left and lower left abdomen.
Additionally, I have been experiencing lower back pain, which started around mid-February when I felt a "pop" in my lower back while sleeping in a straight position due to prolonged sitting at work.
I didn’t think much of it at the time, but within a few days, I developed lower back pain along with the aforementioned constipation symptoms.
I have also been seeing an orthopedic doctor for the back pain, who diagnosed it as myofascial pain syndrome.
In March, after receiving acupuncture and cupping from a traditional Chinese medicine practitioner, my bowel movements returned to normal the next day, with no straining, a clear urge to defecate, and a refreshing feeling of complete evacuation.

On another occasion, while sitting due to back and thigh pain, I twisted my back to one side and felt the same "pop" sound, and the next day my bowel movements were normal again (though that night I accidentally fell, so both instances of sudden improvement only lasted a day).
Since then, my constipation has not improved as suddenly.
I am beginning to wonder if there might be a nerve-related issue caused by a bone or spinal problem (both the colorectal surgeon and orthopedic doctor said it wouldn’t affect it).
I would like to ask for your diagnostic opinion and whether there are any additional tests that could assist in confirming or ruling out certain issues, or if you have any recommendations for further medical consultation.
I heard that there are "chiropractors" abroad, but in Taiwan, it’s not covered by insurance and would be out-of-pocket.
Is it worth trying? Thank you for taking the time to read this.
Thank you!

Mike, 20~29 year old female. Ask Date: 2016/05/22

Dr. Ke Fangxu reply Surgery

Since the colonoscopy results are normal, it indicates that the difficulty in bowel movements is not due to structural issues in the intestines.
Herniated discs can indeed cause abnormal bowel control in very severe cases, similar to patients with spinal cord injuries.
However, your spinal function should not be compromised to that extent.
Currently, I can only recommend a light diet and maintaining a good daily routine.
If symptoms persist without improvement, you may consult a physician for medication.
As for the issue related to "chiropractic neurology," I am unable to provide advice as it is not within my area of expertise.

Reply Date: 2016/05/22

More Info

Constipation is a common gastrointestinal issue that can significantly impact an individual's quality of life. Understanding its causes, symptoms, and treatment options is essential for effective management.

Causes of Constipation
Constipation can arise from various factors, including:
1. Dietary Habits: A diet low in fiber, inadequate fluid intake, and excessive consumption of processed foods can lead to constipation. Fiber is crucial for adding bulk to the stool and promoting regular bowel movements.

2. Lifestyle Factors: Sedentary behavior, such as prolonged sitting, can contribute to constipation. Regular physical activity helps stimulate intestinal function.

3. Medications: Certain medications, including opioids, antacids containing aluminum, and some antidepressants, can cause constipation as a side effect.

4. Medical Conditions: Conditions such as irritable bowel syndrome (IBS), diabetes, hypothyroidism, and neurological disorders can affect bowel function and lead to constipation.

5. Psychological Factors: Stress, anxiety, and depression can also influence bowel habits, leading to constipation.

Symptoms of Constipation
Common symptoms include:
- Infrequent bowel movements (typically less than three times a week)
- Difficulty passing stools
- Hard or lumpy stools
- Abdominal discomfort or bloating
- A sensation of incomplete evacuation after a bowel movement

Treatment Options
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help soften the stool and promote regularity. It's also essential to drink plenty of water.

2. Physical Activity: Engaging in regular exercise can stimulate bowel function. Even simple activities like walking can be beneficial.

3. Over-the-Counter Laxatives: Various laxatives are available, including bulk-forming agents (like psyllium), osmotic agents (like polyethylene glycol), and stimulant laxatives (like bisacodyl). However, these should be used cautiously and not relied upon long-term without medical supervision.

4. Prescription Medications: In some cases, doctors may prescribe medications specifically designed to treat chronic constipation, such as lubiprostone or linaclotide.

5. Behavioral Therapy: Techniques such as biofeedback can help individuals learn how to coordinate their bowel movements better.

6. Alternative Therapies: Some patients find relief through acupuncture or chiropractic care, although evidence for these methods varies.

Diagnostic Considerations
Given your symptoms and history, it may be beneficial to explore further diagnostic evaluations. While you have undergone several tests, including colonoscopy and imaging studies, consider discussing the following with your healthcare provider:
- Pelvic Floor Dysfunction Assessment: Sometimes, constipation can be due to issues with the pelvic floor muscles. A specialized evaluation may help identify if this is a contributing factor.

- Gastrointestinal Motility Studies: These tests can assess how well food moves through your digestive tract and help identify any motility disorders.

- Neurological Evaluation: Since you mentioned back pain and potential nerve involvement, consulting a neurologist may provide insights into whether your spinal health is affecting your bowel function.

Seeking Specialized Care
You mentioned the possibility of seeing a chiropractor or a specialist in spinal health. While these practitioners can offer valuable insights, ensure that they are well-versed in gastrointestinal issues. In the U.S., there are specialists known as "chiropractic neurologists" who focus on the nervous system's role in various health conditions, including gastrointestinal function. However, in Taiwan, you may want to seek a specialist who can integrate both spinal health and gastrointestinal care.

Conclusion
Constipation can be a multifaceted issue requiring a comprehensive approach to treatment. By addressing dietary habits, lifestyle factors, and potential underlying medical conditions, you can work towards achieving better bowel health. If your symptoms persist or worsen, do not hesitate to seek further medical advice or consider a second opinion. Your health and comfort are paramount, and finding the right support is crucial in managing your condition effectively.

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