Chronic Constipation: Causes, Treatments, and Solutions

Q: Chronic Constipation: Causes, Treatments, and Solutions

Hello： 1. It may not be noticeable. 2. If kidney function is normal, magnesium oxide can be used. 3. Irritable bowel syndrome is diagnosed based on recurrent and periodic symptoms, and colonoscopy is used to rule out abnormalities in the colon (such as tumors

Chronic constipation issues?

Dear Dr.
Tsai,
I have been experiencing long-term constipation issues (lack of bowel urge).
I am currently 30 years old, and this problem has been present since my university days.
I previously had a habit of using stimulant laxatives (such as Sennosides) for a long time, but their effectiveness has diminished.
I underwent a colonoscopy at the end of last year, which showed no abnormalities.
I have consulted several doctors, most of whom advised me to increase my fiber and water intake and to exercise more.
I have followed their advice, but the lack of bowel urge remains challenging.

Understanding that long-term use of laxatives can damage the gastrointestinal nerves, I am currently trying to gradually discontinue their use.
I have been attempting the following strategies:
1.
Exercising more, at least 3-4 times a week, including aerobic and strength training at the gym (which I have been doing for about a year).
2.
Increasing fiber, water, and healthy fats intake: switching from white rice to brown rice, increasing the intake of good oils (extra virgin olive oil), and drinking more water (I mix organic honey and lemon).
3.
Massaging my abdomen daily, usually after breakfast and before bed.
4.
Consuming more probiotics, such as bifidobacteria.
5.
Eating more fruits, such as bananas and kiwis.
6.
Drinking coffee in the morning (which was initially effective, but its effect has diminished).
However, these strategies have had limited improvement regarding the "lack of bowel urge." Sometimes I do feel the urge and can pass stool, but the amount is not proportional to what I consume; the stool feels quite small, and the overall quantity is minimal.
Since I exercise, my food intake is quite large.
It feels as though I cannot pass a normal amount without the aid of laxatives, and the urge is weaker without them.
I would like to ask the following questions:
1.
If the gastrointestinal nerves have indeed been damaged or become sluggish due to long-term use of stimulant laxatives, can this be detected through a colonoscopy?
2.
If I switch to taking magnesium oxide 500 mg to improve constipation, can it be used long-term if taken once a day (I am in the U.S., and magnesium oxide is readily available as a supplement)?
3.
Can a colonoscopy determine if I have irritable bowel syndrome (IBS)?
Thank you for taking the time to read my situation and questions.
I look forward to your response!

Mr. Jiang, 30~39 year old female. Ask Date: 2017/03/16

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
It may not be noticeable.
2.
If kidney function is normal, magnesium oxide can be used.
3.
Irritable bowel syndrome is diagnosed based on recurrent and periodic symptoms, and colonoscopy is used to rule out abnormalities in the colon (such as tumors or colitis).
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/03/16

More Info

Chronic constipation is a common gastrointestinal issue that can significantly impact one's quality of life. It is characterized by infrequent bowel movements, difficulty passing stools, and a sensation of incomplete evacuation. Understanding the causes, treatments, and potential solutions for chronic constipation is essential for effective management.

Causes of Chronic Constipation
Chronic constipation can arise from various factors, including:
1. Dietary Habits: Low fiber intake, inadequate hydration, and excessive consumption of processed foods can contribute to constipation.

2. Physical Inactivity: A sedentary lifestyle can slow down the digestive process.

3. Medications: Long-term use of stimulant laxatives, such as Sennosides, can lead to dependency and decreased bowel function.

4. Medical Conditions: Conditions like irritable bowel syndrome (IBS), hypothyroidism, diabetes, and neurological disorders can affect bowel motility.

5. Psychological Factors: Stress, anxiety, and depression can influence bowel habits.

Treatment Options
1. Dietary Modifications: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help promote regular bowel movements. Adequate hydration is also crucial.

2. Physical Activity: Regular exercise can stimulate bowel function and improve overall digestive health.

3. Behavioral Techniques: Establishing a regular bowel routine, such as setting aside time each day for bowel movements, can help train the body.

4. Medications: If dietary and lifestyle changes are insufficient, other medications may be considered. These can include osmotic laxatives like magnesium oxide, which draw water into the intestines to facilitate bowel movements.

5. Probiotics: Incorporating probiotics into your diet may help restore gut flora balance and improve bowel function.

Addressing Your Specific Concerns
1. Impact of Long-term Stimulant Laxative Use: Long-term use of stimulant laxatives can lead to a condition known as "laxative dependency," where the bowel becomes less responsive to natural stimuli. While a colonoscopy (colonoscopy) can identify structural abnormalities, it may not directly show functional issues related to nerve damage or motility disorders. However, it can rule out other serious conditions.

2. Using Magnesium Oxide: Magnesium oxide is an osmotic laxative that can be effective for chronic constipation. It is generally considered safe for long-term use, but it is essential to monitor for any side effects, such as diarrhea or electrolyte imbalances. Always consult with a healthcare provider before starting any new supplement, especially if you have underlying health conditions.

3. Diagnosing Irritable Bowel Syndrome (IBS): A colonoscopy can help rule out other gastrointestinal disorders, but IBS is primarily diagnosed based on symptoms and the exclusion of other conditions. A healthcare provider may use criteria such as the Rome IV criteria to diagnose IBS, which focuses on symptom patterns rather than relying solely on imaging studies.

Conclusion
Chronic constipation can be a complex condition requiring a multifaceted approach to treatment. It is commendable that you are taking proactive steps to manage your symptoms through diet, exercise, and lifestyle changes. However, given the persistence of your symptoms, it may be beneficial to work closely with a healthcare provider who specializes in gastrointestinal disorders. They can provide personalized recommendations, monitor your progress, and adjust your treatment plan as necessary. Remember, addressing chronic constipation often requires patience and a willingness to explore various strategies until you find what works best for you.

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