Constipation: Causes and Concerns for Long-term Sufferers

Q: Constipation: Causes and Concerns for Long-term Sufferers

Hello： If you have daily bowel movements, but the amount may be decreasing, please pay attention to whether you are consuming fewer fruits and vegetables. <br>Changhua Hospital cares about your health. <br>Dr. <br>Tsai An-shun.

Bowel issues

Hello Doctor, I have been experiencing constipation since childhood, and it has been over a decade now, with bowel movements occurring once or twice a week.
I often had bloating as a child, and if I ate too much, I would feel nauseous, but it improved significantly after middle school.
I am currently 168 cm tall and weigh 45 kg.

In the past month or two, I have noticed that the amount of stool has decreased compared to before, but my weight has not changed much.
Previously, I drank very little water, resulting in hard, dry stools that were often pellet-like; if they were formed, there would be two to three pieces.
Recently, I have been drinking about 2000 ml of water a day, which has made my stools softer, but I still only have one formed piece, and while the shape is normal, the total amount feels less than before.
Additionally, I often feel the urge to pass gas, sometimes every ten to twenty minutes.
Could you please explain why the amount of stool has decreased? Is it related to my increased water intake? I eat similar portion sizes as others for my three meals, and I haven't been eating less than before.
I am quite worried about whether I might be ill, and could this be a sign of colon cancer?

Niming, 10~19 year old female. Ask Date: 2017/11/06

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: If you have daily bowel movements, but the amount may be decreasing, please pay attention to whether you are consuming fewer fruits and vegetables.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/11/06

More Info

Constipation is a common gastrointestinal issue that can significantly impact an individual's quality of life. It is characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. Given your long history of constipation, it's understandable that you have concerns about changes in your bowel habits, especially with the recent decrease in stool volume.

Understanding Your Symptoms
1. Long-term Constipation: Chronic constipation can stem from various factors, including dietary habits, hydration levels, physical activity, and even psychological factors. In your case, you mentioned a history of constipation since childhood, which may indicate a long-standing issue with bowel motility or dietary fiber intake.

2. Recent Changes: The fact that your stool volume has decreased recently, despite an increase in water intake, is noteworthy. While hydration is crucial for softening stools, other factors also play a role in stool formation. For instance, the amount of dietary fiber you consume is critical. If your fiber intake has not increased alongside your water intake, it could lead to smaller stool volume.
3. Gas and Bloating: The frequent urge to pass gas, along with your history of bloating, suggests that there may be some underlying gastrointestinal dysmotility or dietary intolerances. Foods that are high in fermentable fibers (like beans, certain fruits, and vegetables) can lead to increased gas production, especially if your body is not accustomed to them.

Potential Causes of Decreased Stool Volume
- Dietary Fiber: Ensure that your diet includes adequate fiber, which is essential for promoting regular bowel movements. The recommended daily intake is about 25 grams for women and 38 grams for men. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

- Hydration: While you mentioned drinking about 2000 ml of water daily, it's important to maintain a balance between hydration and fiber intake. Water helps to soften stools, but without sufficient fiber, the stool may still be small and hard.

- Physical Activity: Regular exercise can stimulate bowel movements. If your activity level has decreased, it could contribute to constipation.

- Medications: If you are taking any medications, review them with your healthcare provider, as some can cause constipation as a side effect.

Concerns About Serious Conditions
Your concern about the possibility of colorectal cancer is valid, especially with changes in bowel habits. While decreased stool volume alone is not a definitive indicator of cancer, it is essential to consider other symptoms, such as:
- Blood in the stool
- Unexplained weight loss
- Severe abdominal pain
- Changes in bowel habits that persist or worsen
Given your age and symptoms, it would be prudent to consult a healthcare professional for a thorough evaluation. They may recommend a colonoscopy or other diagnostic tests to rule out any serious conditions, including colorectal cancer.

Recommendations
1. Dietary Adjustments: Increase your intake of dietary fiber gradually to avoid gastrointestinal discomfort. Incorporate a variety of fiber sources, and consider fiber supplements if necessary.

2. Hydration: Continue to drink plenty of water, but ensure that your fiber intake is adequate to complement your hydration.

3. Physical Activity: Engage in regular physical activity, which can help stimulate bowel function.

4. Medical Consultation: Schedule an appointment with a healthcare provider to discuss your symptoms in detail. They may recommend further testing or dietary modifications tailored to your needs.

In conclusion, while your symptoms may be related to chronic constipation, changes in stool volume warrant further investigation to rule out any serious underlying conditions. A comprehensive approach involving dietary changes, hydration, and medical evaluation will be essential in managing your symptoms effectively.

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