Chronic Constipation: Symptoms and Recommended Tests

Q: Chronic Constipation: Symptoms and Recommended Tests

Hello： It is recommended to consult a gastroenterologist to evaluate whether further tests such as a stool analysis or colonoscopy are necessary. <br>Dr. <br>Cai Jin-ji, Nantou Hospital.

Straining during bowel movements / frequent bowel movements / feeling of incomplete evacuation?

Hello, I have been experiencing constipation for six months.
For the past month, I have been having bowel movements at least 5 to 6 times a day, usually concentrated in the morning.
The first bowel movement in the morning typically consists of leftover stool from the previous night, as I often feel the urge to go before bed but cannot.
The second and third bowel movements in the morning are banana-shaped (sausage-sized, mostly light brown or coffee-colored), while the fourth and fifth movements become thinner (marker-sized, mostly coffee-colored, and sometimes I pass one or two very small, thin pieces of stool).
By the afternoon, around 4 or 5 PM, the stool becomes even thinner and longer, and in the evening, I feel like there is still some stool that hasn't been fully expelled and is stuck, making it difficult to pass.
The next morning, the cycle starts again, with the stool gradually transitioning from thicker to thinner, and I still feel like I haven't completely relieved myself by the evening.
There has been no blood, and the colors are either light brown or coffee-colored.
What could this condition be, and what tests do you recommend? Thank you.

SFH, 30~39 year old female. Ask Date: 2020/03/12

Dr. Cai Jinji reply Gastroenterology and Hepatology

Hello: It is recommended to consult a gastroenterologist to evaluate whether further tests such as a stool analysis or colonoscopy are necessary.
Dr.
Cai Jin-ji, Nantou Hospital.

Reply Date: 2020/03/12

More Info

Chronic constipation is a common gastrointestinal issue that can significantly impact a person's quality of life. It is characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. Based on your description, it seems you are experiencing a cycle of bowel movements that vary in consistency and frequency, which can be indicative of several underlying conditions.

Symptoms of Chronic Constipation
1. Infrequent Bowel Movements: While you mentioned having multiple bowel movements in the morning, the sensation of incomplete evacuation and the variability in stool consistency can be concerning.

2. Stool Consistency: The change from larger, sausage-shaped stools to thinner, pencil-like stools may suggest a narrowing of the bowel or other issues affecting stool formation.

3. Straining: The feeling of needing to push harder to pass stools can be a sign of constipation.

4. Abdominal Discomfort: Many individuals with chronic constipation report bloating, cramping, or discomfort in the abdomen.

5. Feeling of Incomplete Evacuation: This sensation can lead to a cycle of repeated attempts to have a bowel movement without success.

Potential Causes
Chronic constipation can stem from various factors, including:
- Dietary Factors: Low fiber intake, inadequate hydration, and a diet high in processed foods can contribute to constipation.

- Lifestyle Factors: Sedentary behavior and lack of physical activity can slow down bowel motility.

- Medications: Certain medications, such as opioids, antacids containing aluminum, and some antidepressants, can lead to constipation.

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

Recommended Tests
Given your symptoms, it would be prudent to consult a healthcare professional for a thorough evaluation. Here are some recommended tests and assessments that may be considered:
1. Physical Examination: A healthcare provider may perform a physical exam to check for abdominal tenderness, bloating, or any signs of obstruction.

2. Stool Tests: Analyzing stool samples can help rule out infections or malabsorption issues.

3. Blood Tests: Tests to check thyroid function, electrolyte levels, and other metabolic markers can help identify underlying conditions contributing to constipation.

4. Colonoscopy: If there are concerns about structural abnormalities or if symptoms persist despite treatment, a colonoscopy may be recommended to visualize the colon and rectum.

5. Imaging Studies: An abdominal X-ray or CT scan may be used to assess for any blockages or abnormalities in the gastrointestinal tract.

Management Strategies
In addition to diagnostic tests, several management strategies can help alleviate chronic constipation:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help improve bowel regularity. Aim for at least 25-30 grams of fiber per day.

- Hydration: Drinking plenty of water is essential for softening stools and promoting regular bowel movements.

- Physical Activity: Regular exercise can stimulate bowel function and help alleviate constipation.

- Over-the-Counter Laxatives: If dietary changes are insufficient, over-the-counter laxatives (such as fiber supplements, osmotic agents, or stimulant laxatives) may be used under the guidance of a healthcare provider.

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

Conclusion
Chronic constipation can be a complex issue with various contributing factors. It is essential to work closely with a healthcare provider to identify the underlying causes and develop an appropriate treatment plan tailored to your specific needs. Early intervention can help prevent complications and improve your overall well-being. If you have not already done so, I encourage you to seek medical advice to address your symptoms effectively.

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