Chronic Constipation: Seeking Effective Solutions Beyond Laxatives

Bowel issues (constipation)

Hello Doctor: I used to have occasional constipation issues, but they were infrequent.
However, about a year ago, I started experiencing persistent constipation that has continued intermittently until now.
My previous bowel habits were quite normal, with bowel movements every two to three days.
Since the onset of constipation, my situation has changed to having bowel movements every 4 to 5 days, with very hard stools, making it difficult to pass.
There have been several occasions where I had to go to the emergency room for an enema (EVAC) to relieve myself.

About a month after the onset of constipation, I sought medical help to resolve the issue, but I have not been successful.
I have seen two or three doctors (gastroenterologists and internists).
During my medical visits, I underwent a colonoscopy (the bowel preparation was not perfect but acceptable, and the doctor determined there were no significant issues), and an X-ray was performed.
I was told that my constipation was due to stress and an unbalanced diet, and I was prescribed some laxatives (mostly magnesium oxide, lactulose, and polyethylene glycol).

As someone who studied food and nutrition, I have been particularly attentive to increasing my fiber intake since the onset of constipation, and I drink over 3000 ml of water daily.
I also walk to class regularly and have diligently followed my doctor's advice, but to no avail.
I later consulted a traditional Chinese medicine practitioner, which provided some improvement, but it was limited, and without medication, my condition reverted.
Ultimately, I gave up on medical treatment...

Now, I rely on laxatives, and if that doesn't work, I use glycerin suppositories to solve the problem.
Eventually, I often need glycerin suppositories to have a proper bowel movement (sometimes requiring two or three doses).
The process of passing stools is really painful and uncomfortable, but over time, I feel this is not a long-term solution.
I would like to ask the doctor if there are any effective ways to improve my condition.
Is it true that I will have to rely on enemas indefinitely? What problems could arise from long-term use of enemas?

davy, 20~29 year old female. Ask Date: 2020/10/30

Dr. Ye Qianyu reply Family Medicine

Hello! Based on your description, the presence of hard and dry stools indicates that you are still experiencing dehydration issues.
It is recommended that you drink warm clear broth or adequately increase your fluid intake.
Be mindful of the balance of fluid intake and output; sometimes, drinking a large amount of water in a short period can lead to diuresis, causing a loss of water in the body.
Try to hydrate in smaller amounts more frequently to see if it helps.
If there is still no improvement, you may consider using magnesium oxide or other medications to assist with stool softening.

Additionally, you can utilize the "gastrocolic reflex." About 30 minutes after eating, the stomach expands, triggering this reflex, which can enhance intestinal motility for approximately 15 minutes.
It is most effective after breakfast, so consider training yourself to do this daily.
When you feel the urge to have a bowel movement, do not hold it in; responding promptly to the urge is essential for developing healthy bowel habits.

Reply Date: 2020/10/30

More Info

Chronic constipation can be a frustrating and uncomfortable condition, especially when it becomes persistent and resistant to standard treatments. It sounds like you've been proactive in seeking solutions, but despite your efforts with dietary changes, hydration, and medication, you are still struggling with this issue. Let's explore some potential solutions and considerations for managing chronic constipation beyond laxatives.

Understanding Chronic Constipation
Chronic constipation is typically defined as having fewer than three bowel movements per week, along with symptoms such as hard stools, straining during bowel movements, and a sensation of incomplete evacuation. In your case, it seems that the condition has progressed from occasional constipation to a more persistent issue, which can be influenced by various factors, including diet, hydration, physical activity, stress, and underlying medical conditions.

Dietary and Lifestyle Modifications
1. Fiber Intake: While you mentioned that you are already consuming a high-fiber diet, it’s important to ensure that you are getting a variety of fiber types. Soluble fiber (found in oats, beans, and fruits) can help soften stools, while insoluble fiber (found in whole grains and vegetables) can add bulk. Gradually increasing fiber intake can help prevent bloating and gas.

2. Hydration: Drinking plenty of water is crucial, especially when increasing fiber intake. Aim for at least 2-3 liters of water daily, as you are already doing, to help keep stools soft.

3. Physical Activity: Regular exercise can stimulate bowel movements. Incorporating activities like walking, jogging, or yoga can be beneficial.

4. Routine: Establishing a regular bowel routine can help train your body. Try to set aside time each day for bowel movements, ideally after meals when the gastrocolic reflex is strongest.

Medical Interventions
Since you have already tried various laxatives and have undergone diagnostic tests, it may be worth considering additional medical options:
1. Prescription Medications: There are prescription medications specifically designed for chronic constipation, such as lubiprostone (Amitiza) and linaclotide (Linzess). These medications work differently than traditional laxatives and may provide relief for those who do not respond to over-the-counter options.

2. Biofeedback Therapy: If there is a possibility of pelvic floor dysfunction contributing to your constipation, biofeedback therapy can help retrain the muscles involved in bowel movements.

3. Probiotics: Some studies suggest that probiotics may help improve gut health and regularity. Consider discussing this option with your healthcare provider.

4. Alternative Therapies: Acupuncture and certain herbal remedies have been reported to help some individuals with constipation. However, it is essential to consult with a qualified practitioner and your healthcare provider before trying these methods.

Long-term Use of Enemas
While glycerin suppositories and enemas can provide immediate relief, relying on them long-term can lead to dependency, where your bowel may become less responsive to natural stimuli. This can create a cycle of needing more frequent interventions. It’s crucial to use these methods judiciously and under the guidance of a healthcare professional.

When to Seek Further Help
If you continue to experience significant discomfort and difficulty with bowel movements despite trying these strategies, it may be time to revisit your healthcare provider. They may consider further evaluations, such as motility studies or consultations with a gastroenterologist specializing in functional gastrointestinal disorders.

Conclusion
Chronic constipation can be a complex condition requiring a multifaceted approach. While laxatives and enemas can provide temporary relief, exploring dietary changes, lifestyle modifications, and possibly prescription medications may offer more sustainable solutions. It’s essential to work closely with your healthcare provider to develop a personalized plan that addresses your specific needs and concerns. Remember, you are not alone in this journey, and with persistence and the right strategies, improvement is possible.

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