Chronic Constipation: Causes, Treatments, and Surgical Options

About constipation?

Hello: I have had constipation issues since childhood, and the problem has not improved even into adulthood.
I have seen doctors for many years, and while the medications prescribed initially provided some relief, after 2 to 3 doses, they became ineffective, and I experienced stomach discomfort and nausea.
Over-the-counter laxatives and home remedies yield similar results.
I can only use laxatives every 3 to 5 days for them to be effective, but the amount expelled is not significant.
I have tried all the methods recommended by doctors, including drinking stronger milk, which only works slightly if tried every 2 to 3 days.
On average, I can only have a bowel movement every 5 to 7 days, and if I am busy, it can take 10 to 15 days.
During this time, if I cannot have a bowel movement, my body naturally induces vomiting.
Honestly, this is very uncomfortable and painful.
I would like to ask the doctor if there are other methods to resolve this situation.
Additionally, what is a colectomy? Under what circumstances is a colectomy necessary, and what are the qualifying criteria? Thank you for your response!

natsuko, 30~39 year old female. Ask Date: 2005/12/10

Dr. Cai Zonglong reply Internal Medicine

Hello, if you have previously undergone examinations to rule out organic issues related to your constipation (such as colonoscopy or barium studies to exclude tumors, strictures, etc.), it is likely functional.
If the duration exceeds one-fourth of a year, it may be classified as constipation-predominant irritable bowel syndrome (IBS-C).
Currently, in addition to recommending a high-fiber diet, laxatives, and prokinetic agents, there are some newer medications that can stimulate intestinal nerve activity, such as Novartis's Zelmac (tegaserod), which reportedly has good effects in young women.
However, I do not have personal experience with it, so you may want to consult other physicians.
As for colorectal surgery, it may be beneficial for certain severe patients, but it should only be considered after a thorough evaluation and if various treatments have proven ineffective.
It is advisable to seek assessment at a medical center, and surgery should only be performed if truly necessary.
This response is provided by Dr.
Chen Zhi-Ping from the Internal Medicine department.

Reply Date: 2005/12/10

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 stool, or a sensation of incomplete evacuation. Understanding the causes, treatments, and surgical options available for chronic constipation is essential for effective management.

Causes of Chronic Constipation
Chronic constipation can arise from various factors, including:
1. Dietary Factors: A diet low in fiber can lead to hard, dry stools that are difficult to pass. Insufficient fluid intake can also contribute to constipation.

2. Lifestyle Factors: Sedentary behavior and lack of physical activity can slow down bowel movements. Stress and changes in routine can also affect bowel habits.

3. Medical Conditions: Certain medical conditions, such as hypothyroidism, diabetes, irritable bowel syndrome (IBS), and neurological disorders (like Parkinson's disease), can lead to constipation.

4. Medications: Some medications, including opioids, antacids containing aluminum, and certain antidepressants, can cause constipation as a side effect.

5. Structural Issues: Conditions such as rectal prolapse or strictures can physically obstruct the passage of stool.

Treatments for Chronic Constipation
Management of chronic constipation typically begins with lifestyle and dietary modifications:
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help soften stools. Aim for at least 25-30 grams of fiber per day. Additionally, drinking plenty of water is crucial.

2. Physical Activity: Regular exercise can stimulate bowel function. Aim for at least 30 minutes of moderate exercise most days of the week.

3. Medications: Over-the-counter laxatives, such as osmotic agents (e.g., polyethylene glycol) or stimulant laxatives (e.g., bisacodyl), can be used. However, it is essential to use them under medical supervision, especially if they are needed frequently.

4. Behavioral Therapies: Techniques such as biofeedback therapy can help retrain the muscles used in bowel movements.

5. Probiotics: Some studies suggest that probiotics may help improve bowel regularity by promoting a healthy gut microbiome.

Surgical Options
In cases where conservative treatments fail, surgical options may be considered. One such option is a colectomy, which involves the surgical removal of part or all of the colon. This procedure is typically reserved for patients with severe constipation due to structural abnormalities or diseases like colonic inertia, where the colon does not function properly.

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Indications for Colectomy
1. Severe Functional Constipation: Patients who have not responded to extensive medical management and have a confirmed diagnosis of colonic inertia may be candidates for surgery.

2. Obstructive Conditions: If there are anatomical issues, such as strictures or tumors causing obstruction, surgical intervention may be necessary.

3. Quality of Life: If chronic constipation severely impacts a patient's quality of life and leads to complications (e.g., fecal impaction), surgery may be warranted.

Conclusion
Chronic constipation can be a challenging condition, especially when standard treatments fail. It is crucial to work closely with a healthcare provider to explore all available options, including dietary changes, medications, and possibly surgical interventions. If you are considering surgical options like colectomy, a thorough evaluation by a gastroenterologist or colorectal surgeon is essential to determine the best course of action based on your specific situation. Always discuss any new symptoms or concerns with your healthcare provider to ensure appropriate management and care.

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