Chronic Constipation: Causes and Solutions - Gastroenterology and Hepatology

Constipation

Long-term constipation has been troubling me...
Whenever I have difficulty with bowel movements, I always feel like I can't urinate properly.
Even though I drink a lot of water and feel the urge to urinate, I just can't seem to do it.
It feels as if something is pressing on my other organs.
I have to strain to get out just a little bit...
Even when I try to relax, it feels like I'm turning on a stubborn faucet, similar to the sensation of holding in urine.
Then, I feel numb...
Gradually, I lose the urge to go to the bathroom...
I go when I see the restroom because I haven't felt the need to urinate for a while...
Despite drinking a lot of water, I only manage to urinate less than half of what I should...
After having a bowel movement, things feel more normal...
What could this be?

Hui, 20~29 year old female. Ask Date: 2008/09/07

Dr. You Ligang reply Gastroenterology and Hepatology

Hello, your difficulty in urination is caused by constipation, so it is important to first improve your bowel movements.
Constipation can be classified into two types: "functional constipation," which is chronic and habitual, and "organic constipation," which is caused by underlying diseases.
You likely have functional constipation, as most individuals with constipation fall into this category.
The causes are often related to lifestyle and personal behaviors, such as:
1.
Insufficient water intake: When you drink less water, the moisture retained in the intestines decreases, leading to dry and hard stools.
Additionally, individuals who consume spicy foods, have a strong taste preference, drink excessively, or are experiencing a cold may have increased intestinal heat and insufficient moisture, resulting in hard stools.
2.
Inadequate fiber intake: Due to the refinement of diets, there is often a lack of fiber-rich foods, which reduces stool bulk.
3.
Lack of bowel movement motivation: Factors such as aging, obesity, emotional issues (stress, anxiety, or excessive worry) can affect the nerves that facilitate bowel movements and lead to decreased gastrointestinal function, causing constipation.
4.
Fatigue: Individuals who are frequently fatigued may experience reduced intestinal motility, making them more prone to constipation.
5.
Medication effects: Certain medications that slow down intestinal motility, such as sedatives, pain relievers, amphetamines, weight loss drugs, antidepressants, cough medications containing codeine, calcium supplements, and iron supplements, can also lead to constipation.
6.
Lack of exercise: Prolonged sitting, low activity levels, or long-term bed rest can result in insufficient intestinal motility, making constipation more likely.
7.
Poor habits: Not having a regular bowel movement schedule or frequently delaying the urge to defecate can disrupt the reflexes associated with bowel movements.
Organic constipation occurs due to diseases such as intestinal obstruction, rectal cancer, intestinal adhesions, diverticulitis, intestinal tuberculosis, megacolon, or congenital anal atresia.
You may want to visit a hospital for examination to determine the underlying cause.
Wishing you good health,
Dr.
Yu Li-Kuang, Taoyuan Hospital, Department of Health

Reply Date: 2008/09/07

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. Understanding the causes and potential solutions for chronic constipation is essential for effective management.

Causes of Chronic Constipation
1. Dietary Factors: A diet low in fiber can lead to constipation. Fiber is crucial for adding bulk to the stool and promoting regular bowel movements. Insufficient fluid intake can also contribute to hard, dry stools that are difficult to pass.

2. Physical Inactivity: Regular physical activity stimulates intestinal function. Sedentary lifestyles can slow down the digestive system, leading to constipation.

3. Medications: Certain medications, including opioids, antacids containing aluminum, and some antidepressants, can cause constipation as a side effect.

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

5. Psychological Factors: Stress, anxiety, and depression can affect bowel habits. Some individuals may experience constipation as a response to psychological stressors.

6. Structural Issues: Conditions such as rectal prolapse, anal fissures, or strictures can physically obstruct the passage of stool.

Symptoms Associated with Chronic Constipation
In addition to infrequent bowel movements, individuals may experience:
- Abdominal discomfort or pain
- Bloating
- A feeling of fullness or pressure in the abdomen
- Straining during bowel movements
- Hard or lumpy stools
- A sensation of incomplete evacuation after a bowel movement

Understanding Your Symptoms
From your description, it seems you are experiencing a combination of urinary and bowel symptoms. The feeling of being unable to urinate despite drinking plenty of fluids, along with the sensation of pressure and difficulty with bowel movements, may suggest a few possibilities:
- Pelvic Floor Dysfunction: This condition occurs when the muscles of the pelvic floor do not function properly, leading to difficulties in both bowel and bladder control. This can result in a sensation of pressure and difficulty emptying the bladder and bowels.

- Constipation-Related Urinary Symptoms: Chronic constipation can lead to increased pressure in the abdomen, which may affect the bladder's ability to function properly. This can create a sensation of urgency or difficulty urinating.

- Nerve Issues: If you are experiencing numbness or a lack of sensation regarding the urge to urinate or defecate, it could indicate nerve involvement, which may require further evaluation.

Solutions for Chronic Constipation
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help. Aim for at least 25-30 grams of fiber per day. Additionally, ensure adequate hydration by drinking plenty of water.

2. Regular Exercise: Engaging in regular physical activity can stimulate bowel movements. Aim for at least 30 minutes of moderate exercise most days of the week.

3. Medications: Over-the-counter laxatives, such as fiber supplements (e.g., psyllium) or osmotic agents (e.g., polyethylene glycol), can be helpful. However, consult with a healthcare provider before starting any medication.

4. Behavioral Techniques: Establishing a regular bowel routine, such as setting aside time each day to use the bathroom, can help train your body to have regular bowel movements.

5. Pelvic Floor Therapy: If pelvic floor dysfunction is suspected, working with a physical therapist specializing in pelvic health can be beneficial.

6. Medical Evaluation: If symptoms persist despite lifestyle changes, it may be necessary to consult a healthcare provider for further evaluation. This could include tests to rule out underlying conditions or structural issues.

Conclusion
Chronic constipation can be a multifaceted issue requiring a comprehensive approach to management. By addressing dietary habits, physical activity, and potential underlying conditions, many individuals can find relief from their symptoms. If you continue to experience significant discomfort or changes in your bowel or urinary habits, it is crucial to seek medical advice for tailored treatment options.

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