Long-Term Constipation: Causes, Effects, and Solutions

Inquiry

1.
I have been experiencing chronic constipation for over 20 years, primarily straining to have bowel movements, which has led to decreased bowel function.
Now my stools are soft, and sometimes I experience cramping diarrhea that I cannot pass without taking a deep breath.
What could be the cause of this condition?
2.
I have undergone surgery for uterine fibroids and have had a barium enema.
Could these procedures affect my bowel movements?
3.
Given the long-term damage to my body caused by constipation (which has led to issues ranging from headaches to leg problems), can general methods for improving constipation (such as exercise, hydration, and consuming fruits) truly lead to recovery?

Ling, 40~49 year old female. Ask Date: 2009/02/27

Dr. Lin Minghui reply Gastroenterology and Hepatology

1.
After abdominal surgery, the intestines are more prone to adhesions, leading to chronic constipation.
Sometimes, holding one's breath can increase abdominal pressure, which may assist in bowel movements.

2.
A barium enema is an examination of the lower gastrointestinal tract that can identify tumors, polyps, and diverticula.
The examination will not affect bowel movement conditions.

3.
Causes of constipation include dietary factors, colorectal pelvic disorders, functional gastrointestinal disorders, endocrine and metabolic diseases, mental health issues, and medications.
It is generally important to identify the underlying cause of constipation for targeted treatment.
Regular exercise, adequate hydration, increased fiber intake, and establishing a routine for bowel movements can help alleviate constipation.

Best wishes for health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2009/02/27

More Info

Long-term constipation, especially one that has persisted for over 20 years, can be a complex issue with multiple underlying causes and effects. Your description indicates a significant struggle with bowel movements, including the need for excessive straining, soft stools, and episodes of diarrhea accompanied by abdominal cramping. This situation can be indicative of a condition known as functional constipation, which may be exacerbated by factors such as diet, lifestyle, and possibly previous medical interventions.

1. Understanding Your Symptoms: The symptoms you describe—difficulty in passing stools, reliance on straining, and alternating between constipation and diarrhea—suggest a possible dysfunction in the coordination of the muscles involved in bowel movements. This could be due to a variety of factors, including a weakened pelvic floor, changes in gut motility, or even psychological factors such as anxiety related to bowel movements. The fact that you have experienced these symptoms for such a long time indicates that your bowel function may have adapted to a state of chronic constipation, leading to further complications such as fecal impaction or rectal prolapse.

2. Impact of Previous Surgeries: You mentioned having undergone surgery for uterine fibroids and having had a barium enema for colon imaging. Surgical procedures in the pelvic region can sometimes affect bowel function, either through direct manipulation of the intestines or through changes in nerve function and blood supply. Additionally, the barium enema itself, while a diagnostic tool, can sometimes lead to temporary changes in bowel habits. It’s essential to discuss with your healthcare provider how these procedures may have influenced your current bowel health.

3. Can Lifestyle Changes Help?: While it may seem daunting given the duration of your symptoms, lifestyle modifications can indeed play a significant role in improving bowel function. Increasing dietary fiber through fruits, vegetables, and whole grains can help bulk up stools and promote regularity. Staying well-hydrated is equally important, as adequate fluid intake can soften stools and facilitate easier passage. Regular physical activity is also beneficial, as exercise stimulates intestinal motility.
However, given the chronic nature of your condition, it may be necessary to approach these changes gradually and with professional guidance. Consulting a gastroenterologist or a dietitian specializing in gastrointestinal health can provide tailored advice and possibly recommend additional treatments, such as fiber supplements or medications that promote bowel movements.

In some cases, biofeedback therapy may be beneficial, especially if there are issues with pelvic floor dysfunction. This therapy can help retrain the muscles involved in bowel movements, improving coordination and reducing the need for straining.

4. Addressing the Broader Impact: Chronic constipation can lead to a range of systemic issues, including headaches, fatigue, and even mood disturbances. This is often due to the body's response to discomfort and the stress of dealing with persistent bowel issues. Therefore, addressing constipation not only improves bowel health but can also enhance overall well-being.

In conclusion, while your situation is complex and may require a multifaceted approach, there is hope for improvement. Engaging with healthcare professionals who can provide a comprehensive evaluation and personalized treatment plan is crucial. Lifestyle changes, while they may take time to show results, can significantly impact your quality of life and help restore normal bowel function.

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