Chronic Constipation: Causes, Symptoms, and Solutions

Constipation issues?

I have been unable to have regular bowel movements and have been relying on medications (laxatives or traditional Chinese medicine) to force out a small amount.
This situation has persisted for almost a year, and now my stomach and abdomen feel very bloated and uncomfortable, feeling hard and protruding.
I previously underwent gastroscopy and colonoscopy, which showed no significant issues (but that was back in April).
Later, I had laparoscopic surgery for an ovarian teratoma, and I'm unsure if there are any adhesion issues.
Recently, I visited a doctor who prescribed me Laxative Granules to try, but I still haven't felt any effect after taking them.
I have been drinking a lot of water, but instead, my stomach feels even more bloated and uncomfortable.
What could be causing this? What should I do?

Jiajia, 20~29 year old female. Ask Date: 2015/09/19

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, with a history of abdominal surgery, the likelihood of adhesions is certainly not low.
However, habitual constipation can also lead to these symptoms.
It is recommended to increase water intake and consume more fruits and vegetables, while reducing fried and irritating foods.
Ensure adequate physical activity and consider massaging the abdomen during bowel movements.
If there is still no improvement, then medication options should be considered.
In cases of more severe adhesions, clinicians may consider adding prokinetic agents.
Sincerely, Dr.
Chen Chi-Feng, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/09/19

More Info

Chronic constipation is a common gastrointestinal issue that can significantly affect 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, symptoms, and potential solutions for chronic constipation can help individuals manage this condition effectively.

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

2. Lifestyle Choices: Sedentary lifestyles and lack of physical activity can slow down the digestive system. Regular exercise is crucial for stimulating bowel function.

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. Structural Issues: Conditions such as bowel obstructions, strictures, or adhesions from previous surgeries can physically impede the passage of stool.

6. Psychological Factors: Stress, anxiety, and depression can affect bowel habits and lead to constipation.

Symptoms of Chronic Constipation
Individuals with chronic constipation may experience a range of symptoms, including:
- Infrequent bowel movements (fewer than three times a week)
- Straining during bowel movements
- Hard or lumpy stools
- A feeling of blockage or obstruction in the rectum
- Abdominal discomfort, bloating, or pain
- A sensation of incomplete evacuation after a bowel movement

Solutions and Management Strategies
1. Dietary Changes: Increasing fiber intake is one of the most effective ways to alleviate constipation. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Aim for at least 25-30 grams of fiber per day. Additionally, ensure adequate hydration by drinking plenty of water throughout the day.

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

3. Establishing a Routine: Setting a regular time each day for bowel movements can help train the body to have more predictable bowel habits. It’s essential to listen to your body’s signals and not ignore the urge to go.

4. Medications: If dietary and lifestyle changes are insufficient, over-the-counter laxatives may be used. However, it’s crucial to consult with a healthcare provider before starting any medication, especially if you have been relying on laxatives for an extended period. Your doctor may recommend different types of laxatives, such as osmotic agents (e.g., polyethylene glycol) or stimulant laxatives, depending on your specific situation.

5. Medical Evaluation: Given your history of ovarian teratoma surgery and ongoing symptoms, it’s essential to follow up with your healthcare provider. They may consider imaging studies or further evaluations to rule out any adhesions or structural issues that could be contributing to your constipation.

6. Psychological Support: If stress or anxiety is a contributing factor, consider seeking support from a mental health professional. Techniques such as cognitive-behavioral therapy (CBT) can be beneficial in managing stress and its impact on bowel health.

Conclusion
Chronic constipation can be a frustrating and uncomfortable condition, but with the right approach, it can often be managed effectively. It’s essential to work closely with your healthcare provider to identify the underlying causes and develop a tailored treatment plan. If you continue to experience discomfort despite making lifestyle changes and following medical advice, do not hesitate to seek further evaluation. Remember, addressing chronic constipation is not just about finding immediate relief but also about improving your overall digestive health and well-being.

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