Just Constipation? There is more to it!!


I see a lot of patients in my office with chronic constipation. I am always amazed at how much disruption constipation could cause in patients' lives. 

Many patients are surprised that there are types of constipation. Yes, there are different types of constipation.

Constipation to most people means hard stools, straining to pass stools, sitting on the toilet bowl for too long to push the stool out, not passing stool every day. Some people might have a normal tendency to pass 1 stool every 2 days or even 3 days. 

Constipation can cause a sense of fullness, bloating, excess flatus, worsening acid reflux and a general sense of discomfort in the abdomen. 

Once Laxatives and fiber fail, a simple test called anorectal manometry is recommended. It takes 15 minutes to 20 minutes in the office. You can learn more about it here:https://www.gastrooffice.com/services/anorectal-manometry

This test distinguishes dyssynergic defecation from other types. This type is more common in females with stool having difficulty leaving the rectum through the anus. There is a dysfunction of the mechanism where the rectum and anus do not work in a coordinated fashion thereby leading to stool being pushed inside than outside. This is called outlet dysfunction constipation. This is a very underrecognized problem in my experience. Pelvic floor physical therapy/biofeedback helps with this type of constipation. I have patients who make one stool every few weeks or one stool every month even with this type of constipation. 

Other variety of constipation involves slow or normal (distinguished by using small  plastic rings that are swallowed and belly xrayed after, a little complicated...so let's not worry) movement of the stool through the colon which results in constipation. Thyroid abnormalities, not taking enough fiber or not drinking enough water or taking opioid medication for pain can cause this type of constipation. Normally responds to fiber. I advise 2 tablespoons of soluble fiber at bedtime and if needed I usually advise polyethylene glycol at bedtime as well. Your urge to pass stool is best when you wake up so I try to prepare the gut through the night by taking the fiber/medication at bedtime.    

It is mind-boggling to see how much morbidity constipation causes in ones' personal life.

Wishing you soft and regular stools until next time!!

Krishna Rayapudi MD Krishna Rayapudi MD, Gastroenterologist. Trained in world-class facilities with world-class mentors. Managed thousands of patients in all practice setups possible, with experience in seven different US states. You learn more about his practice at www.gastrooffice.com.

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