Introduction to Chronic Constipation
Chronic Constipation
When people refer to constipation, they usually mean chronic constipation. That is, constipation which occurs over a period of time, rather than belong to an isolated or particular event. There are a number of terms used interchangeably for chronic constipation, including "bowel irregulatory", "bowel sluggishness", "intestinal hypomotility".
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A large fraction of the general population will agree that they suffer from chronic constipation. As such, it is not difficult to imagine that treatment procedures and medications have a long, rich (and perhaps amusing) history. Looking back, it turns out that many of the ideas for treating constipation are not only ineffective, but patently untrue. In modern times, it is no different. There are a number of cures and constipation treatments touted as cure-alls for constipation which upon closer examination are just completely ineffective. But fortunately, modern science has produced constipation medication and treatments that work in double-blind, randomized trials.
Indicators of Constipation
In truth, the term chronic constipation is a stand-in for a number of symptoms. One popular conception is that constipation refers to the frequency of bowel movements. However, only about 25% of all sufferers indicate a low frequency of bowel movements (defined as three or fewer a week). Some are worried long residence times of the stool in the intestine leads to toxicity. These beliefs are likely fueled in small part to the proliferation of "colon cleanse" products. Fortunately, this fear is not rooted in fact as revealed by recent studies. For the majority of patients, the symptom of constipation is reported as a feeling of fullness and the need to exert force for a bowel movement.
The Rome Criteria
Before embarking on constipation treatments, a proper diagnosis must be made. In medical terminology, the diagnosis of constipation should follow something called the "Rome criteria". It is a set of conditions detailing symptoms aside from those involving frequency of bowel movement. The Rome criteria is extraordinarily useful because it is a quick way to assess the severity of chronic constipation without the need for expensive and potentially useless diagnostics. Moreover, the Rome criteria permit more uniform assessment and systematic reporting of chronic constipation in the population.
A Variety of Causes
Surprisingly, constipation is caused by a variety of factors and not just diet along as some may believe. For example, due to genetics, some have intrinsically low motility of intestinal passageways which slows down transit of stool. Constipation will be observed for two or more generations in these cases. For others, medication can lead to constipation. People who take high blood pressure medications such as calcium antagonists can find themselves struct by chronic constipation. In these, therapy consists of altering the active antihypertensive substance. The lesson is that constipation treatments and constipation medication should target the underlying problem as much as possible.
Diet and Lifestyle
For many people, rather than turning to constipation medication, will find that diet plays a real role in constipation. The correlation between very low dietary fiber (less than 25 grams per day) and low stool volume is real. It is important to eliminate that cause of constipation by switching to a high fiber diet with adequate water intake. However, for other patients it has been found that increasing fiber intake has no effect at all on constipation and is not effective as constipation treatments.