Chronic constipation

Understanding chronic constipation

What counts as constipation

Constipation is not defined by a fixed number of bowel movements. Normal ranges from three times a day to three times a week. What matters is a change from your own pattern, plus difficulty.

Clinically we look for fewer than three bowel movements a week, hard or lumpy stools, straining, a sense of incomplete emptying or blockage, or needing manual assistance. Chronic constipation means these have persisted for months rather than days.

Understanding chronic constipation

Common causes

The great majority of chronic constipation is functional, meaning no structural disease is found. Contributing factors are usually multiple and modifiable:

• Low dietary fibre, common where refined foods dominate
• Inadequate fluid intake, particularly in Lagos heat
• A sedentary routine, including long hours in traffic
• Ignoring the urge to go, often because of poor toilet access at work
• Medications: opioid painkillers, some antacids, iron tablets, certain antidepressants and blood pressure drugs
• Pregnancy
• Underactive thyroid, diabetes, and low potassium or high calcium
• Pelvic floor dysfunction, where the muscles fail to relax properly during defecation

Understanding chronic constipation

When constipation needs investigation

Long-standing constipation that has been present since youth, with no alarm features, rarely needs a camera. The picture changes when constipation is new.

A genuine change in bowel habit toward constipation in someone over 45, particularly with bleeding, weight loss or anaemia, requires a colonoscopy to exclude a narrowing or a growth in the left colon. New constipation alternating with diarrhoea deserves the same attention.

Understanding chronic constipation

How it is assessed

Assessment starts with history, medication review and examination, including of the back passage, which alone identifies many cases of pelvic floor dysfunction or a fissure causing painful, avoided defecation.

Blood tests check thyroid function, calcium, glucose and anaemia. A colonoscopy is performed where alarm features are present or age warrants it. Where the bowel is structurally normal but symptoms persist, specialised tests of transit time and pelvic floor function guide treatment.

Understanding chronic constipation

Treatment

The foundation is unglamorous and effective: fibre, fluid, movement and routine. Fibre should be increased gradually, because a sudden jump causes bloating and discourages people from continuing.

Toilet habit matters more than most people realise. Answer the urge promptly, allow unhurried time, ideally after a meal when the bowel is naturally more active, and use a footstool to raise the knees, which straightens the anorectal angle.

Where these are insufficient, laxatives are used in a stepped way: bulk-forming first, then osmotic agents, with stimulants for short-term rescue rather than daily indefinite use. Newer prescription agents exist for resistant cases, and pelvic floor dysfunction responds well to biofeedback physiotherapy rather than to more laxatives.