Fast Five Quiz: Embarrassing Medical Conditions

George D. Harris, MD, MS

Disclosures

June 27, 2019

Constipation is frequently chronic, can greatly affect an individual's quality of life, and may be associated with significant health care costs. It is considered chronic if it is present for at least 12 weeks (in total, not necessarily consecutively) during the previous year. Chronic constipation may be associated with psychological disturbances, and the reverse is true as well.

Primary (idiopathic, functional) constipation can generally be subdivided into the following three types:

  • Normal-transit constipation

  • Slow-transit constipation

  • Pelvic floor dysfunction (ie, pelvic floor dyssynergia)

Normal-transit constipation is the most common subtype of primary constipation. Although the stool passes through the colon at a normal rate, patients find it difficult to evacuate their bowels.

Chronic constipation has various etiologies. Anatomical and pathologic causes include bowel obstruction, colorectal cancer, and stricture. Neuromuscular causes include autonomic neuropathy, multiple sclerosis, and stroke. Hormonal causes include diabetes, hyperparathyroidism, and hypothyroidism.

The key to treating most patients with constipation is correction of dietary deficiencies. This generally involves increasing intake of fiber and fluid and decreasing the use of constipating agents, such as milk products, coffee, tea, and alcohol. Patients should be cautioned that although various stool softeners, such as docusate sodium, appear much more palatable than fiber, they are not suitable for long-term use. Tachyphylaxis to stool softeners develops over time.

Read more on constipation.

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