They say love is a journey and complex, and so is the path to overcoming constipation. From someone who has struggled with constipation, it can be a long road with many twists and turns to find the correct treatment.  Constipation symptoms are common, and it is not a disease but often a symptom of another medical condition, medication, or dysfunction.(1) 

How can you determine if you’re experiencing constipation? 

Functional constipation is characterized by the following criteria per Rome IV criteria.  You need to experience 2 or more symptoms below for >25% of bowel movements(2):

• Less than 3 bowel movements per week 

• Difficulty or pain during passing bowel movements 

• Sensation of incomplete emptying 

• Lumpy, hard, pellet-like, or dry stool consistency

It is important to note that normal bowel movements can vary and differ for each individual.  Some people may have bowel movements up to three times a day, while others may have them every three days, with a formed stool resembling a ripe banana. If you find yourself falling into the constipation category, rest assured, you’re not alone.  Up to 16% of adults grapple with constipation and this figure rises to 33% for adults over 60. (1)

What Causes Constipation? 

Numerous factors can contribute to constipation, making it challenging to pinpoint the root cause of the issue.  Examples include slow colon motility, diet, lifestyle, pelvic floor muscle tension, health or nutritional disorders, anxiety/stress and medications (4). Tracking your diet, stress levels, activity and the frequency of bowel movements can serve as a good starting point in identifying the root cause.  Additionally, assessing your stool consistency using the Bristol Stool Chart can help you establish a pattern. See image below to use as a reference: 

What treatment options are available for constipation?

First Line of Defense 

Typically, many individuals can address constipation through non-operative methods.  The first line of defense involves lifestyle changes, such as incorporating high-fiber foods into the diet, increasing physical activity, and enhancing water intake.  Over-the-counter medication can be helpful, depending on whether you need to bulk up or soften your stool or facilitate its movement through your colon.  While laxatives can offer quick relief, prolonged use may have an impact on your colon.  

Second Line of Defense 

Your second line of defense begins with seeking specialist advice, especially if lifestyle changes prove unsuccessful. After a thorough history intake, they may recommend testing. Various tests can determine the speed of food transit through your colon, your defecations patterns, and identify any obstructions in the rectum and/or colon. At this point, prescribed medications may be appropriate depending on results of your test or history intake.  Physicians may also suggest participating in pelvic floor physical therapy, which encompasses a range of interventions.  These include:

• Biofeedback

• Coordination training of the rectum and pelvic floor muscles

• Retraining of bowel movement

• Pelvic floor muscle and abdominal release

• Education on toileting mechanics and posture

• Exercise  

Surgical Intervention: 

If treatment proves unsuccessful with medication, lifestyle changes, or physical therapy, surgical intervention becomes a consideration.  Various types of surgeries include abdominal colectomy, ileorectal anastomosis, and rectal or rectocele repairs(4).  These surgical options should be discussed with a healthcare provider, preferably a Gastrointestinal or Colorectal Surgeon, to determine your candidacy.  

Identify early!

Identifying the signs and symptoms and seeking early treatment can improve the prognosis of constipation.  If you have been struggling, a variety of treatments may be warranted to address the condition.  While there are guidelines, everyone is different and may exhibit variability in their approach to treating constipation. Understanding that constipation is a symptom and not a disease can help set you on the path to recovery.  If you wish to speak with someone, seek out a pelvic health physical therapist, and they can help recommend appropriate physicians and treatment.  

Dr. Susan Miller PT, DPT, is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. She welcomes both in-person and telehealth appointments for Colorado residents, as well as coaching calls for clients residing out of state.  

Book at www.lotuscorept.com 

Resources; 

1. American Gastroenterological Association, Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211–217.

2. Tomica Milosavljevic, Dusan D. Popovic, Dragana Danilo Mijac, Tamara Milovanovic, Slobodan Krstic, Miodrag N. Krstic; Chronic Constipation: Gastroenterohepatologist’s Approach. Dig Dis 28 February 2022; 40 (2): 175–180. https://doi.org/10.1159/000516976

3. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes

4. Bharucha AE, Wald A. Chronic Constipation. Mayo Clin Proc. 2019;94(11):2340-2357. doi:10.1016/j.mayocp.2019.01.031