Chronic Constipation ... Causes and Treatment
Chronic constipation is constipation lasting for more than six months.
It is a very debilitating disorder. Some sufferers are unable to achieve more than one bowel motion a week for many years. In the very bad cases, lack of bowel motion for three weeks or only once in a month has been reported.
Some individuals with this type of constipation have found themselves taking laxatives up to five times every day in order to be able to open their bowel. But what causes chronic constipation?
What Is the Cause of Chronic Constipation
The cause of chronic constipation is not known. It is nevertheless known that the major problem in chronic constipation is that what is called colonic transit time is significantly increased.
This is the time it takes food to pass from the stomach to reach the rectum. It is usually between 24 to 100 hours. It averages two to three days.
A culprit for this increased transit time in constipation is what has been described as colonic inertia.
Colonic inertia is a condition whereby the muscles of the colon that contracts and helps in propelling faecal material down to the rectum is not working well. It may become very sluggish.
The cause for this may be due to problem with the nerves supplying the muscle. Paradoxically, colonic inertia is worsened, and has even been thought to be caused, by laxative over use.
Another cause of chronic constipation may be problems with the muscles in the pelvic floor. These muscles increase the pelvic pressure and helps in “pushing” the content of the bowel or colon downward. Muscle diseases and injury to the nerves that work the muscle have been blamed.
Spinal cord injury, from any cause can also lead to chronic constipation.
What Tests are Available for Chronic Constipation
Anyone with constipation lasting for more than six month but with no other problem like weight loss, poor appetite, abdominal swelling, blood or mucus in the stool, nausea or vomiting may not need extensive investigation.
Each case is considered on its own merit. The concern of the G.P or family physician should be to exclude other potentially serious causes of constipation. You can see test done for this on the constipation page.
Remedy for chronic constipation is different from those with mild constipation, in which treatment is centred on dietary control, exercise and laxatives. This will worsen the constipation if anything.
Successful treatment of chronic constipation is now shown to be centred on the following:
Patients are thought how to voluntarily control the muscles of the pelvis by looping them to a computer system, facilitated by a therapist.
This has proved to be very successful in achieving excellent bowel function. The draw back to this very effective treatment option is easy availability. Severe chronic constipation that requires this form of treatment should thus be referred to a near by specialist centre that has such facility.
The traditional constipation medications do not work in chronic constipation. Agents useful in the treatment of chronic constipation include Tegaserod (Zelnorm), Polyethylene glycol (PEG), Psyllium, and more recently Colchicine.
Tegaserod, also called zelnorm , has been shown to be very effective in treatment of chronic constipation, and constipation seen in IBS.
It has been approved in 66 countries, excluding the UK for the treatment of chronic constipation. Any physician wishing to use it in the UK must apply for permission to use if as per patient to patient basis.
Side effects of tegaserod are mainly abdominal pain, diarrhoea, light headedness, dizziness, headache, nausea and vomiting in some. Again, not ALL patients will respond to tegaserod.
Those who do, if they relapse after stopping the medication, could be started on it again. They tend to do well even after a second time. See more on tegaserod here
Polyethylene glycol is a family of non-toxic high molecular weight substance that dissolves easily in water and other solvents. They form thick viscid liquid. There have been used as bulking agent in constipation.
Psyllium is a laxative made from the seed of an plant, Plantago afra. When the leaves or seed are immersed in water, it forms thick gelatine that has strong laxative effect.
Colchicine is a drug derived from a poisonous alkaloid plant called colchicum. It is primarily used in treating gout. It is known to cause diarrhoea as side effect, and was tried for use in constipation.
Spinal Nerve Stimulation
This is also a new and effective therapy in patients failing all the above treatment modalities. A wire is passed to the pelvic nerves, and gentle current of electricity is released to stimulate the nerves to contract and propel the bowel content.
Once this is achieved after a two weeks trial, a permanent devise is implanted into the skin which is essentially a battery with a life of about six years. It can be recharged if it runs out.
Surgery for chronic constipation does not work. Some have operated to cut off the “excessive length of the colon” in the thought that since transit time is lengthened in constipation, cutting off and reducing the length of the bowel will mean curing the problem.
They may even go to the length of saying that the length of colon or large bowel in patient with chronic constipation is more than in normal individuals.
The truth is that, constipation could cause the length of the colon to seem elongated, as it is not contracting, but relatively flaccid.
After such operation, patient operated for constipation may show some response, but experience shows that almost all will become constipated again when followed up for five years.
Chronic constipation can lead to mega colon, and faecal impaction. If this happens, there is sound reason to operate.
The operation here may take the form of manual faecal evacuation or resection of the dilated portion of the bowel.
The information presented on this site is strictly for educational purposes only. It by no means constitutes a recommendation of treatment or substitute for medical consultations.
Medical knowledge is dynamic. Whilst every care has been taken to ensure the accuracy and up-to- date-ness of the content of this site, abdopain.com or its owners or partners will not accept responsibility or liability of any sort for the use of information here-in in any manner.
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