What are the main causes of constipation in cancer patients. How does cancer treatment affect bowel movements. What are effective ways to manage constipation during cancer therapy.

Understanding Constipation in Cancer Patients

Constipation is a common issue for individuals with cancer, often arising as a side effect of treatment or due to the disease itself. It’s characterized by difficulty in having bowel movements, which can significantly impact a patient’s quality of life.

What Defines Constipation?

Constipation occurs when passing stools becomes challenging. In cancer patients, this can be due to various factors related to their condition and treatment. It’s important to recognize that normal bowel habits vary from person to person, but generally, constipation involves infrequent bowel movements (typically less than three times a week) or the passage of hard, dry stools that are difficult to expel.

The Physiology of Bowel Movements

To comprehend constipation, it’s crucial to understand how the bowels function normally. The large intestine, or colon, plays a vital role in this process.

How Does the Large Intestine Work?

The large intestine is responsible for absorbing water and nutrients from the food we consume. As digested food moves through the colon, waste matter gradually forms into stool. This waste is then stored in the rectum until it’s ready to be expelled from the body.

Muscles in the bowel assist in pushing the stool into the rectum. Under normal circumstances, when the stool reaches the rectum, it should be formed enough to pass comfortably. However, constipation can occur if too much water is reabsorbed into the body or if the bowel muscles are weak and slow.

Cancer Treatments and Their Impact on Bowel Function

Various cancer treatments can lead to constipation, affecting the normal functioning of the digestive system.

Chemotherapy and Targeted Therapies

Some chemotherapy drugs and targeted cancer therapies can cause constipation by affecting the nerve supply to the gut. This side effect can be exacerbated by certain anti-nausea medications and painkillers commonly prescribed during cancer treatment.

Abdominal Surgery

Surgery to the abdomen can temporarily or permanently weaken bowel muscles, depending on the type of operation. Post-surgical constipation may result from several factors:

• Weakened muscles making it difficult to expel stool
• Abdominal soreness hindering the pushing action needed for bowel movements
• Anesthetics and pain medications causing constipation
• Reduced food and fluid intake immediately after surgery
• Potential nerve damage from major pelvic operations affecting bowel function

The Direct Impact of Cancer on Bowel Function

Cancer itself can cause constipation through various mechanisms related to tumor growth and location.

Spinal Cord Compression

Tumors pressing on the nerves in the spinal cord can slow down or halt bowel movements, leading to constipation.

Abdominal Tumors

Tumors in the abdomen may compress, squeeze, or narrow the bowel and rectum, making it challenging to have a bowel movement. Additionally, tumors in the bowel lining can affect the nerve supply to the muscles, causing constipation.

Medications and Their Role in Causing Constipation

Many medications used in cancer treatment and symptom management can contribute to constipation.

Common Culprits in Cancer Care

The most frequent medications causing constipation in cancer patients include:

1. Opioid painkillers
2. Anti-nausea medications

Other Medications That May Cause Constipation

Several other drugs can also lead to constipation:

• Blood pressure medications
• Antidepressants
• Vitamin supplements (especially iron and calcium)
• Anti-epileptic drugs
• Parkinson’s disease medications
• Diuretics
• Some antacids

It’s crucial for patients to inform their healthcare providers about all medications they’re taking, including over-the-counter constipation remedies.

Dietary Factors Contributing to Constipation

Diet plays a significant role in bowel health, and certain dietary habits can contribute to constipation in cancer patients.

Fiber Intake and Its Importance

A diet low in fiber can lead to constipation. Fiber helps keep bowels working regularly by adding bulk to stools and promoting regular bowel movements. However, cancer patients experiencing nausea may find it challenging to consume sufficient fiber-rich foods.

Hydration and Bowel Function

Adequate fluid intake is essential for maintaining soft stools that pass easily through the bowel. Dehydration can lead to harder stools and constipation. Cancer patients may be at risk of dehydration due to treatment side effects or reduced fluid intake.

Lifestyle Factors Affecting Bowel Movements

Certain lifestyle aspects can significantly impact bowel function, especially in cancer patients.

The Role of Physical Activity

Lack of daily exercise can reduce muscle tone in the abdomen and bowel, slowing down the movement of stool through the gut. Regular, gentle exercise can help maintain proper bowel function. However, cancer patients may face challenges in maintaining physical activity due to fatigue or treatment side effects.

Age-Related Changes in Bowel Function

As people age, their bowel function tends to change, often due to reduced activity levels or dietary changes. This puts older individuals, including many cancer patients, at a higher risk of constipation.

Ignoring the Urge to Defecate

Some individuals may find it difficult to have bowel movements outside their homes or may ignore the urge due to busy schedules. Research has shown that regularly ignoring the urge to defecate can increase the risk of constipation.

Diagnostic Approaches for Constipation in Cancer Patients

Proper diagnosis of constipation in cancer patients is crucial for effective management.

Medical History and Physical Examination

Healthcare providers typically start with a detailed medical history and physical examination. They may inquire about bowel habits, medication use, diet, and any recent changes in these areas.

Diagnostic Tests

In some cases, additional tests may be necessary to determine the underlying cause of constipation:

• Abdominal X-rays to visualize any blockages
• Colonoscopy to examine the colon for any abnormalities
• Blood tests to check for metabolic or hormonal imbalances
• Transit time studies to assess how quickly food moves through the digestive system

Treatment Strategies for Constipation in Cancer Patients

Managing constipation in cancer patients often requires a multi-faceted approach.

Dietary Modifications

Increasing fiber intake through diet or supplements can help improve bowel regularity. Healthcare providers may recommend:

• Consuming more fruits, vegetables, and whole grains
• Adding fiber supplements to the diet
• Increasing fluid intake to soften stools

Lifestyle Changes

Simple lifestyle adjustments can significantly impact bowel function:

• Engaging in regular, gentle exercise as tolerated
• Establishing a routine for bowel movements
• Using relaxation techniques to reduce stress and promote bowel regularity

Pharmacological Interventions

Various medications can be used to manage constipation in cancer patients:

1. Stool softeners to make bowel movements easier
2. Stimulant laxatives to increase bowel activity
3. Osmotic laxatives to draw water into the bowel
4. Prescription medications for chronic constipation

It’s important to note that the use of these medications should be under the guidance of a healthcare provider, as they may interact with cancer treatments or have side effects.

Preventing Constipation During Cancer Treatment

Prevention is often easier than treatment when it comes to constipation in cancer patients.

Proactive Measures

Healthcare providers may recommend preventive strategies, especially for patients starting treatments known to cause constipation:

• Prophylactic use of stool softeners or mild laxatives
• Regular monitoring of bowel habits
• Early intervention at the first signs of constipation

Patient Education

Educating patients about the importance of maintaining bowel health can be crucial. This may include information on:

• Recognizing early signs of constipation
• Understanding the impact of diet and hydration on bowel function
• Learning techniques for effective bowel movements

Complications of Untreated Constipation in Cancer Patients

If left untreated, constipation can lead to serious complications in cancer patients.

Potential Risks

Complications of severe or chronic constipation may include:

• Fecal impaction, where hardened stool becomes lodged in the rectum
• Bowel obstruction, potentially requiring surgical intervention
• Hemorrhoids or anal fissures from straining
• Urinary retention or incontinence due to pressure on the bladder

Impact on Quality of Life

Chronic constipation can significantly affect a cancer patient’s quality of life, leading to:

• Discomfort and pain
• Reduced appetite and nutritional intake
• Psychological distress and anxiety
• Interference with cancer treatment schedules

Special Considerations for Different Cancer Types

Constipation management may vary depending on the type and location of cancer.

Colorectal Cancer

Patients with colorectal cancer may face unique challenges in managing constipation due to the direct involvement of the bowel. Treatment approaches may need to be more cautious and tailored to avoid exacerbating tumor-related symptoms.

Cancers Affecting the Nervous System

Cancers that impact the nervous system, such as brain tumors or spinal cord tumors, may cause neurogenic bowel dysfunction. This requires specialized management strategies that address both the constipation and the underlying neurological issues.

Cancers Requiring Extensive Abdominal Surgery

Patients undergoing major abdominal surgeries for cancers like ovarian or pancreatic cancer may experience prolonged post-operative constipation. Management in these cases often involves a combination of early mobilization, careful pain management, and gradual reintroduction of diet.

The Role of Palliative Care in Managing Constipation

Palliative care plays a crucial role in managing symptoms like constipation, especially in advanced cancer patients.

Holistic Approach

Palliative care teams take a comprehensive approach to constipation management, considering:

• The patient’s overall comfort and quality of life
• Balancing constipation management with other symptom control measures
• Psychological and emotional support for patients dealing with chronic symptoms

End-of-Life Considerations

In end-of-life care, managing constipation remains important for patient comfort. Approaches may include:

• Simplified medication regimens
• Non-pharmacological comfort measures
• Family education on bowel care

Emerging Research and Future Directions

Ongoing research continues to explore new strategies for managing constipation in cancer patients.

Novel Therapies

Emerging treatments for constipation in cancer care include:

• New classes of medications targeting specific receptors in the gut
• Probiotic and prebiotic therapies to modulate gut microbiota
• Advanced non-invasive techniques for stimulating bowel function

Personalized Medicine Approaches

Future management strategies may involve more personalized approaches, considering:

• Genetic factors influencing drug metabolism and bowel function
• Individual patient microbiome profiles
• Tailored dietary and lifestyle interventions based on patient-specific factors

As research progresses, the management of constipation in cancer patients is likely to become more sophisticated and effective, improving quality of life and treatment outcomes for those affected by this common and challenging symptom.

Causes of constipation | Coping physically

Constipation means difficulty having a poo. It can be a problem for people with cancer and during cancer treatment.

The bowels and how they work

To understand what causes constipation, it helps to know how your bowel (large intestine) works.

The large bowel draws water and nutrients into the body from the food you eat and drink. As the digested food passes through the bowel (the colon), the waste matter or stool (poo) gradually forms.

The poo is stored in your rectum, or back passage, until it is ready to pass out of your body as a bowel motion.

The muscles in your bowel help to push the poo into your rectum. When it gets to your rectum the poo is should be formed enough to pass through comfortably.  But you can become constipated if:

• too much water is drawn back into the body from the bowel
• the muscles in your bowel are weak and slow

Chronic constipation 

Long term or chronic constipation means difficulty having a poo that can last for several weeks or longer.

Cancer treatments

Some cancer treatments can cause constipation. This includes several chemotherapy drugs and having surgery to your tummy (abdomen). 

Cancer drugs

Some chemotherapy drugs and targeted cancer drugs cause constipation. This is because they can affect the nerve supply to the gut. 

Unfortunately, some anti sickness drugs and painkillers can make this worse.

Surgery to your tummy (abdomen)

After surgery to your bowel, your bowel muscles might be weaker. This may be temporary, but sometimes it can be permanent – this depends on the type of operation you have.

After this type of surgery, there are several factors that can cause constipation:

• weak muscles may make it more difficult to push the poo out
• your tummy might be too sore for you to push out the poo
• the drugs you have as an anaesthetic or for pain can also cause constipation
• you may not be able to eat or drink for a few days after your operation, which makes constipation more likely
• occasionally, some major pelvic operations can damage the nerves that help the bowel to work properly

The cancer itself

A tumour that presses on the nerves in your spinal cord can slow down or stop the movement of your bowel. This causes constipation.

Tumours in the tummy (abdomen) can squash, squeeze, or narrow the bowel and back passage (rectum) making it difficult for you to have a bowel motion.

Or a tumour in the lining of the bowel can affect the nerve supply to the muscles and cause constipation.

Side effects from other medicines

Constipation can be a side effect of many types of drugs. Some of these drugs help control cancer symptoms or reduce side effects from treatments.

Your doctor or nurse will also prescribe medicine to help prevent constipation.

The most common drugs to cause constipation in people with cancer are:

• painkillers, especially morphine based drugs (opioids)
• anti sickness medicines

Other drugs that can cause constipation are:

• some blood pressure medicines
• anti depressants
• vitamin supplements, such as iron and calcium
• drugs to stop fits (anti convulsants or anti epileptics)
• drugs for Parkinson’s disease
• drugs to make you pass urine (diuretics)
• some medicines for indigestion (antacids)

It is important to tell your doctor or pharmacist if you are taking over the counter medication for constipation.

Too little fibre in your diet

Fibre helps to keep our bowels working regularly. If you eat plenty of foods high in fibre you’re less likely to become constipated. 

But if you feel sick, you might find it hard to eat enough fibre.

Not drinking enough

Your body needs plenty of fluid to help poo stay soft and pass easily through your bowel. You can become dehydrated and begin to have problems with constipation if you don’t drink enough.

Lack of exercise

Not getting much daily exercise can reduce muscle tone in your tummy (abdomen) and bowel. This slows down the movement of poo through your gut. 

Taking regular gentle exercise will help keep your bowels working properly. 

Age

As we get older, the way our bowels work tends to change. This might be due to being less active or changes to your diet. So there is a higher risk of constipation.

Ignoring the urge to open your bowels

Some people find it difficult to open their bowels away from the comfort of their own home. Others find that a busy lifestyle stops them opening their bowels. 

Research has shown people who ignore the urge to open their bowels are more at risk of constipation. Water is drawn out of the poo as it sits in the rectum and so it gets harder and more difficult to pass. It is always best to listen to your body. Try to go to the toilet when you feel the urge to have a bowel movement. 

Depression and anxiety

People with cancer may suffer from depression and anxiety. These conditions can sometimes lead to constipation.

Nerves link your brain and gut. When you are depressed, these nerves are not as active as usual. This can affect the way the muscles in your bowel work.

Other medical conditions

Many medical conditions, other than cancer, can cause constipation. Some of these include:

• bowel blockage (obstruction)
• Parkinson’s disease
• spinal cord injuries
• diabetes
• having too much calcium in your blood (hypercalcaemia)
• multiple sclerosis
• thyroid problems
• having a stroke
• problems with the structure of the bowel and back passage (rectum)
• Hirschsprung’s disease – a rare disease that is present from birth and affects the nerves in your bowel
• high calcium levels in the blood (hypercalcaemia)
• low levels of potassium in the blood (hypokalaemia)

• Constipation – Clinical Knowledge Summary 
  National Institute for Health and Care Excellence (NICE), revised March 2021 

• Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines

  P. J Larkin and others

  Annals of Oncology, 2018. Vol 29, Supplement 4.

• Managing Constipation in Adults With Cancer

  Rita J. Wickham

  Journal of Advanced Practioner in Oncology, 2017. Volume 8, Issue 2, Pages 149–161.

• Constipation: Evaluation and Management

  B Jani, and E Marsicano

  Missouri Medicine 2018. Volume 115, Issue 3, Pages 236–240.

Last reviewed: 

13 Dec 2022

Next review due: 

13 Dec 2025

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Constipation | Causes, Symptoms, Treatment & Support

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1. Overview

2. Causes

3. Symptoms

4. Treatment

5. Complications

6. Support

7. Research

Overview

This factsheet is about constipation

Constipation is a symptom that can mean different things to different people, but the usual meaning is that a person has difficulty or infrequency with opening their bowels. Constipation affects around 1 in 7 otherwise healthy people. The two groups of people most likely to be trouble by constipation are young women and the elderly – especially those who need to take regular medicines.

There is a common belief that people need to open their bowels every day, but this is not the case. Opening the bowels can vary between three times a day to three times a week in healthy individuals. Symptoms can constantly fluctuate and 3 people in every 100 adults have persistent constipation over 20 years. It is a common problem and does not usually mean that anything is seriously wrong. Most cases are temporary and will clear up with simple lifestyle measures.

How do you know if you have constipation?

This chart, called the Bristol Stool Chart, it is a way identifying constipation. If your poo is type 1 or type 2 on the chart, this is constipation. The poo is often hard and difficult to pass.

Causes

Why does constipation occur?

There are three main physical causes. One of the causes is where the muscles of the intestine and large bowel stop working properly; this results in slow movement of contents through the bowel down to the rectum (leading to a reduced urge to empty the bowel and hard stools). This is termed slow transit constipation and patients have an infrequent urge to go to the toilet.

Another type of constipation is called obstructed defaecation where the movement (transit) of the bowel is normal, but the person experiences symptoms of difficulty with emptying their bowel. Patients may need to strain, and feel they cannot empty. There are some patients who have both slow transit and obstructed defaecation.

Finally, there is constipation-predominant Irritable Bowel Syndrome (IBS-C) when the person has difficulty with bowel opening and abdominal pain associated with not going. This type of constipation can be made worse with stress or depression.

What are the causes of constipation?

Medicines: Over the counter or prescription medicines (e.g. opioids, a type of pain relief drugs) often carry a side effect of constipation. If symptoms began (or got worse) after starting one of these drugs, ask your doctor to see if there are any alternatives. Please see Guts UK information on Opioid Induced Constipation (OIC) for more information.

Emotion: there is a strong connection between feelings and how the gut works. This is called the gut brain connection, the gut and brain ‘talk’ to each other, normal signals involve feeling hungry (gut talking to brain) or getting butterflies (brain talking to gut. ) Sometimes the brain and gut overshare information. Being upset or depressed can make the bowel slow down or speed up. Emotional upsets, even in childhood, may result in functional constipation many years later.

Disturbed eating behaviour: eating disorders and sustained periods of erratic eating can result in constipation, even if eating behaviour returns to normal.

Ignoring the natural urges to open bowels: ignoring bowel urges because of an aversion to public toilets or time or social constraints can result in changes to both how the bowel muscles work and the pattern of bowel opening.

Excessive straining: this can be because of difficulty co-ordinating the muscles that empty the bowel.

Irregular mealtimes reduced liquid intake and reduced physical activity: these can all worsen symptoms in people with a tendency towards constipation.

Pain, or fear of pain, on passing stools.

Menstrual constipation: some women notice that their bowels are more sluggish at certain times of their menstrual cycle.

Pelvic floor weakness: some women develop a weakness of the pelvic floor allowing the bowel to bulge abnormally during attempting rectal emptying (“rectocele”), further interfering with the emptying mechanism. This can be especially common in women who have had children.

Dilated bowel: this is a less common condition in which the bowel becomes abnormally large (dilated) creating a condition called megacolon or megarectum, which can cause constipation. This condition is different to the dilatation of the bowel seen in Inflammatory Bowel Disease (IBD).

> Read our factsheet on Ulcerative Colitis

Symptoms

What are the symptoms of constipation?

• Opening the bowels less than three times a week.
• Needing to strain to open your bowels on more than a quarter of occasions.
• Passing a hard or pellet-like stool on more than a quarter of occasions.
• Experiencing a sense of incomplete emptying after a bowel opening.
• Needing to use manual manoeuvres to achieve bowel emptying.
• Severe constipation can occasionally cause an ‘overflow’ of diarrhoea.

The more of these symptoms you have the more likely you are to be constipated. If abdominal pain is also present, constipation may be part of Irritable Bowel Syndrome (IBS) (see our separate leaflet). Abdominal bloating is often part of many bowel complaints, including constipation.

Read our factsheet on Irritable Bowel Syndrome

How is constipation diagnosed?

Constipation is bothersome but usually not serious. If the simple measures described later do not help and your symptoms persist, then you will need to consult your GP. Also, a sudden slowing up of your bowel, especially if you are aged over 40, should also be reported. Try not to take laxatives before seeing your doctor.

If you also experience any of the following symptoms, you should see you GP immediately:

• Unexplained weight loss
• Bleeding in the stool (nhs. uk/conditions/bleeding-from-the-bottom-rectal-bleeding)
• or rectal pain

Your doctor will diagnose you according to the number or severity of symptoms as above. They may also want to examine your abdomen to check for any tenderness, swelling or blockage. Further investigation is usually unnecessary and will depend on your symptoms, age and possibly whether you have a history of bowel problems in your family. In rare cases the bowels may not be working properly because the bowel itself is diseased. If your doctor has any concerns, they may organise one or more of the following investigations:

• Blood tests: these are usually to look for anaemia, thyroid hormone or metabolic problems.
• Flexible sigmoidoscopy, colonoscopy, barium enema or CT scan: these are tests which allow doctors to examine the lining of your bowel and are routine procedures which are extremely safe. Bowel preparation is required prior to these procedures.
• Transit studies: a simple test involving an X-ray which shows the speed of passage through the bowel. A highlighting substance is ingested which shows up on X-ray. Laxatives cannot be taken during the test. Please note that a simple abdominal Xray, without the highlighting substance, is rarely helpful in diagnosing constipation.
• Anorectal physiology testing and proctography: rarely carried out, they indicate how the pelvic floor and the nerves and muscles around the back-passage work. No bowel preparation is required.

Treatment

What treatment is available for constipation?

Most treatment is self-managed and based around dietary and lifestyle changes:

• Dietary changes: Regular meals and an adequate fluid intake (approximately 8 cups a day) are the mainstays of treating and preventing constipation. Although drinking more than this is unlikely to make a difference.
• A high fibre diet: this may help some patients with constipation. This should include a mixture of high fibre foods such as fruit, vegetables, nuts, wholemeal bread and pasta, wholegrain cereals and brown rice. The aim should be to include a high fibre food at each meal along with five portions of fruit or vegetables each day. Some people may find that it helps to eat more fruit and vegetables while others might prefer cereals and grains. Eating more fibre may lead to bloating and can worsen discomfort, so it is important to increase levels slowly. Fibre is most helpful for people with mild symptoms of constipation, however if the condition is severe then continuing to increase fibre may make symptoms worse.

See our information here on fibre: https://gutscharity.org.uk/advice-and-information/health-and-lifestyle/fibre/

If you are struggling with your diet, ask your GP for a referral to a dietitian.

• Listening to your body: it is important to identify a routine of a place and time of day when you are comfortably able to spend time in the toilet. Respond to your bowel’s natural pattern so when you feel the urge, don’t delay. A warm drink with breakfast can help encourage the bowel into a pattern of regular working.
• Exercise: keeping active and mobile may help some people whose bowel is sluggish.

Should I take laxatives and are they safe?

Regular use of laxatives is generally not encouraged but occasional use is not harmful. Things to consider:

• The effects of laxatives are unpredictable – a dose that works today may not produce an effect tomorrow.
• Laxatives can cause pain and result in the passage of loose stools especially if the dose is too high.
• Long term use can lead to the bowel becoming progressively less responsive in some people, and in these individuals it may be important to switch to a different agent.
• Certain laxatives will not work in some patients.
• While laxatives and suppositories may ease bowel opening, they don’t often help the common problems of pain and bloating.

Nevertheless, the balance of scientific evidence suggests that laxatives do not cause any damage to the bowel and there is no evidence that using them puts you at risk of getting colon cancer. Sometimes doctors will advise people to take laxatives and some people do need them longer term, if your doctor has advised them, they are unlikely to be harmful in the long term. Suppositories or mini-enemas are more predictable than laxatives and tend to be very well tolerated and effective. They are especially useful for people who have difficulty with needing to strain to evacuate their bowel. It may be best to use laxatives only with proper guidance.

Taking laxatives does not result in weight loss, they work on the large bowel and most of the goodness from food is absorbed in the small bowel.

Recently, commercial products containing laxatives such as ‘weight loss or skinny tea’ have become commercially available, these products do not result in weight loss and are therefore not advised to be used. Taking high doses of laxatives long term can be harmful.

If you suspect an eating disorder is the reason that you are taking excessive laxatives, please discuss this with your GP. www.beateatingdisorders.org.uk

If you remain troubled with constipation despite strict adherence to the measures described before, you may need further treatment. These can include:

• Medicines: novel non-laxative drug therapies are proving helpful for some people who don’t tolerate or don’t respond to laxatives. Some of these are licensed for use in selected people with constipation symptoms despite lifestyle changes and use of laxatives. Adult people with constipation caused by opioids who do not respond to laxatives might respond to a drugs called PAMORA see our information on Opioid Induced Constipation here: ask your GP if this applies to you.
• Biofeedback: available in some centres, people are trained to co-ordinate rectal and abdominal muscles better in order to help the bowel empty rather more effectively.
• Surgery: it is usually best to avoid surgery because many people do not have a successful outcome. Indeed, there are some people who develop new symptoms after an operation such as diarrhoea, bowel obstruction or incontinence. Pelvic floor surgery for conditions like rectocele and rectal prolapse (see above) may be a possibility but would need a specialist assessment to decide this.
• Psychological treatments: These can be extremely helpful in reducing the symptom burden of some people who experience emotional influences on their constipation.

Complications

How can constipation affect you?

Although people often worry about it, there is no reason to believe that constipation causes a ‘poisoning’ of the system. It can cause feelings of sluggishness and bloating, but there is no evidence that bugs or toxins leak from the bowel into any other part of the body. Another common idea is that constipation may lead to cancer but there is no evidence that long-term constipation increases the chances of getting bowel cancer.

It is important to remember that the vast majority of cases of constipation are easily resolved with simple diet, lifestyle or medication change. However if constipation does not respond to different treatments there can be medium to long term effects including:

• Haemorrhoids or fissures: bleeding from haemorrhoids, or more rarely a fissure (painful tear) at the anus, is the commonest complication of constipation.
• Rectal prolapse: chronic straining can lead to the rectal wall protruding out through the anus.
• Faecal impaction: elderly or immobile patients may get so badly constipated that they quite literally get bunged up and this will need prompt treatment by either the GP or hospital.
• Diverticular disease: this is where small hard stools lead to increased intestinal contractions, creating pressure which causes the inner section of the intestine to bulge through the protective outer tube of muscle which surrounds it, creating a little pouch of intestine (see our leaflet on Diverticular Disease).

Support

What to ask your doctor?

• Could any of my medications be causing my constipation and if so is there an alternative?
• What dietary or lifestyle changes do you suggest I introduce?
• Are laxatives suitable for me and if so which one would be best for me to use?
• How will my constipation be monitored?
• Are there any over the counter remedies which will reduce the chances of me getting haemorrhoids or an anal tear?

Research

Much more research is needed in constipation considering how many people do suffer with it.

Guts UK is the charity for the digestive system. We are the only UK charity funding research into the digestive system from top to tail; the gut, liver and pancreas.

Visit our website to see our past and current research, or contact us for further information. www.gutscharity.org.uk

1. https://www.gov.uk/government/publications/public-assessment-report-of-over-the-counter-stimulant-laxatives-benefit-risk-review/over-the-counter-stimulant-laxatives-benefit-risk-review
2. Camilleri M, Ford AC, Mawe GM et al (2017) Chronic constipation. Nature Reviews Disease Primers. 3, 17095. doi: 10.1038/nrdp.2017.95
3.  https://cks.nice.org.uk/topics/constipation/

This video from Colorado Children’s Hospital about constipation is a great tool that the whole family will understand.

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Constipation – causes, diseases, diagnosis, prevention and treatment

Description

Constipation (or constipation) is a condition in which a person has difficulty with bowel movements or is able to do so less often than usual. Constipation can be temporary or chronic and have a variety of causes.

Symptoms of constipation may include:

• Infrequent trips to the toilet for bowel movements (less than three times a week)
• Difficulty in emptying bowels
• Need for effort or strain to empty bowels
• Feeling of incomplete emptying after going to the toilet
• Fullness or discomfort in the abdomen
• Loose or thick stools

Constipation is often associated with insufficient dietary fiber, low fluid intake, lack of physical activity, and certain medications. However, constipation can also be due to certain medical conditions such as irritable bowel syndrome, intestinal dysbiosis, hypothyroidism, etc.

If constipation is left untreated, it can lead to other problems such as hemorrhoids, anal fissures, urinary tract infections and even intestinal obstruction in severe cases. Therefore, it is important not to ignore intestinal problems and consult a doctor at the first symptoms.

The dangers of constipation

Constipation can be dangerous when it becomes chronic and untreated. Inadequate bowel movements can cause stool to remain in the bowel for extended periods of time, which can lead to the following problems:

1. Hemorrhoids: With frequent straining during bowel movements, pressure in the veins of the anus increases, which can lead to the development of hemorrhoids.

2. Anal fissures: Stress and difficulty during bowel movements can cause microtrauma in the anus, which can lead to anal fissures.

3. Diverticulosis: Retention of feces in the intestines can lead to the appearance of diverticula – protrusions on the intestinal wall.

4. Urolithiasis: Retention of feces in the intestines can lead to deterioration of kidney function and the appearance of urolithiasis.

5. Intestinal obstruction: Constipation left untreated for a long time can lead to intestinal obstruction, in which part of the intestine becomes blocked.

6. Toxic megacolon: This is a serious complication in which excessive accumulation of gases and waste products in the intestine can lead to intestinal dilation and impaired function.

Physiological causes of constipation

Constipation is a condition in which the intestines function less efficiently and the process of stool evacuation slows down. Physiological causes of constipation may include:

1. Insufficient water intake: When the body does not get enough water, the intestines can become dry and unable to function properly.

2. Insufficient intake of dietary fiber: Dietary fiber is an important element of food that helps to maintain the volume of feces and speeds up its passage through the intestines.

3. Insufficient physical activity: A sedentary lifestyle can lead to slower blood flow and intestinal motility, which in turn can lead to constipation.

4. Certain medicines: Some medicines, such as antidepressants and allergy medicines, can cause constipation.

5. Certain medical conditions: Certain medical conditions, such as diabetes, Parkinson’s disease, and thyroid disease, can cause constipation.

6. Some changes within the body: pregnancy, aging, hormonal changes and stress can lead to constipation.

Pathological causes of constipation

Pathological causes of constipation may be associated with various diseases or conditions that may affect the normal functioning of the intestines. Some of them include:

1. Irritable Bowel Syndrome: This is a disorder in which bowel function is impaired, which can lead to constipation, diarrhea, or both.

2. Intestinal obstruction: This is a condition in which the intestines are blocked, which can lead to difficulty in passing feces and cause constipation.

3. Bowel tumors: Tumors can block the intestines and lead to constipation.

4. Diaphragmatic hernia: This is a condition in which part of the stomach or intestines passes through a hole in the diaphragm and enters the chest cavity, which can lead to constipation.

5. Rectal problems: Various diseases such as hemorrhoids, anal fissures or proctitis can lead to difficulty passing stool and cause constipation.

6. Other diseases: Some diseases such as scleroderma, Hirschsprung’s disease and celiac disease can lead to constipation.

Accompanying symptoms

Symptoms of constipation may include:

1. No or infrequent bowel movements: The person may have difficulty or not urinate for several days.

2. Hard or dry stools: stools may be dry, hard and painful to pass.

3. Abdominal pain: The person may experience pain or discomfort in the abdomen.

4. Sensation of incomplete bowel evacuation: the person may feel that all of the stool is not being expelled from the bowel.

5. Flatulence and bloating: this may be due to slow bowel movements.

6. Decreased Appetite: Due to discomfort and pain in the abdomen, a person may experience a decrease in appetite.

7. Mucus in the stool: A person may notice the presence of mucus in the stool.

8. Vomiting: In rare cases, constipation may lead to vomiting.

9. Fatigue and depression: The person may feel tired and depressed due to prolonged periods of constipation.

What are the scenarios

The scenarios for constipation can be different, and depend on the cause of constipation and how quickly it is treated. Some of the possible constipation scenarios include:

1. Self-management: If constipation was caused by a temporary change in lifestyle or diet, then only a temporary adjustment in diet and physical activity may be needed to resolve the problem.

2. Medications: In cases where lifestyle changes do not relieve constipation, your doctor may prescribe medications such as laxatives, moisturizers, or probiotics.

3. Use of coarse laxatives: If simple laxatives do not work, the doctor may prescribe coarse laxatives, which can gently and safely improve the passage of stool.

4. Surgery: In severe cases where constipation is caused by physical problems in the intestines, surgery may be required.

5. Complications: If constipation is not removed, complications such as hemorrhoidal bleeding, anal fissures, infections and other diseases may develop.

6. Psychological effects: Prolonged constipation can cause stress and depression, which can negatively affect a person’s mental and emotional state.

What causes constipation

Constipation can be associated with various diseases and conditions, including:

1. Irritable Bowel Syndrome (IBS): This is a functional bowel disorder that can lead to decreased intestinal motility, which can cause constipation.

2. Thyroid disorders: Hypothyroidism or underactive thyroid can slow down the body’s metabolic processes and cause constipation.

3. Diseases of the rectum: hemorrhoids, anal fissures or anal spasm can make it difficult to pass stool.

4. Diseases of the nervous system: diseases of the nervous system, such as Parkinson’s disease, can lead to slow bowel movements and cause constipation.

5. Tumors: Tumors in or near the intestines can block the passage of feces and cause constipation.

6. Intestinal overexcitation: Stress and nervous tension can cause overexcitation of the intestines, which can lead to constipation.

7. Medications: Certain medications such as antidepressants, anticholinergics and iron supplements can cause constipation.

8. Bowel kink: Bowel kink can lead to obstruction of the passage of feces.

9. Other diseases: many other diseases, such as diabetes, heart and vascular disease, kidney disease, etc., can be associated with constipation.

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Titova Elena Alekseevna

Experience 29 years

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What tests to get

If you have problems with constipation, you should see a doctor who will examine you and prescribe the necessary tests based on your condition and symptoms. Some of the possible tests that may be ordered for constipation include:

1. Clinical blood test – to determine the level of hemoglobin and other indicators that may indicate the presence of digestive problems or anemia.

2. Clinical urinalysis – to determine the presence of a urinary tract infection.

3. Scatological examination – to determine the presence of occult blood in the stool and other markers that may indicate the presence of digestive problems.

4. Ultrasound examination – for visualization of organs in the abdominal cavity and detection of possible disorders in their functioning.

5. Colonoscopy – to visually examine the large intestine and determine the causes of constipation.

6. Rectoscopy – for visual examination of the rectum and identification of possible problems in this area.

7. X-ray examination – to detect violations in the functioning of the digestive system.

8. Computed tomography (CT) – for detailed visualization of internal organs and identification of possible problems in their functioning.

How to relieve constipation

There are several ways to help relieve constipation. Some of them include:

1. Increased water intake – this may help soften the stool and make it easier to pass through the intestines.

2. Eating foods rich in fiber – this includes fruits, vegetables, whole grains, legumes and nuts that help improve bowel movements.

3. Regular exercise – this can help improve bowel movement and speed up the process of digestion.

4. Taking laxatives – these can be drugs that help soften stool and speed up its passage through the intestines.

5. Avoidance of stressful situations – stress can lead to slower bowel movements, therefore it is recommended to avoid stressful situations or engage in relaxation exercises.

6. Avoidance of foods that can cause constipation – this includes fatty, fried, smoked foods, as well as foods rich in sugar and flour products.

7. Taking probiotics – this can help restore the balance of microflora in the intestines and improve food digestion.

Where to see a doctor

If you have problems with constipation, you can contact a general practitioner (GP) who will conduct an initial examination, find out the causes and prescribe the initial treatment. In some cases, when a more detailed analysis of the situation is necessary, the therapist may refer you to a gastroenterologist or coloproctologist for consultation and treatment.

A gastroenterologist is a specialist who diagnoses and treats diseases of the gastrointestinal tract, including constipation. A coloproctologist is a specialist who diagnoses and treats diseases of the rectum and anal canal, which can also be associated with constipation problems.

In any case, if you have problems with constipation, it is important to see a doctor for professional advice and treatment.

There are contraindications. Specialist consultation is required.

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causes, symptoms, degrees, methods of treatment of rectal prolapse in Moscow at the Center of Surgery “SM-Clinic”

general information

Kinds

Symptoms

Causes

Diagnostics

Conservative treatment

Surgery

Expert opinion of a doctor

Prevention

Rehabilitation

Question answer

General information

Rectal prolapse is a condition when all layers of the organ come out through the anus. The prolapse is often preceded by internal intussusception, in which the superior sections of the rectum protrude into the lumen of the inferior ones, but do not go beyond the anal canal.

The prolapse is treated by a coloproctologist.

Prolapse of the rectum is characterized by the exit through the anus to the outside of all layers of this section of the intestine. The disease is often accompanied by constipation and incontinence of intestinal contents.

Prolapse is often the result of weakened pelvic floor muscles. Women who have given birth are at risk. However, the disease can also occur in nulliparous patients and men.

Diagnosis of rectal prolapse is not difficult. The patient himself discovers that he has a problem. However, a medical examination is required. Only according to its results and data from an additional examination, it is possible to establish a final diagnosis, determine the degree of progression of the pathology and draw up a treatment program.

The main and only way to radically solve the problem is surgery. The operation allows you to restore the anatomy of the pelvic organs and the function of the rectum. To prevent relapse, it is important to normalize the stool and perform gymnastics aimed at strengthening the muscles of the pelvic floor.

Types of rectal prolapse

Symptoms of rectal prolapse

Causes

Diagnostics

To establish the final diagnosis and select the optimal method of treatment, an extended diagnosis is carried out:

• Objective examination. When examining a patient on a gynecological chair, rectal prolapse is easily detected. The doctor determines the presence in the pathological structure of not only the mucous, but also the muscle layer. This allows you to distinguish the initial prolapse of the rectum from the hemorrhoid.
• Rectal digital examination. It helps not only to determine the severity of pelvic prolapse, but also to diagnose concomitant diseases (rectal polyps, anal fissure, hemorrhoids, etc.), which may require additional treatment.
• Strain test. The patient should push as if defecation. This allows you to identify the initial stages of the disease.
• Sigmoidoscopy. Endoscopically, the doctor examines the final section of the intestine (rectum).
• Colonoscopy. With the help of an endoscope, the condition of almost the entire large intestine, and not just its final section, is studied.
• Irrigoscopy. This is an X-ray contrast study of the colon.
• Defecography. Determines the position of the rectum in relation to the pubococcygeal line in different periods (rest, straining, contraction by willpower). The method is necessary for detailed planning of surgical intervention.
• Sphincterometry. Allows you to evaluate the functional activity of the rectal sphincter.

Conservative treatment

Surgery

Surgery is the only effective treatment for rectal prolapse. Before it is carried out, the coloproctologist excludes the presence of contraindications in the patient – malignant tumors of any localization, chronic pathologies (ischemic heart disease, arterial hypertension, diabetes mellitus) without an adequate level of compensation, mental disorders.

There are different types of surgery. Operations consist in restoring the anatomical position of the rectum and its subsequent fixation in the small pelvis.

Conventionally, the options for surgical intervention are divided into 2 types, taking into account access to the rectum:

• performed through perineal access;
• performed through the anterior wall of the abdomen.

Intra-abdominal rectopexy is an effective treatment for rectal prolapse. The coloproctologist creates access to the rectum through the anterior abdominal wall. Returns it to the correct position, and then fixes it with a mesh implant.

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Medical expert opinion

Prophylaxis

Rehabilitation

Q&A

This disease is treated by a coloproctologist.

No. Special training can only slow down the progression of the rectocele – the prolapse of the rectum into the vagina. This condition precedes prolapse and is associated with weakness of the pelvic floor muscles.

Usually improves by the end of the first week after surgery. The full rehabilitation period lasts 2-3 months, after which the patient can return to his usual way of life without restrictions.

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