About Constipation
About Constipation
Constipation is a widespread condition that impacts quality of life1
Constipation is a widespread condition that impacts quality of life1
41 million adults in the United States suffer from the discomfort of constipation each year2
Constipation symptoms can interrupt patients’ daily lives1
~70% of people had difficulty working, and at least 1 in 10 people missed work completely due to chronic constipation.
Unresolved constipation can lead to long-term consequences3
Untreated constipation can lead to more serious health problems such as hemorrhoids, anal fissures, rectal prolapse, or fecal impaction.
Constipation is a common problem in patients with diabetes mellitus (DM)
of patients with DM report at least 1 GI symptom—the most common of which is constipation4-7
of patients with DM report at least 1 GI symptom—the most common of which is constipation4-7
of patients with DM have constipation4,6,7
of patients with DM have constipation4,6,7
While the exact mechanism of diabetic bowel dysfunction is not known, it’s suggested that neuropathy caused by hyperglycemia affects colon motility.8
NEUROPATHY8
Hyperglycemia-induced diabetic neuropathy causes autonomic neuronal damage, nerve flow reduction, and vascular endothelium damage. Because autonomic neurons and smooth muscle are believed to regulate GI motility, diabetes increases the risk of constipation or hard stool as a result of decreased motility, bowel transmit time, and atony of the colon. Diabetic neuropathy also leads to reduced rectal sensation and impaired external sphincter function, which result in symptoms such as fecal urgency and feeling of incomplete evacuation.
NEUROPATHY8
Hyperglycemia-induced diabetic neuropathy causes autonomic neuronal damage, nerve flow reduction, and vascular endothelium damage. Because autonomic neurons and smooth muscle are believed to regulate GI motility, diabetes increases the risk of constipation or hard stool as a result of decreased motility, bowel transmit time, and atony of the colon. Diabetic neuropathy also leads to reduced rectal sensation and impaired external sphincter function, which result in symptoms such as fecal urgency and feeling of incomplete evacuation.
In a large, hospital-based cross-sectional study including 4738 patients of whom 603 were diabetic, the authors concluded that diabetes is associated with an increased risk of8:
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Additionally, they found that the risk of these symptoms is affected by8:
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These symptoms remained associated even after the exclusion of organic gastrointestinal diseases.8
In a large, hospital-based cross-sectional study including 4738 patients of whom 603 were diabetic, the authors concluded that diabetes is associated with an increased risk of8:
- Constipation
- Fecal urgency
- Hard stools
- Incomplete evacuation
Additionally, they found that the risk of these symptoms is affected by8:
- High HbA1c levels
- Long duration of diabetes
- Low BMI
- High serum creatinine levels
- Use of insulin
These symptoms remained associated even after the exclusion of organic gastrointestinal diseases.8
Female patients are more likely than males to experience constipation9
Female patients are more likely than males to experience constipation9
Hormones, diet, supplemental iron, pregnancy, and menopause are all factors that may lead to constipation in women.10-14
Pregnancy is a common cause of constipation15
Pregnancy is a common cause of constipation15
Note that pregnant women are advised to talk to their doctors if they experience constipation during pregnancy to determine the best specific course of action for them.
Why is menopause often accompanied by constipation?
Physical changes associated with menopause affect all systems of women’s bodies, including the GI tract, often resulting in constipation.16
Hormonal changes17
Decline in estrogen and progesterone levels in menopause may cause changes that include constipation.
Joint and back pain16,18,19
Clearly related to declining estrogen levels, menopausal arthralgia occurs in more than half of menopausal women. Low back pain also has an increased incidence in perimenopausal women compared with women of other ages. Inactivity that can result may reduce bowel movements and cause constipation.
Medications20
As women age, they take more medications, including many that are known to contribute to constipation.
The connection between constipation and lower urinary tract symptoms21
An article in the Journal of Women’s Health reported that constipation was prospectively associated with increased risks of urgency and hesitancy in parous middle-aged women. The study suggests that untreated constipation could lead to the development of lower urinary tract symptoms (LUTS) in this patient population.21
An article in the Journal of Women’s Health reported that constipation was prospectively associated with increased risks of urgency and hesitancy in parous middle-aged women. The study suggests that untreated constipation could lead to the development of lower urinary tract symptoms (LUTS) in this patient population.21
If additional research supports a causal relationship, it implies that women should seek treatment for constipation to reduce their consequent risk of developing LUTS.21
Diagnostic tools: Distinguishing occasional vs chronic constipation
The criteria below may help when diagnosing patients1,2
While there’s no formal definition for occasional constipation, it can include1:
- Infrequent bowel movements
- Difficulty in passing stool
- Straining
- The feeling of incomplete evacuation
Chronic constipation is defined by Rome III criteria2:
- Presence of 2 or more of the following symptoms:
- Straining during ≥25% of defecations
- Lumpy or hard stools in ≥25% of defecations
- Sensation of incomplete evacuation for ≥25% of defecations
- Sensation of anorectal obstruction/blockage for ≥25% of defecations
- Manual maneuvers to facilitate ≥25% of defecations (such as digital evacuation, support of the pelvic floor)
- Fewer than 3 bowel movements a week
- Loose stools are rarely present without the use of laxatives
- Criteria must have been met for the previous 3 months with symptom onset at least 6 months prior to diagnosis
The Bristol scale describes changes in bowel movement consistency3
The Bristol scale can be used to evaluate bowel movements and helps patients describe them in an objective and minimally embarrassing manner.
Comparison of OTC occasional constipation treatments
OTC laxatives work in different ways
Click for more details about each treatment >
The trademarks depicted herein are owned by their respective owners.
Not all OTC constipation treatments offer both effective results and few side effects
The trademarks depicted herein are owned by their respective owners.
Medications that may cause constipation
Many commonly used medications have constipation as a side effect. Depending on patients' existing medical concerns, some current treatment regimens may be the cause of their constipation symptoms. Note that patients are advised to talk to their doctor if they experience constipation due to medication.
This represents a small sample of brand name products, some of which may no longer be available. The trademarks depicted in this table are the property of their respective owners.
