Constipation means something slightly different to each person. To some, constipation means having infrequent bowel movements. To others, it means having difficult-to-pass or hard stools that cause straining. Still, others might define constipation as having a feeling of incomplete emptying of their bowel after a bowel movement.
Chronic vs. acute constipation
The main difference between chronic and acute constipation is how long the constipation lasts.
In general, acute or short-term constipation is:
- infrequent, lasting only a few days
- brought on by a change in diet or routine, travel, lack of exercise, illness, or a medication
- relieved by over-the-counter (OTC) laxatives, exercise, or a high-fiber diet
On the other hand, chronic constipation is:
- long-term, lasting for more than three months and sometimes even continuing for years
- disruptive to a person’s personal or work life
- not relieved by a change in diet or exercise, so requires medical attention or prescription medications
Who is at risk for chronic constipation
Constipation is one of the most common chronic gastrointestinal disorders in adults. In the United States, more than 2.5 million people visit their doctor each year for constipation. Annually, Americans spend nearly $800 million on laxatives to treat constipation.
The following people are at a higher risk of experiencing chronic constipation:
- people over the age of 65
- people who don’t engage in physical activity or are confined to bed due to a physical disability such as a spinal cord injury
- women who are pregnant
Causes of chronic constipation
While poor diet and lack of exercise can lead to short-term tummy troubles, chronic constipation can be caused by other health conditions and medications, including:
- pelvic floor dysfunction, which may make it difficult to coordinate muscle contractions in the rectum
- endocrine or metabolic problems, such as diabetes and hypothyroidism
- neurologic problems, including multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke
- tears in the anus and rectum
- narrowing of the colon (bowel stricture)
- mental health problems, such as depression, eating disorders, and anxiety
- bowel diseases, such as Crohn’s disease, colon cancer, diverticulosis, and irritable bowel syndrome
- physical disabilities that lead to immobility
Chronic constipation can also be caused by taking a prescription or OTC medication for another health condition. Some medications that can cause chronic constipation include:
- calcium channel blockers
- anticholinergic agents
- tricyclic antidepressants
- Parkinson’s disease medications
- antacids, especially antacids high in calcium
- calcium supplements
- iron supplements
- anti-diarrheal agents
It isn’t always known what causes chronic constipation. Chronic constipation that happens for unknown reasons is called chronic idiopathic constipation (CIC).
Diagnostic criteria for chronic constipation
What is considered a “normal” bowel movement can change depending on the person. For some, it may mean going three times a week or twice a day. For others, it may mean going every day. There really isn’t a standard or perfect number for bowel movements.
Because of this, doctors have tried to put together a list of criteria to help them diagnose chronic constipation. The Rome IV diagnostic criteria for functional constipation require that symptoms must include two or more of the following:
- fewer than three spontaneous bowel movements per week
- straining during at least 25 percent of bowel movements
- lumpy or hard stools at least 25 percent of the time (The Bristol Stool Chart can help you describe your stool form.)
- a sensation of incomplete evacuation for at least 25 percent of bowel movements
- a sensation of obstruction or blockage for at least 25 percent of bowel movements
- manual maneuvers (like using your fingers) to help at least 25 percent of bowel movements
The main criterion for chronic constipation, however, is that the symptoms have persisted for more than three months.
Your doctor will ask you questions about your symptoms, medical history, and medications (prescription, OTC, and supplements) you’re taking. If you’ve been experiencing symptoms of constipation for more than three months and meet the other diagnostic criteria for chronic constipation, your doctor may want to perform a physical examination.
A physical examination may include blood tests and a rectal exam. A rectal exam means that your doctor will insert a gloved finger into your rectum to check for any blockages, tenderness, or blood.
Your doctor might want to do additional tests to identify the cause of your symptoms. These tests may include the following:
- Marker study (colorectal transit study): You ingest a pill that contains markers that will show up on an X-ray. Your doctor can see how food is moving through your intestines and how well the muscles of your intestines are working.
- Anorectal manometry: Your doctor inserts a tube with a balloon on the tip into your anus. The doctor inflates the balloon and slowly pulls it out. This allows your doctor to measure the tightness of the muscles around your anus and how well your rectum functions.
- Barium enema X-ray: A doctor inserts barium dye into your rectum using a tube. The barium highlights the rectum and large intestine, allowing the doctor to better view them on an X-ray.
- Colonoscopy: Your doctor examines your colon using a camera and a light attached to a flexible tube, called a colonoscope. This often involves a sedative and pain medication.
The main difference between chronic and short-term constipation is how long symptoms last. Unlike short-term constipation, chronic constipation can dominate a person’s work or social life.
Constipation lasting for more than three months that doesn’t get any better after eating more fiber, drinking water, and getting some exercise is considered chronic.
It’s important to visit a doctor for a more accurate diagnosis. A doctor will ask you questions about your bowel movements and use diagnostic tests to find out what’s causing your constipation. They can prescribe medications to help or may advise that you stop taking certain medications. Two drugs approved by the U.S. Food and Drug Administration, lubiprostone (Amitiza) and linaclotide (Linzess), have both been shown to safely improve symptoms of chronic constipation.
If you have blood in your stool, unexplained weight loss, or severe pain with your bowel movements, see your doctor right away.