Constipation can be a distressing, unpleasant condition. Most people will at some stage in their life find it difficult to go to the toilet, although this is usually transient and precipitated by a lifestyle change; however, sometimes constipation becomes a more persistent problem and can represent an underlying physical or functional problem.
Constipation is defined as having at least two of the following symptoms:- straining at bowel movements, lumpy/hard stools, a sensation of incomplete evacuation, a sense of anorectal blockage, less than three bowel movements per week, and the need for manual manoeuvres to aid evacuation. Persistent, troublesome constipation can occur in adults, particularly after the age of 65 years. It is twice as common in women as men.
Constipation can be categorized in a number of ways. Two major types of constipation are recognized. Primary, functional constipation (also known as intrinsic constipation) is due to a disturbance of the normal mechanisms of effective defaecation; it is essentially divided into slow transit constipation (constipation-predominant irritable bowel syndrome), and obstructed defaecation (pelvic floor function dysfunction). Secondary constipation (extrinsic constipation) is due to another cause, such as colorectal cancer, hypothyroidism, diabetes, use of medication including opiates, antidepressants, and diuretics, or stool impaction in the elderly.
The management of constipation revolves around establishing the underlying cause. Often investigations are indicated to rule out a serious cause, or to accurately determine the problem. Once the cause is identified, treatment can be tailored to attempt to alleviate symptoms. In all patients with constipation, simple medical approaches are appropriate, either in isolation or combined with surgery. Patients are encouraged to modify their diet to increase the amount of dietary fibre and fluid. If these simple measures fail, laxatives can be taken (the type will again be determined by the cause of the constipation).
Occasionally, surgical intervention is required. Surgery for constipation is largely concerned with correcting pelvic floor problems, e.g. laparoscopic ventral rectopexy or STARR procedure for obstructed defaecation. Your surgeon will be able to advise you on the most appropriate management strategy.