We’ve all experienced that occasional feeling of being “backed up”—perhaps after travel, a change in diet, or a period of stress. For most, it’s a temporary inconvenience. But for millions, this discomfort is a persistent, daily struggle known as chronic constipation. It’s more than just infrequent bathroom visits; it’s a complex medical condition that can significantly impact your quality of life, causing bloating, abdominal pain, and a constant feeling of unease.

At S N Super Specialty Hospital’s Department of Gastroenterology in Sri Ganga Nagar, we understand that chronic constipation is a sensitive issue, often shrouded in silence and embarrassment. However, it is a very common and treatable condition. This guide aims to demystify chronic constipation, explore its underlying causes, and outline the effective treatment strategies that can help you regain control and comfort.

What Truly Defines Chronic Constipation?

Chronic constipation is diagnosed when difficult, infrequent, or incomplete bowel movements persist for several weeks or longer—typically for at least three months. It’s a marked shift from occasional trouble, becoming a persistent pattern that your body can’t resolve on its own.

According to the ROME IV criteria, the gold standard for diagnosis, chronic constipation is characterized by experiencing two or more of the following symptoms for at least three months:

• Straining during more than a quarter of bowel movements.
• Lumpy or hard stools (like types 1 or 2 on the Bristol Stool Chart) regularly.
• A sensation of incomplete evacuation after a bowel movement.
• A feeling of rectal blockage or obstruction.
• Needing to perform manual maneuvers (like using fingers) to facilitate a bowel movement.
• Having fewer than three spontaneous bowel movements per week.

Crucially, loose stools are rarely present without the use of laxatives.

The Four Types of Chronic Constipation: Why a Precise Diagnosis Matters

A key to effective treatment is understanding that not all constipation is the same. Gastroenterologists typically classify chronic constipation into four main types, which can sometimes overlap:

1. Normal Transit Constipation: This is the most common type. Surprisingly, stool moves through the colon at a normal speed. The primary issue is that patients feel constipated—experiencing bloating, abdominal discomfort, and a sense of difficult evacuation, often due to hard stools.
2. Slow Transit Constipation: Here, the colon itself is sluggish. The muscles in the colon wall contract slowly, causing stool to move too gradually through the digestive tract. This allows more water to be absorbed from the stool, leading to hard, dry stools and infrequent bowel movements.
3. Dyssynergic Defecation (Pelvic Floor Dysfunction): This is a problem of coordination, not just speed. The muscles and nerves of the pelvic floor fail to work in harmony during a bowel movement. Essentially, when you try to pass stool, the anal sphincter and pelvic muscles tighten instead of relaxing, blocking the exit. This leads to intense straining and a feeling of incomplete emptying.
4. Combination (Slow-Transit and Dyssynergic): Many patients, especially those with long-standing constipation, have a mix of both slow transit through the colon and dysfunctional pelvic floor muscles.

Unraveling the Root Causes: From Lifestyle to Underlying Conditions

Chronic constipation can stem from a wide array of factors, which is why a medical evaluation is crucial.

Lifestyle and Dietary Factors:

• Low-Fibre Diet: Fibre adds bulk and softness to stool. Diets high in processed foods, meat, and dairy and low in fruits, vegetables, and whole grains are a primary culprit.
• Inadequate Hydration: Without sufficient fluid, the colon pulls more water from the stool, making it hard and difficult to pass.
• Lack of Physical Activity: Exercise helps stimulate the natural contractions of the intestines.
• Ignoring the Urge: Regularly delaying a bowel movement can dull the nerve signals over time, reducing the urge.

Medications:

A surprising number of common medications can cause constipation, including:

• Opioid painkillers
• Certain antidepressants (especially tricyclics)
• Antacids containing calcium or aluminium
• Iron supplements
• Blood pressure medications like calcium channel blockers
• Some antihistamines and diuretics

Underlying Medical Conditions:

Constipation can be a symptom of another health issue, such as:

• Irritable Bowel Syndrome (IBS-C)
• Endocrine Disorders: Hypothyroidism, diabetes, hypercalcemia.
• Neurological Conditions: Parkinson’s disease, multiple sclerosis, spinal cord injuries.
• Pelvic Floor Dysfunction: As described above.
• Structural Issues: Rectocele, colon strictures.

When no specific cause is found after thorough investigation, the condition is termed Chronic Idiopathic Constipation.

A Stepwise Approach to Effective Treatment at S N Super Specialty Hospital

Treatment for chronic constipation is not one-size-fits-all. Our gastroenterologists employ a structured, stepwise approach tailored to the individual’s specific type and cause of constipation.

Step 1: Foundation of Care – Lifestyle and Dietary Modifications
This is always the first line of defense.

• Increase Fibre Intake: Aim for 25-35 grams of fibre daily. Incorporate foods like oats, bran, lentils, berries, apples, broccoli, and nuts. Increase intake gradually to avoid gas and bloating.
• Hydrate, Hydrate, Hydrate: Drink plenty of water throughout the day. Fibre cannot work effectively without adequate fluid.
• Embrace Regular Exercise: Even a daily 30-minute brisk walk can stimulate bowel motility.
• Establish a Routine: Try to visit the bathroom at the same time each day, ideally 15-45 minutes after a meal, to leverage the gastrocolic reflex.

Step 2: Over-the-Counter (OTC) Therapies
If lifestyle changes aren’t sufficient, several types of laxatives can help:

• Bulk-Forming Agents (Psyllium, Methylcellulose): Our first choice; they are gentle and work like dietary fibre.
• Osmotic Laxatives (Polyethylene Glycol, Lactulose): Draw water into the colon to soften stool.
• Stool Softeners (Docusate): Help moisten and soften hard stools.
• Stimulant Laxatives (Bisacodyl, Senna): Should be used short-term as they can lead to dependency with long-term use.

Step 3: Prescription Medications and Specialized Therapies
For cases resistant to the above steps, we have advanced options:

• Prescription Medications: Drugs like Lubiprostone, Linaclotide, Plecanatide, and Prucalopride work by increasing fluid secretion in the intestines or enhancing colonic motility.
• Biofeedback Therapy: This is the gold-standard treatment for Dyssynergic Defecation. It is a non-invasive therapy that retrains the pelvic floor muscles, teaching patients how to relax and coordinate them correctly during a bowel movement. Success rates are exceptionally high for the right candidates.

Step 4: Surgical Interventions (A Last Resort)
Surgery is considered only for a very small subset of patients with severe, intractable slow-transit constipation that has failed all other treatments. Procedures like a colectomy are major and require careful patient selection.

When Should You Consult a Doctor?

Do not hesitate to seek professional help if you experience:

• Constipation that is new, persistent, or severe.
• Symptoms lasting for more than three weeks.
• Unexplained weight loss.
• Rectal bleeding or blood in your stool.
• Severe abdominal pain.
• Persistent nausea or vomiting.

Regain Your Comfort and Confidence

Living with chronic constipation can be physically and emotionally draining, but it is important to remember that you are not alone, and effective help is available. Open communication with a healthcare provider is the first step toward lasting relief.

The gastroenterology team at S N Super Specialty Hospital, Sri Ganga Nagar, is dedicated to providing compassionate, comprehensive care for digestive disorders. We utilize state-of-the-art diagnostic tools to pinpoint the exact cause of your constipation and create a personalized treatment plan to restore your digestive health and improve your overall well being.

Take the first step towards a more comfortable life. Schedule a consultation with our specialists today.