Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Constipation is generally described as having fewer than three bowel movements a week.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms.

The number of bowel movements generally decreases with age. Most adults have what is considered normal, between three and 21 times per week. The most common pattern is one bowle movement a day, but this pattern is seen in less than half of individuals. Moreover, most are irregular, and don’t have bowel movements every day or the same number every day.

Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have one bowel movement every day. Going without one for two or three days does not cause physical discomfort, only mental distress (in some people). Contrary to popular belief, there is no evidence that “toxins” accumulate when movements are infrequent or that constipation leads to cancer.

It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumors of the colon). It also requires an immediate assessment if it is accompanied by symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary loss of weight. The evaluation of chronic constipation may not be urgent, particularly if simple measures bring relief.

 SIGNS AND SYMPTOMS OF CONSTIPATION INCLUDE;

• Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

CAUSES 

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

• Anal fissure
• Bowel obstruction
• Colon cancer
• Narrowing of the colon (bowel stricture)
• Other abdominal cancer that presses on the colon
• Rectal cancer
• Rectum bulge through the back wall of the vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

• Autonomic neuropathy
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Stroke

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• Inability to relax the pelvic muscles to allow for a bowel movement (anismus)
• Pelvic muscles don’t coordinate relaxation and contraction correctly (dyssynergia)
• Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes
• Overactive parathyroid gland (hyperparathyroidism)
• Pregnancy
• Underactive thyroid (hypothyroidism)

RISK FACTOR 

Factors that may increase your risk of chronic constipation include:

• Being an older adult
• Being a woman
• Being dehydrated
• Eating a diet that’s low in fiber
• Getting little or no physical activity
• Taking certain medications, including sedatives, narcotics, some antidepressants or medications to lower blood pressure
• Having a mental health condition such as depression or an eating disorder

 COMPLICATIONS

Complications of chronic constipation include:

• Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
• Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
• Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
• Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

PREVENTION

The following can help you avoid developing chronic constipation.

• Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
• Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular exercise.
• Try to manage stress.
• Don’t ignore the urge to pass stool.
• Try to create a regular schedule for bowel movements, especially after a meal.
• Make sure children who begin to eat solid foods get plenty of fiber in their diets.

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