GI Motility Disorders Unit

Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movement ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or faeces becomes harder and more difficult to pass.

Causes

Constipation can be caused by anatomical or functional problems.

Rectocoele – is condition is most commonly found in women who have had a baby by vaginal delivery OR women who have strained repeatedly because of heavy lifting and constipation.

Nerve disease/injury – Nerve problems will cause problems with defaecation, especially constipation e.g. spinal cord injury, multiple sclerosis, Parkinson's disease, stroke

Medications – Constipation is common side effects of a wide variety of prescribed and over the counter medications. These include pain killers (especially opioids, antacids containing aluminium and calcium, calcium channel blockers (for blood pressure), anti-Parkinson drugs, antispasmodics, antidepressants, iron supplements, diuretics (fluid tablet), using laxatives regularly for a long period of time can reduce your bowel's movements

Pregnancy and after childbirth – During pregnancy, changes in hormone levels cause the gut to slow down. Also, as the uterus grows, there is the additional factor of the extra volume in the pelvis. New mothers may find that they cannot respond to the urge to open their bowels.

Following an operation – The general anaesthetic and painkillers given during / after surgery can slow down the bowel manipulation of the bowel during intestinal surgery can temporarily but significantly reduce bowel movements the pain after an abdominal operation may be too painful for you to try pushing some major pelvic operations can damage the pelvic nerves, interrupting defaecation reflexes

Psychological disturbances – Having experienced major traumatic life events can place you at risk for constipation. Patients who have experienced sexual or physical abuse often have in-coordination between the rectum and the anus as well as slowing down of gut transit. As the rectum tries to contract to squeeze the stool out, the anus contracts to retain it.

Complications

Common features associated with constipation include abdominal bloating and discomfort, tired, easily fatigued, pain and vomiting.

It is uncommon for young or fit people to get serious complications from constipation. However, elderly or malnourished people may develop serious complications.

Faecal impaction – when a solid ball of stool builds up in the rectum. This can present diarrhoea as liquid stool leaks out around the ball of obstructing stool. This is most commonly seen in patients with poor mobility who are taking multiple medications

Stool perforation – (exceptionally rare) when hard stool sits in the colon for so long that it wears through the wall and makes a perforation (hole) requiring surgical therapy

Rectal prolapse – rectum comes down and out of the back passage. This is a complication of constipation / a weak pelvic floor / advanced age or malnutrition