Patient Care


What is Constipation?

The definition of Constipation varies from person to person and can be affected by the individual's diet.

Like how height varies from person to person, bowel habits are different for different people. For most people, it is normal for bowel movements to occur from three times a day to three times a week, other people may go a week or more without experiencing discomfort or harmful effects.

Normal bowel habits are affected by diet. The average diet includes 12 to 15 grams of fibre per day, although 25 to 30 grams of fibre and about 60 to 80 ounces of fluid daily are recommended for proper bowel function. Exercise is also beneficial to proper function of the colon.

About 80 percent of people suffer from Constipation at some time during their lives and brief periods of constipation are normal. Constipation may also be diagnosed if bowel movements occur fewer than three times weekly on an ongoing basis.

There are many causes of Constipation. These include mechanical causes (structural blockage in the colon), functional causes (no structural blockage in the colon, just a result of how the colon moves) and medical reasons. The most worrisome cause to look out for is cancer.

  • Anatomic causes
    • Cancer
    • Stricture (Narrowing)
  • Functional causes
    • Irritable bowel syndrome
    • Slow transit constipation
    • Pelvic outlet dysfunction
  • Medical causes
    • Medication
    • Disorders of nervous system
      • Parkinson's disease
      • Stroke
      • Spinal cord injuries
  • Disorders of endocrine system
    • Thyroid disease
What are the signs & symptoms of Constipation?

Constipation is a symptom that has different meanings to different people. These include:

  • Infrequent bowel movements
  • Decrease in the volume or weight of stool
  • The need to strain to have a movement
  • A sense of incomplete evacuation
  • The need for enemas, suppositories or laxatives in order to maintain regularity
How is Constipation diagnosed?

Your doctor will try to exclude worrisome causes, like cancer (especially if you are older than 50 years). He may do a colonoscopy, a CT colonography, a barium enema or some form of screening.

He will also go through your history to see if you have any medical conditions predisposing you to Constipation.

After excluding any mechanical cause of obstruction, and if your doctor tells you that you have functional constipation, he may evaluate you further to see if you have a slow-transit colon ('sleepy' colon), or pelvic floor dysfunction (discoordination of your pelvic floor and 'pooping' muscles) by ordering transit marker studies or defecography studies.

Slow Transit Colon

Sometimes also known as a 'sleepy colon' or a 'lazy colon' or 'inactive colon', it essentially means that the colon moves slowly and hence propels the stool in the colon slowly. The colon is a muscular tube that connects the small intestines to the anus. It propels the stool that comes out of the small intestines towards the rectum and anus.

Pelvic Floor Dyssynergia

Also known as puborectalis paradoxis, non-relaxing puborectalis, Pelvic Floor Dysfunction, it is a discoordination of the 'pooping' muscles. In essence, 'pooping' involves the coordination of several muscles. Your abdominal muscles need to contract and squeeze the stool out, and at the same time, your anal sphincter muscles need to relax and open up to let the stool out, and your puborectalis needs to relax and let the kinked rectum straighten up so that the stool can pass out easily. In Pelvic Floor Dyssynergia, the puborectalis contracts even more and kinks the rectum further so the stool has more difficulty passing through.

Who is at risk of Constipation?

Excluding the worrisome causes of Constipation, some factors in our lives can contribute to Constipation. These include:

  • Inadequate fibre and fluid intake
  • A sedentary lifestyle
  • Environmental changes
  • Travel
  • Pregnancy
  • Change in diet
  • Repeatedly ignoring the urge to have a bowel movement

Certain medications also may cause Constipation. Remember to talk to your doctor about it, and do not stop them on your own. They are:

  • Pain killers
  • Antidepressants
  • Tranquilisers
  • Psychiatric medications
  • Blood pressure medication
  • Diuretics
  • Iron supplements
  • Calcium supplements
  • Aluminum containing antacids
  • Laxative dependence or abuse
What are the treatment options for Constipation?

Simple measures can include increasing the fibre in your diet and drinking more water. Exercise is good as it stimulates the colon.

Sometimes, if the doctor finds that you have incoordination of your 'pooping' muscles (Pelvic Floor Dyssynergia), the physiotherapist can teach you exercises or biofeedback techniques to retrain the muscles and relax the puborectalis during the process of defecation (pooping).

Find A Doctor

Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

You can search by -
  • Condition name 'Constipation' AND
  • Institution
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