The definition of constipation is variable but it generally implies the infrequent passage of hard stools. This is a very common problem especially among elderly patients with limited mobility. This problem also occurs in young patients especially females and in those taking Opiate type pain medications.
What causes constipation?
Anatomical causes of constipation include narrowing to the lumen of the colon caused from strictures and colon cancer. In many cases, no obstruction is encountered; there is a motility (colon contraction) problem. The use of pain medications especially opiates (Morphine,Vicodin etc) can slow colon contractions and contribute to constipation. In young patients especially females, constipation occurs as a result of a neuropathy or myopathy that affects may other hollow organs as well (urinary bladder, uterus etc).
How is Constipation evaluated?
As colon obstruction can cause constipation, narrowing due to stricture (scar tissue) or tumor (colon cancer or large polyp) needs to be excluded. This is best done by colonoscopy.
Once an obstruction is excluded, Sitz-Mark test using radio-opaque O-Rings packed into a capsule can be useful. Each capsule with many O-Rings is swallowed and X-Rays taken on Day 3 and Day 5. In patients with dysmotility more than 80% of the rings will be seen on Day 5.
How is Constipation treated?
Once obstruction is excluded, treatment is symptomatic. Those using narcotics medicines have to weaned off the medication. Fiber products such Metamucil, Citrucel may help some patients. Others require laxatives that do not hurt the colon can be tried. These include MiraLax, Amitiza and certain medications such as Misoprostil, Colchicine.
In a few cases radical measures such as removing a large part of the colon may be necessary.