What is constipation? How is it defined?

Constipation is a problem associated with the digestive system where the patients evacuate less than three bowel movements in a week. Mostly, the stool would be rigid or very dry. However, constipation has varied meanings for different individuals. Generally,a patient describes the condition has uncomfortable or difficulty in bowel movement. Constipation invariantly affects the individual quality of life which imparts mentally and physically.

What are the signs and symptoms of chronic constipation?

Constipation is very common among people and can be treated by simple home remedies itself. But in a few cases it gets worse to chronic constipation.

Signs and symptoms of chronic constipation includes:

Very fewer bowel movements than usual
Straining during the bowel movement
Belly bloating and nausea
Most of them feel the sensation that they didn’t evacuate completely
Hard or lumpy stools
Abdominal cramps
Stomach ache
Loss of appetite
Stools that cause tearing and bleeding to the anus part

What is Bristol stool scale?

It is a diagnostic tool that evaluates human stool health condition. It describes about size, shape, color, and consistency of stool. The scale was created in 1997 by a team of doctors at the British Royal Infirmary in Bristol, England. Since that it has been used as a diagnostic tool for gastrointestinal disorders

The seven types of stool are:


Type 1: separate hard lumps like nuts, difficult to pass
Type 2: Sausage-shaped, similar to type 1

Types 1 and 2 indicate constipation

Type 3: Sausage-shaped but with cracks on the surface
Type 4: Like a sausage or snake, smooth and soft

Types 3 and 4 being the ideal stools and they are easy to defecate

Type 5: Soft blobs and smooth with clear-cut edges

Type 5 tending towards diarrhea

Type 6: mushy stool, fluffy pieces with ragged edges Type
Type7: Watery, no solid pieces, entirely liquid

Types 6 and 7 indicate diarrhea.

Risk factors

Factors that may increase the risk of chronic constipation includes
Geriatrics (especially older adults)
Women in the gestation period
Women who have just given birth
People who have just undergone surgery

What are the cause and etiological factors for chronic constipation?

It occurs mainly due to Colorectal transit studies have been performed to study the movement of bowel through your colon using radiopaque markers and with scintigraphy methods.

The large intestine converts liquid waste into solid stool. Constipation occurs when the large intestine absorbs too much water from the stool with the result dry and hard stools are passed. It may also be due to inadequate contraction of bowel walls
to expel the stool and waste product. The cause of constipation is multifactorial. There also several other reasons which act together to worse constipation which are mentioned below

Inadequate fluid intake
Low content of fiber-rich food in the diet
Absence of physical activity or exercise
Eating more junk foods
Ignoring to urge to defecate
Consuming a lot of dairy products
Irritable bowel syndrome
Having mental health issues like depression and eating disorders
Aging, travel, and stress related conditions

Constipation due to endocrine disorders

Hormones in our body help to balance the fluids. Diseases like diabetes, hyper and hypo parathyroidism and the pregnancy condition will lead the way to the imbalance of the hormones which may lead to constipation

Constipation due to Medications

Many drugs and therapy contribute to constipation issues which are the following:

Antacids drugs containing calcium or aluminium as an ingredient will worsen the constipation condition
Over usage of laxatives
Sometimes constipation occurs due to the adverse effect of the drugs like Opioid, Anti-Parkinsonian agents, Tricyclic Anti-Depressant, Anti-Cholinergics, Diuretics, Calcium channel blockers
Side effects due to oral iron supplements and anti-histamines.
Problems with the colon or rectum (Secondary to Diseases): Anal fissure, chronic renal failure, colon or rectal cancer, hypercalcemia etc.

How to diagnose constipation

Diagnosis is done to find out the cause of constipation by asking the patients about individual symptoms, family and medical history and their regular habits. Based on your answers, physical exam and medical tests are carried out by healthcare professionals.Physicians are likely to question about your symptoms, such as

How many times do you have a bowel movement in a week?
How long the symptoms are?
How do your stools look like?
Do you look red streaks in your stools?
Are there streaks of blood on your toilet paper when you wipe?

Physicians will ask about your medical history, such as

Have you undergone any surgery to your digestive tract?
Do you have recently lost or gained weight?
Do you have a history of anemia?

Physicians will ask about daily routine activities, such as

What are your eating habits?
What is your level of physical activity?
What medicines, including supplements, and complementary and alternative medicines, do you take?

Physicians will prescribe the medication to improve the symptoms to patients. If the problem persists they will undergo the blood test, urine test, stool test. Endoscopy is performed to find out the underlying reason for constipation through using colonoscopy, flexible sigmoidoscopy techniques. Colorectal transit studies have been performed to study the movement of bowel through your colon using radiopaque markers and with scintigraphy methods

Other problems of constipation are diagnosed through imaging test like lower gastrointestinal series, magnetic resonance imaging and through computed tomography methods.

How to prevent constipation
Drinking 8-10 glasses of water daily or can take fluids in the form of juice, soup, milk, or tea
Eating well balanced diet at a scheduled time to promote normal bowel function.
Taking warm water in empty stomach in early morning
Adding lots of fruits of vegetables in the diet
Consuming bran cereal, prunes, legumes, grains, etc.
Regular exercise
Managing stress
Toddlers who begin to eat solid food need to get plenty amount of fiber in their food


Constipation is not a life-threatening disease or disorder. However, chronic constipation can develop into more serious complication which includes

Rectal bleeding after continually straining to pass stools
Anal fissure, or a small tear around the anus
Hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum

How to treat chronic constipation?

Most often the acute constipation is successfully treated by our bodies own self-healing capability. But in worst cases, it may develop into a chronic condition where it only can be treated by medication. Most the practitioners prescribe laxatives and
steroid containing ointment for treating constipation and its associated problems. But taking medication have a lot of side effects and discomfort to the patients. Drinking enough liquids and adding addition fiber increase the bowel movement activity. High fiber diet, not only relieve from constipation it also lower the cholesterol level, and reduced the developing of colon polyps and colon cancer. A change in lifestyle like fixing a specific time for bowel movement may be helpful. In worsening cases, surgery is needed to treat constipation.

Below we discussed few disadvantages of allopathic drugs like laxatives and steroids.


Most of the laxatives are used for stool softening and easy bowel movement. But overuse of laxatives will provide the route to dependency and slower the bowel functionality which leads to many other complications like bloody stools, cramps in stomach,dizziness, rectal bleeding etc.… other risk factors are stimulant laxatives cannot be given to pregnant women’s, most of the laxatives will interact with food and other medication will cause more adverse effects to patients.

Topical steroids

Most of the steroidal ointments are prescribed for temporary relief from itching, swelling, caused by anal fissure and hemorrhoids. In worst cases, the long terms of use of steroids and local anesthetics cause a structural change of skin, numbness in anus area etc… Switching to natural fiber: Dietary fiber is called as edible part of plant source. Fiber is present in all type of plant based food items, vegetables, nuts, legumes, grains. Though some persons cannot be taken in the form of food can switch to formula based fiber to reduce and relief from severe constipation.