Constipation occurs when bowel movements become less frequent and stools become difficult to pass. It happens most often due to changes in diet or routine, or due to inadequate intake of fiber. You should call your doctor if you have severe pain, blood in your stools, or constipation that lasts longer than three weeks.
Dr. Daniel Ngui, BSc, (P.T.), MD, CFPC, FCFP, Family Physician, discusses diagnosing and treating constipation.
David Israel, BSc, MD, FRCPC, discusses constipation.
Diagnosing and Treating Constipation
Constipation is a big problem that patients just don’t want to talk about with their doctor.
It’s often embarrassing and they just don’t know how to bring it up. Based on some new studies on patient self-reporting, the prevalence of chronic constipation can be anywhere from 10-20 percent. Chronic constipation is a challenging problem because it affects one’s quality of life. It can cause emotions such as frustration, anxiety, embarrassment and stress. I think that chronic constipation definitely is important to speak about with your family doctor.
As patients and as doctors, we can often define the normal spectrum of normal bowel movements. Many times, we think normal is three spontaneous, complete bowel movements per week. But according to the American College of Gastroenterology, chronic constipation is defined as unsatisfactory defecation characterized by infrequent stools, difficult passage of stools, or both.
Patients often think about difficult bowel movements as being straining, having hard, lumpy bowel movements. Trying very hard or having a difficult time passing the bowel movement and also spending an exorbitant amount of time trying to have a bowel movement.
When you see your family doctor and talk about chronic constipation, it’s important that you don’t feel shy or embarrassed. It’s important that you bring up your history, as your family doctor will do their best to find out what’s going on.
When you see your family doctor, what they’ll do is talk to you about your history. What medical conditions you have, what medications you’re taking that can affect you. They are going to look for red flags or danger signs. The red flags can include weight loss, anemia, pain, problems with blood in the stool, or even new symptomatology that occurs in patients over 50 years of age.
These are all red flags that your family doctor will be listening to. During the visit, they’ll ask you about your family history of colon cancer or any inflammatory bowel diseases. During your visit, there may be a physical exam examining the abdomen or doing a rectal exam and they will offer you some tests. These tests will include blood tests to check for anemia, your thyroid, but also may include a referral for colonoscopy if there is a concern.
It’s important when you speak to your family doctor about treatment options for chronic constipation that they provide education about fluid and fibre. It has to be adequate combined with exercise to allow the body to deal with this naturally. Luckily, we have many over-the-counter products that can help with chronic constipation.
If there’s an adequate trial, and if you’ve tried your best as a patient and it’s not working, don’t be afraid to speak to your doctor because besides over-the-counters, there are prescription medications – prokinetic agents that can help you. It’s important you speak to your family doctor about treatment options for chronic constipation.
Presenter: Dr. Daniel Ngui, Family Doctor, Vancouver, BC
Local Practitioners: Family Doctor