Constipation is a common condition, affecting people of all ages. While the symptoms of constipation can impact your quality of life, it is often easy enough to manage at home. However, in some cases, constipation can present severe symptoms or health risks that require medical intervention and in some cases emergency treatment.
In this article, we will explore the causes and symptoms of constipation before answering the question: when is constipation an emergency? In addition, we will cover a range of common treatments for more severe cases of constipation.
What is constipation?
Constipation is usually defined by the following factors:
- Bowel movements happen less than three times a week
- Difficulty passing stools often accompanied by straining
- Hard, lumpy or dry stools
The Bristol Stool Chart, also known as the Bristol Stool Scale, is a common medical reference for classifying types of stool. Typically type 1 and type 2 on the Bristol Stool Chart would be considered constipation.
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What causes constipation?
After your body has digested the nutrients from the food that you eat, the remaining undigested food begins to move through your colon. Here water is absorbed, creating the stool. The longer the stool remains in your colon, the more water is absorbed and the harder the stool becomes. If it remains too long it can become hard and difficult to pass.
On this basis several common lifestyle factors can cause constipation:
- Diet – foods that are rich in fibre help to soften your stool making it easy to pass. So, a low fibre diet can result in harder stools.
- Dehydration – if you are not drinking enough fluids, then your body will try to absorb even more water from food waste causing harder stools.
- Lack of movement or exercise – movement can help to reduce the time it takes for stool to move through your digestive system. So, a lack of activity can result in more water being absorbed by the colon, making stool harder to pass.
- Ignoring the urge to go to the toilet – while it’s not always possible to use the toilet when you feel the urge, regularly holding bowel movements can lead to constipation.
- Medication – constipation can also be a side effect of several medicines.
In addition to these lifestyle factors, constipation can also result from other underlying conditions:
- Conditions affecting the nervous system such as multiple sclerosis, spina bifida and spinal cord injuries can impact control of the colon and increase the likelihood of constipation.
- Constipation is one of many symptoms typically linked with irritable bowel syndrome (IBS) and other functional bowel disorders.
- Certain hormone conditions such as diabetes or hypothyroidism
- Damage or defects in the digestive tract or pelvic floor muscles.
- Sometimes cancer, as well as certain cancer treatments, can increase the risk of constipation
- Many women also report experiencing constipation during pregnancy.
Types of constipation
It is very common to experience occasional constipation, as described earlier. It is estimated that between 2-28% of the population experience occasional symptoms of constipation. Women also report experiencing constipation as much as ten times more frequently than men. ii
If the difficulty with passing stool remains for more than three months, or you pass less than three stools in a week, this is referred to as Chronic Constipation. These prolonged effects can impact both health and quality of life, as the symptoms begin to interfere with daily life.
While occasional constipation can lead to the need for medical intervention, typically it is those experiencing chronic constipation who find themselves having to receive emergency treatment.
Chronic Constipation Symptoms
The symptoms of chronic constipation are similar to those of regular constipation, but other more serious symptoms can also occur. These include:
- Back pain due to the build-up of stools pressing on the nerves in your lower back
- A swollen tummy
- High or low blood pressure
- A fast heart rate
- A fever
- Feeling or being sick
- Abdominal pain
- Explosive diarrhoea
When is constipation an emergency?
While most constipation related issues resolve themselves with time, chronic constipation may require medical assistance. If you’ve had constipation related symptoms for more than three weeks, have severe stomach pain or spot blood in your stool, you should speak with your doctor.
Without treatment, chronic constipation may also result in the following complications:
- Haemorrhoids (swollen veins around your anus)
- Anal Fissures (tears in your skin)
- Rectal Prolapse (Straining can cause a small amount of the rectum to stretch and protrude from the anus)
- Faecal Impaction
Faecal impaction is a large build-up of dry, hard stool in the back passage (rectum) that is too hard to push out. As a result, your bowel may begin leaking out watery stools, which can soil your underwear and is referred to as overflow diarrhoea. If this happens, you should not take any anti-diarrhoea medication, as this may further harm the situation. If you experience severe constipation, followed by diarrhoea, speak with your doctor as further treatment may be required.
Wellspect lead nurse in the UK describes what may happen in the instance that you require emergency medical treatment for constipation:
If you come into the emergency room with severe constipation, the first step will be to understand how critical the situation is. So, you may also need an X-ray to see if you are impacted and, if so, how full your bowels are. If your bowels are especially full it might even be possible to see and feel the extent of the backup with an abdominal examination.
The clinician may then look at either a suppository or an enema to get things moving, this might be accompanied by some strong laxatives.
The topic of chronic constipation may seem embarrassing or awkward to talk about. However, it is important to speak openly and honestly with your doctor about it to receive the best care and treatment.
Mild to moderate cases of constipation can usually be treated and managed at home. Some recommendations to help relieve mild to moderate constipation include:
- Increasing your water intake
- Adding high-fibre foods to your diet
- Check your position on the toilet. Raising your feet and leaning back may help your bowel movements
- Over-the-counter fibre supplements or stool softeners (laxatives for constipation)
If you have tried managing your constipation at home to no effect or suffer from reoccurring chronic constipation, there are further treatments available. If you have faecal impaction, doctors will usually treat this with an enema, which helps to moisten and soften the stool. If this does not work, the stool may need to be physically removed by a trained nurse or doctor.
Prescription medications may be recommended if over-the-counter options don’t help your chronic constipation. These include stronger laxatives and medications that draw water into your intestines. Most medications are however not ideal for long-term use and may become less effective with time.
Surgery is rarely needed for constipation, but if you have a structural problem within your colon, surgery may however be recommended. If cancer is found in your colon, rectum or anus, surgery may also be required.
If you have an underlying health problem that is causing your constipation or if you have not found success with other treatments, bowel irrigation, also known as Transanal Irrigation (TAI) may be used.
TAI is a proven therapy for bowel management that uses only lukewarm water inserted through a rectal catheter to empty the bowel. The water stimulates the body’s peristaltic movement to evacuate stool and helps restore a well-functioning bowel. This gives control over time and place of when you visit the toilet and prevents constipation and accidents associated with overflow diarrhoea.
TAI is also minimally invasive and safe for long-term use. This is true where chronic constipation is related to conditions such as MS, Spinal Cord Injury or Spina Bifida. As well as where no underlying cause is found - functional bowel disorders and other treatments have failed. TAI is a prescribed therapy and can be prescribed to you by a healthcare professional.
Living with chronic constipation
It might feel embarrassing to speak about chronic constipation due to its nature and many try to hide their condition from family and friends. Often people aren’t aware of the difference between occasional constipation, which almost everyone will experience at some point in their life, and chronic constipation. This can lead to confusion when discussing the topic.
For someone who suffers from chronic constipation, it can impact their quality of life. It can be both mentally and physically draining, isolating due to fear of accidents and pain or discomfort.
While living with chronic constipation can be hard, there are ways to help make it more manageable.
Confiding in family or friends
You don’t need to suffer in silence, doing so can cause feelings of isolation and loneliness. If possible, sharing your symptoms with your closest friends or family can be helpful. They may find it hard to understand at first but explaining what you are experiencing and the impact on your daily life can help them to understand. It can also help make it easier for you and them to plan how to socialise together. It may help them understand why it is easier to do so in your own home or if out why it is important to be at a place where you have easy access to a toilet.
Carry a water bottle
Drinking enough water is an important part of a healthy bowel routine. By always carrying a water bottle with you, you are reminded to stay hydrated throughout the day.
Establish a routine
Changing your lifestyle and habits frequently can negatively impact your bowel movements. Eating your meals at irregular times and not sleeping enough can impact your body’s rhythm. Allocating time for regular meals, sleep and undisturbed time in the bathroom may help relieve stress and help regulate your bowel movements. It makes it easier for you to plan your life around and gives you more structure to manage your symptoms.
Depending on your underlying causes, TAI may be a solution for you. Regular irrigation of the bowel helps empty the colon and rectum effectively. This limits the risk of any accidents and gives you control to plan the time and place of your irrigations. Irrigating regularly with water prevents constipation and keeps your bowels clear.
TAI can take some time to learn and establish a routine. Once this is established the aim is often to irrigate every other day. TAI can help you to achieve a bowel routine and avoid constipation or accidents So you to spend less time worrying about bowel management and more time focusing on your life.
Interested in learning more about TAI?