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Types of Constipation

Let’s talk about your bowel movements

Ladies, today we have to get comfortable with a taboo topic… In the best interest of your health, we have to talk about bowel movements.

Take a moment to cringe and sigh, but get it all out. This is an important topic, and knowing more about it is going to help you to figure out what might be going on in your own body, and thus be able to take appropriate steps of action to solve the issue.

Let’s start, shall we…

When you just can’t “go”

When your belly feels swollen and gassy and you’re struggling to “go”, you suspect that there’s a bit of a backup in your system. Believe it or not, the prevalence of constipation worldwide is estimated to affect around 18% of adults, with an increase to 34% in those who are older than 601. One study, however, conducted across Europe and Oceania, showed that in some population groups, its as high at 80%!2

That’s a lot of people, which is why we need to talk about it.

There are a number of reasons you may become constipated. It can be as a result of diet, genetic predispositions, the motility of your colon, how you absorb food, your daily behaviors or as a result of a disease3. Each of these would indicate a different plan of action. What you also need to consider is the type of constipation you may have.

Yes! There are different types of constipation. Constipation is divided up into a primary or functional category and a secondary category. The functional category is the most common, and indicates that the problem lies within the digestive system itself.

Primary or functional constipation

This functional category is further divided into three subtypes. They are:

1. Slow-transit constipation4.

The cause of this type of constipation is exactly what the name suggests: your waste is simply not moving through the digestive system quickly enough and it results in a number of unpleasant symptoms of bloating, gas and sometimes abdominal pain. This is the type of constipation most common in young women, but, according to the site, WebMD, doctors aren’t sure why5.

Signs of this type of constipation include:

  • Having little urge to use the bathroom
  • Having a bowel movement only once a week
  • Needing to pass hard or dried stools when you do go
  • Being bloated often, with pain and pressure in the belly

The treatment approach for this type of constipation is typically behavioral as a means to control the nerve dysfunction associated with the cause. A therapy called biofeedback is used to do this6. On occasion, surgery may be recommended7.

2. Outlet constipation (also known as pelvic-floor dysfunction or defecation disorder)8.

When there is a problem with the muscular ring that makes up the anus, it can lead to outlet constipation. Either the muscle contracts too much, which makes it difficult to move waste through the opening, or, there may be messages being sent that stop the muscle from relaxing when you’re ready to go.

In this case, you may feel like you need to go, but when you do, it’s difficult and it may be painful.

Some of the signs of this type of constipation include:

  • Being on the toilet for more time than necessary, training and pushing to eliminate your bowel movements
  • Your constipation is not relieved by laxative use or by increasing your fibre intake
  • Hemorroids or any other signs of anal injury

This type of constipation is usually treated with behavioral modification and relaxation techniques that target smooth muscle relaxation.

3. Normal-transit constipation9.

This is the most common type of constipation. None of the factors from the above two types are involved in the cause. Your bowel signals are working as they should, pushing the food and waste towards elimination, and your anal muscle is responsive to the messages when the time comes.

The trouble here is that the stool itself is not as it should be. Either there is not enough bulk-forming fibre in the content of the stool, or there is too little moisture to allow the bulk to form. This results in stool that is broken up into pieces, which has a more pebble-like consistency, hardened and more difficult to pass.

The treatment for this type of constipation is lifestyle modification. The diet is the primary target of the treatment, which includes adding more fibre-rich fruit, vegetables and grains to your meals, eating smaller, more regular meals, and drinking more water10,11.

These are all primary causes of constipation, which means there is also a category for the secondary causes of constipation.

Secondary constipation

This type of constipation is caused by an imbalance in another body system, which has an impact on bowel movements.

Can you think of one of the most common secondary causes of digestive upsets?

Stress. That’s right! Often, you’d associate stress with increased bowel movements and diarrhea, but it can also cause constipation12. When your body is in flight or fight mode, which is the response to a stressful stimulus, there is little need for digestive processes to take place. The body prioritizes blood flow to the working organs and muscles to cope with the stress, namely the brain, heart, lungs and skeletal muscles, which may cause slow transit of food and thus waste through the colon.

Diseases and conditions like hypothyroidism (too little thyroid hormone being produced), Parkinson’s disease, multiple sclerosis, celiac disease and colon cancer are just some of the secondary conditions that interfere with digestive processes13.
No matter what the cause of your constipation, if it’s affecting your quality of life and impacting your health, it’s essential to seek medical attention. It may be uncomfortable or you may feel embarrassed about it, but the medical professionals that deal with these conditions see people suffering with them every day. They are there to help you to determine what’s going wrong, and then implement a plan of action to put it right.

References:

  1. Frootan, M., et al. Chronic constipation. Medicine (Baltimore). 2018 May; 97(20): e10631.
  2. Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011 Oct; 25 Suppl B():11B-15B.
  3. Tack J., et al. Diagnosis and treatment of chronic constipation–a European perspective. Neurogastroenterol Motil. 2011 Aug; 23(8):697-710.
  4. Jamshed N, Lee ZE, Olden KW. Diagnostic approach to chronic constipation in adults. American family physician. Aug 1 2011;84(3):299-306.
  5. WebMD. What is Functional Constipation? Crohn’s Complications.Digestive Disorders.
  6. Chiarioni, G, Salandini, L, Whithead, WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005; 129: 86–97.
  7. Tsimogiannis, K.E., Karlbom, U., Lundin, E. et al. Long-term outcome after segmental colonic resection for slow transit constipation. Int J Colorectal Dis (2019) 34: 1013.
  8. Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based review. J Am Board Fam Med. Jul-Aug 2011;24(4):436-451.
  9. Andromanakos NP, Pinis SI, Kostakis AI. Chronic severe constipation: current pathophysiological aspects, new diagnostic approaches, and therapeutic options. European journal of gastroenterology & hepatology. Mar 2015;27(3):204-214.
  10. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011 Sep; 106(9):1582-91; quiz 1581, 1592.
  11. Markland, AD, Palsson, O, Goode, PS. Association of low dietary intake of fiber and liquids with constipation: Evidence from the national health and nutrition examination survey. Am J Gastroenterol 2013; 108: 796–803.
  12. Roa, S., et al. Diagnosis and management of chronic constipation in adults. Nature Reviews Gastroenterology & Hepatology volume 13, pages 295–305 (2016).
  13. Volta U, Villanacci V. Celiac disease: diagnostic criteria in progress. Cellular & molecular immunology. Mar 2011;8(2):96-102.

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