Constipation – Diagnosis and Treatment

Diagnosis

Blood and Other Lab Examinations

Doctors often run lab tests to figure out what’s behind constipation. They might check your blood for low thyroid hormone, diabetes, or high calcium—these can sometimes lead to chronic constipation.

Sometimes, they’ll also look at urine or stool samples, especially if you’ve got signs of infection, blood in your stool, or something else seems off with your bowels. These results point the way for more testing or treatment.

Common lab tests:

Test Name	Purpose
CBC	Checks for anemia or infection
Thyroid panel	Evaluates thyroid hormone levels
Blood glucose	Looks for signs of diabetes
Calcium levels	Identifies metabolic or kidney issues

Internal Visualization Procedures

Sometimes, doctors need to get a direct look inside the colon and rectum. They use colonoscopy and sigmoidoscopy—basically, flexible tubes with cameras—to see the lining of your large intestine.

These tools help spot things like blockages, odd tissue, polyps, or even cancer.

• Colonoscopy: Looks at the whole colon. Doctors usually do this if symptoms are severe, if there’s blood in your stool, or if you’re over 45 and haven’t had one before.
• Sigmoidoscopy: Focuses on the rectum and sigmoid colon, especially when problems seem lower down.

Before these procedures, you’ll need to clear out your bowels. That might mean fasting, using laxatives, or getting enemas.

Common findings:

• Bleeding
• Inflammation
• Tumors or polyps
• Structural changes

Imaging and Structural Scans

Doctors use imaging scans to spot colon problems that you can’t see from the outside. A plain abdominal X-ray, for example, shows where stool is stuck and can reveal a bowel blockage.

CT scans or MRIs give a more detailed look. These help doctors find structural issues or other diseases that slow down your gut, like fecal impaction or slow-transit constipation.

Types of imaging:

• Abdominal X-ray: Shows stool buildup, blockages, or unusual gas.
• Barium Enema (Lower GI Series): Outlines the colon’s shape, highlights narrowing or twisting.
• CT Scan/MRI: Gives detailed pictures of pelvic organs and colon.

Studies of Bowel Movement Speed

Doctors sometimes want to know how fast things move through your colon. These tests sort constipation into normal, slow-transit, or defecation-related types.

• Radiopaque Marker Test: You swallow tiny markers, and X-rays track them for a few days.
• Scintigraphy: You eat a radioactive meal, and doctors watch how food and waste travel through your gut.

Key points recorded:

• How many days until markers leave your body
• Where stool is delayed (left, right, or all over)
• If the whole colon or just a part is slow

These tests help with:

• Chronic idiopathic constipation
• Telling slow from normal colon transit
• Understanding functional constipation

Evaluation of Rectal and Anal Function

Some folks with constipation can’t coordinate the muscles for going to the bathroom—a problem called pelvic floor dyssynergia.

To check this:

• Anorectal Manometry: A slim tube with sensors measures muscle pressure and coordination.
• Balloon Expulsion Test: A small water balloon goes in the rectum, and you try to push it out. The time it takes is measured.
• DeFecography: Doctors place a thick paste (visible on X-ray or MRI) in the rectum, then watch how you pass it. This shows how your rectum and anus work.

These tests help diagnose:

• Defecation disorders
• Muscle coordination problems
• Structural issues that affect bowel habits and quality of life

When doctors combine these tests, they can put together a personalized plan and help improve life for those struggling with constant constipation.

Treatment

Healthy Eating and Lifestyle Habits

Most people start by tweaking habits and diet. Eating more fiber—think fruits, veggies, beans, whole grains—adds bulk and moisture to stool, making it easier to pass.

Fiber also helps stool move through the colon at a better pace. Aim for 25 to 34 grams daily, but bump it up slowly so you don’t get gassy or bloated.

Habit	Benefit
Eat more fiber	Adds stool bulk, eases passage
Drink plenty of water	Softens stool, prevents hardening
Exercise regularly	Boosts colon movement
Don’t ignore the urge	Encourages regularity
Eat prunes	Natural laxative effect

Drinking plenty of water matters too. Hydration softens stool and keeps things moving. Go for water or drinks without caffeine or alcohol, since those can dry you out.

Physical activity helps a lot. Walking or other exercise most days gets food and stool moving through your system.

Stick to a regular bathroom schedule and don’t ignore the urge to go. That helps set good habits. Prunes can be a handy natural fix—they’re high in fiber and draw water into your colon.

Over-the-Counter Medicines to Help You Go

Laxatives can help loosen stool and move it along if diet and habits aren’t cutting it. You can find several types at any pharmacy.

Types of Laxatives

Laxative Type	Main Action
Fiber Supplements	Add bulk and fluids to stool
Osmotics	Increase water in colon
Stimulants	Trigger bowel muscles to contract
Lubricants	Grease the stools for easy passage
Softeners	Draw fluids into the stool

1. Bulk-Forming Agents: These are fiber supplements like psyllium and calcium polycarbophil. They soak up fluid and add weight to stool, making it softer and easier to pass.

2. Osmotic Laxatives: Medicines like polyethylene glycol and magnesium citrate pull water into the colon, which helps stool move out.

3. Stimulant laxatives: Bisacodyl and sennosides get your intestines to contract, pushing stool along.

4. Lubricants: Mineral oil coats stool, so it slides out more easily.

5. Stool Softeners: Docusate sodium and docusate calcium draw water into stool, making it less hard.

Using Enemas and Suppositories

If nothing else works, enemas or suppositories might be worth a try. An enema gently pumps liquid into your rectum to soften and loosen stuck stool. People usually use water, soapy water, or mineral oil for enemas.

A suppository is a small medicine-filled object you place in the rectum. It melts and releases medicine—could be a stimulant, osmotic, or lubricant—to get things moving.

Types of Enema Fluids

• Tap water
• Soapy water
• Mineral oil

Suppository Uses

• Stimulant to trigger muscles
• Osmotic to bring in water
• Lubricant to ease stool passage

Medical Prescriptions for Constipation

If over-the-counter stuff isn’t enough, your doctor might prescribe medicine.
Options like chloride channel activators, guanylate cyclase-C agonists, or selective serotonin (5-HT4) receptor agonists work in different ways to bring water into the colon or speed things up.

People dealing with constipation from opioid pain meds may need a special prescription. Medicines like peripheral opioid receptor antagonists block opioids’ effects on the gut, making bowel movements easier.

Pelvic Floor Muscle Training and Biofeedback

If you have trouble using the right pelvic muscles to go, therapies like biofeedback can really help. A trained therapist runs these sessions, using sensors and a feedback device to show how your muscles are working.

With practice, you can learn to relax and coordinate your pelvic, rectal, and anal muscles for normal bowel movements. These sessions can make a big difference for people with chronic constipation or issues like dyssynergic defecation.

Biofeedback Therapy Steps:

• Sensors go on your skin or inside the rectum.
• The device shows if your muscles are tightening or relaxing.
• The therapist coaches you through exercises while you watch the feedback.
• Over time, you’ll get better muscle control and easier stool passage.

Surgical Solutions

If nothing else fixes the problem, surgery might be the last resort. Doctors save surgery for serious cases—like physical blockages, tissue damage, or nerve and muscle issues in the colon or rectum that just won’t budge.

Some surgeries remove part of the colon, others fix muscle problems. This option is only for severe constipation that doesn’t improve with less invasive treatments.

Getting Ready for Your Doctor Visit

Steps You Can Take Before the Appointment

Being prepared can really help you get more from your visit. Here are a few things to try:

• Find Out About Any Special Instructions: Ask if you need to fast or avoid certain foods before your appointment.

• List Your Symptoms: Write down everything you’re feeling—abdominal pain, nausea, vomiting, weight loss, or blood in the stool. Note how long symptoms last and if they come and go.

• Record Personal and Family Details: Jot down any life changes, like travel, stress, pregnancy, or new habits. Make a list of any digestive issues in your family, like cancer, IBS, or hemorrhoids.

• Make a Medication Table

Medication/Supplement	Dose	Purpose
Example: Opioids	10 mg daily	Pain management
Example: Anticholinergics	5 mg daily	Overactive bladder

List all medications, supplements, and vitamins you’re taking. Many drugs, including opioids and anticholinergics, can cause constipation.

• Bring a Support Person
  Think about asking a friend or family member to come along. They can help remember details or ask about things like fecal incontinence, rectal prolapse, or functional GI disorders.

• Write Down Questions to Ask
  Prepare your questions so you get the most out of your visit:
  • What’s likely causing my constipation?
  • Could something like hypothyroidism, diabetes, or Parkinson’s play a role?
  • What tests do I need? How should I get ready?
  • Does my age put me at risk? What about constipation in children or older adults?
  • Are treatments based on current guidelines?
  • What if the first treatment doesn’t work?
  • Should I change my diet or routine?

What Your Doctor Will Discuss

Your doctor will ask questions to understand your situation better. Expect to talk about:

• Symptom Details
  • When did your constipation start?
  • How often and how severe are the symptoms?
  • Any anal fissures, hemorrhoids, or rectal prolapse?
  • Any abdominal pain, nausea, vomiting, or weight loss you didn’t plan for?
• Stool and Bowel Habits
  • Any blood in your stool, on toilet paper, or in the toilet?
  • Do you need to strain?
  • Any loss of control or leakage (fecal incontinence)?
• Lifestyle and Diet
  • How many meals do you eat each day?
  • How much water and other drinks do you have?
  • Do certain foods make symptoms better or worse?
• Medical and Family History
  • Have you been diagnosed with other medical issues like GI disorders, hypothyroidism, or neurological diseases?
  • Any family history of colon cancer or similar problems?
  • Have you started new meds or changed doses recently?

Tip: If you’ve had chronic symptoms or have risk factors for constipation—like being older, taking certain meds, or having specific health conditions—be sure to mention them.

By organizing this info, you’ll help your doctor get a clearer picture and plan any needed exams or tests. This approach boosts your chances of finding the right treatment for both adults and kids dealing with constipation.