Functional Constipation

WHAT IS FUNCTIONAL CONSTIPATION?

Constipation can occur to people across all age groups. One in four Canadians experiences some degree of constipation. Functional constipation is a bowel disorder causing symptoms of difficult, infrequent, or incomplete clearing of bowel movements without any organic or physical cause. Abdominal pain and bloating may be present, but they are not the main symptoms.

For the most part, stools are dry, hard, and lumpy. The Bristol Stool Form Scale is used to assess bowel forms, and types 1 to 2 are the typical patterns seen with constipation.

It is normal for some people to have a bowel movement every 2-3 days. Stool patterns may change depending on what you eat and your fluid intake. Keeping a Stool Diary for 7 days to track your bowel movements is helpful and will give your healthcare provider some insight during your visit.

Bristol Stool Scale

RISK FACTORS

female sex
reduced caloric intake
increasing age

DIAGNOSIS

Your healthcare provider will take a detailed history of your symptoms, complete a physical examination, and review the medications you are currently taking. There are medications that may cause constipation (for example: iron supplements and pain medications) and it is important to review if any of these medications can be changed or stopped. There are also medical conditions that can increase your chances of having constipation, such as diabetes, kidney disease, and neurologic conditions.

Functional constipation is diagnosed if you have 2 or more of the following symptoms:

Straining during more than 25% of bowel movements
Lumpy or hard stools more than 25% of bowel movements
Sensation of incomplete clearance of bowel movements more than 25% of bowel movements
Sensation of blockage in the rectum and/or anus more than 25% of bowel movements
Manual removal of stools (for example: using fingers or support of the pelvic floor muscles) more than 25% of bowel movements
Having less than 3 bowel movements per week without the use of laxatives
Rare episodes of loose stools, unless after using a laxative
Does not meet criteria for Irritable Bowel Syndrome (IBS)*
* see section on Irritable Bowel Syndrome

ALARM OR CONCERNING FEATURES

There are concerning features NOT typical for functional constipation and may signal other serious health problems. See your healthcare provider or seek immediate medical attention if you experience any of the following symptoms:

Blood in your stools or black, tarry stools
Excessive and unintentional weight loss
Fever
Persistent abdominal pain that does not resolve with having a bowel movement and wakes you throughout the night
Persistent nausea and vomiting

TREATMENT

Making a few changes to your daily routine is the first step in managing functional constipation.

Always speak with your healthcare provider before trying any treatment to see if it is right for you and to review potential harmful effects. The following recommendations are general guidelines for the treatment of constipation and may not be suitable for everyone.

Lifestyle Changes:

Increase dietary fiber (soluble and insoluble fibers)

Fiber comes in two forms known as soluble and insoluble. Soluble fibers can easily melt or dissolve in water. Insoluble fibers do not melt or dissolve in water.

Insoluble fibers are mostly found in fruits and vegetables and are not easily broken down by the digestive system. Insoluble fiber helps move your stool to make them easier to pass.

Examples of insoluble fibers: skins on fruits and vegetables, legumes (for example: lentils), nuts, seeds, and whole grain products like, cereals, whole grain breads, and brown rice.

Soluble fibers may come in supplement forms and can also be found in some foods. They draw water in the large intestine (colon) to make stools easier to pass. Some forms can cause bloating and excessive gas. It is important to start with small amounts and increasing the dose as tolerated.
Examples of soluble fibers: psyllium (Metamucil®), inulin (Benefibre®), guar gum (Fiber4®), oats, beans, peas, barley, citrus fruits, carrots

Generally, women need 25 grams of fiber per day and men need 38 grams of fiber per day. It was found that, on average, Canadians only consume half or less than the recommended amount*.

* Source: https://www.canada.ca/en/health-canada/services/nutrients/fibre.html

Foods with Laxative Effects

Prunes, kiwis, pineapples, and papayas have natural digestive enzymes and laxative effects and have known to help manage constipation.

Adequate Fluid Intake

Unless you have a health condition that limits the amount of fluid intake, aim to drink about 2 litres of water or fluids a day. It is good for your health and can enhance the effectiveness of dietary or supplemental fiber.

Increase Physical Activity

Exercise has been shown to help increase the transit time of your gut and can help alleviate symptoms of constipation. If you are new to exercising, consult your healthcare provider prior to starting a new exercise routine.

In a week, aim to be active 2.5 hours. Focus on moderate to vigorous aerobic activities throughout the week and breaking them into sessions of 10 minutes or more. Every bit counts and it’s not necessary to commit a huge amount of time.

TIPS:

Take the stairs instead of the elevator
Get off 1 bus stop before your destination and walk the remainder of the way
Ride your bike to work
Go for a walk during your lunch break

Try participating in different activities you enjoy to keep things interesting. For example, try doing a brisk walk one day, riding a bike or stationary bike the next day, and swimming another day. Variation keeps you engaged and makes the activities more fun.

Make Time to Use the Toilet

Just as you would schedule time for a meeting or set aside a part of your day to finish a task, it is also important to make time to use the toilet. Consistency is the key to making it a part of your daily routine. For example, you may plan to wake up a bit earlier, have your breakfast, and make time to use the toilet.

Place a stool on the floor at the base of the toilet to elevate your knees above your hips can also help decrease straining and improve emptying.

If lifestyle changes are not enough to ease your constipation, your healthcare provider may recommend adding medications in addition to your lifestyle changes.

Medications

Laxatives are medications that can help you have a bowel movement. They come in various forms, work in different ways, and can either be purchased over-the-counter (without prescription) or prescribed by your healthcare provider.

Always use laxatives with caution and consult your healthcare provider before starting any medications. Medications do not replace the importance of lifestyle changes.

Osmotic Laxatives

Draws water into the intestine that helps soften stools and makes it easier to pass.

Examples: polyethylene glycol (Restoralax, Lax-A-Day), magnesium citrate, lactulose

Stimulant Laxatives

Increases the muscle contraction of the intestines to push stool along.

Examples: bisacodyl (Dulcolax), senna

Secretagogues

Prokinetic

Enhances chloride secretion that helps draw water long. This helps soften stools and makes it easier to pass.

Examples: linaclotide (Constella), plecanatide (Trulance)

Helps to increase the force and contractions of the intestines to help push stool along.

Example: prucalopride (Resotran)