Constipation is one of the unfortunately all-too-common medical conditions that affects virtually everyone at some point. While usually not a serious condition, being constipated can nevertheless be an uncomfortable experience. This is even more true when the constipation becomes chronic and ongoing; trips to the bathroom become futile exercises in waiting for your body to return to normal. What a lot of people don’t realize, however, is that chronic constipation tends to affect women more often than men.  

How Does the Digestive System Work?

At a basic level, constipation is a function of the digestive process functioning abnormally. When everything is working properly, food that has been chewed and swallowed enters the stomach. This mass of chewed food, known as a bolus, is further broken down via digestive juices and peristalsis, a series of contractions in the stomach muscles. The resulting semi-liquid substance, called chyme, enters the small intestine, where it is exposed to additional intestinal juices as it winds its way through. It is during this time in the small intestine when the majority of nutrients are extracted from the chyme and absorbed into the bloodstream. 

Any remaining solids or liquids then enter the large intestine (often referred to interchangeably as the colon). This remaining waste includes indigestible bits of food, damaged cellular material, and a lot of fluids. Indeed, one of the main jobs of the colon is to absorb water from waste materials. As the waste gradually makes its way through the colon (also via peristalsis by the muscles in the colon wall), water is absorbed and solid stool begins to form. By the time the stool reaches the sigmoid colon—the final segment before the rectum—it should be solid and firm and passable without straining. 

What is Chronic Constipation? 

It’s when dysfunction in the process described above arises that constipation becomes a problem. Constipation is defined as having fewer than three bowel movements in a week or having generally difficult bowel movements. In addition to there being many potential underlying causes of constipation, it can also simply be a symptom of more complex gastrointestinal disorders like irritable bowel syndrome (IBS), hypercalcemia, or inflammatory bowel disease (IBD). It can also be a symptom of a neurological disorder like Parkinson’s disease, multiple sclerosis, or dyssynergia. 

Having occasionally infrequent bowel movements is sometimes also known as acute constipation. Chronic constipation, on the other hand, is usually defined as having the same kind of bowel irregularity, but over weeks or months. By some estimates, over 15% of the population of the United States suffers or has suffered from chronic constipation. Because there aren’t easily identifiable biological markers for this condition, diagnosis is often based on a subjective perception of bowel regularity or other symptoms of chronic constipation (abdominal pain, bloating, etc.). Thus it can be difficult to clearly diagnose it as a separate condition.  

Common Causes of Constipation

Apart from situations where the constipation is a symptom of a larger problem, there are some common causes that doctors have identified. Many of these causes can be treated or managed, but they also represent a number of dietary and lifestyle changes that can directly impact colonic transit time. Over time, if these habits remain unchanged, acute constipation can become chronic constipation. Below are some examples of possible causes: 

  • Low Fiber: Dietary fiber is a crucial element in terms of digestive health. Fiber isn’t actually digestible in the same way as other food components, so it remains partially intact all throughout the digestive tract. Once in the colon, fiber contributes to forming softer and more consistent stools. If you don’t consume enough fiber, though, stools become hard and make defecation much more difficult and uncomfortable.
  • Not Enough Water: Water intake is similarly important for healthy digestion because of the way water interacts with the formation of stools. Drinking insufficient amounts of water can also cause stools to be hard and dry, leading again to low motility and potential constipation.
  • Insufficient Exercise: Physical activity is important for overall health, but it’s also a factor in bowel regularity. Exercise increases bowel motility, and that in turn limits the amount of water that can be absorbed by the colon. When less water is absorbed, stools end up being softer and more moist and are then easier to pass.  
  • Life Changes: Sometimes changes to our daily life habits can lead to constipation. Travel, stressful circumstances, or new eating habits can all have an impact on developing constipation. 
  • Resisting the Urge: Constipation can also be brought on by not defecating when the “urge” arises. Either because of lack of access to facilities or being very busy, ignoring the urge to go can keep stool sitting in the sigmoid colon too long. When this happens, water continues to be absorbed, leading to increasingly dry and hard stools that are difficult to pass. 

Why Are Women More Likely to Get Constipated?

As noted earlier, chronic constipation tends to be more common in women than men. By some estimates, it is more common in women by a 2-to-1 margin, and it also tends to increase in prevalence as people get older. It is still not fully understood why women are more susceptible, but it may be due to a variety of factors: different hormones, sociologically derived mental stress, or problems with straining too much during defecation because of pregnancy-related familiarity with the pelvic floor muscles. Also, beyond constipation, women are generally more likely to develop colon or rectal disorders like hemorrhoids or anal fissures.   

Treatment Options  

If the constipation isn’t due to a deeper, underlying condition (even if chronic), there are fortunately a number of treatment methods that can either relieve discomfort or avoid constipation in the first place. To diagnose your condition, the doctor may use an anorectal manometry test; also used to determine fecal incontinence, this test involves a catheter being inserted into the rectum to measure the strength of the anal sphincter muscles through biofeedback. The results of the test (or a balloon expulsion test) can help determine an appropriate treatment path. The following are some of the most common methods for treating or managing constipation: 

  • fiber supplements: if you find it difficult to incorporate regular dietary fiber into your diet, supplements like psyllium may help improve motility 
  • laxatives: over-the-counter laxatives (like Lubiprostone) can be a helpful temporary solution to constipation, but they can end up having the opposite effect if used too frequently 
  • enemas: an enema is an easy way to resolve a single instance of constipation by using water (sometimes with an additive) to soften stool that won’t pass
  • stool softeners 
  • suppositories 

Gastroenterologist Appointment   

Even though fields like gynecology and obstetrics are obviously focused on women, gastroenterology is another area of importance that can have a big impact on quality of life.  One of the main reasons for this is because women are more prone to develop gastrointestinal disorders than men. Because of this, Cary Gastro’s Women’s Center for GI Health is dedicated to providing high quality, compassionate health care for women. If you have been experiencing chronic constipation, it may be time to come see us for a physical examination. Contact us today to request an appointment!