Constipation

Background

Constipation is commonly seen in patients with urinary tract infections and pelvic floor dysfunction. Up to 30% of patients with pelvic floor problems will also have constipation

Defecation is a term used to describe having a bowel movement.

Causes

Constipation can occur for a number of reasons.

It can be the result of functional, slow transit or pelvic floor problems.

Diagnosis & Evaluation

How do you know if you are constipated?

There are criteria for defining constipation. The ROME III criteria define constipation as 2 or greater of the following:

  • straining during at least 25% of defecations

  • lumpy or hard stools in at least 25% of defections

  • sensation of incomplete evacuation in at least 25% of defections

  • sensation of anorectal obstruction or blockage in at least 25% of defecations

  • manual manoeuvres to facilitate defection in at least 25% of defecations

  • fewer than 3 defecations per week

Treatment

Managing constipation often is achieved by simple conservative measures that allows patients relief from constipation symptoms.

Conservative measures:

  1. Increasing exercise

  2. Utilizing a high fiber diet (25-30 grams per day)

  3. ensuring that you are emptying your bowel and bladder regularly through the day

  4. adequate water intake

It is important to note that the function of fibre is to bind and carry water. If fibre is added to an already constipated patient in absence of water, this can make the constipation worse. iF you are adding fibre to your diet to treat your constipation it is essential to be drinking at least 1 L of water per day.

A common dietary fibre supplement are Bran Buds. 1/3 cup provides 44% of daily fibre

Chia seeds are also a good source of fibre. 1 tablespoon has 15% of daily fibre 

Medication Options:

Often adding a medication to start the bowels working is helpful to treating constipation.

The medication with the best evidence is Polyethylene Glycol (PEG). Products that are PEG products are Restorolax or Miralax. These work by softening the stool by increasing the water content of the stool.

The usual dosage of PEG/Restorolax is 17 grams per day. It is often helpful to start at a lower dose and work up to a full adult dose as needed. Some common measurements for PEG are listed below

  • 1 tablespoon is approximately 15 grams

  • 1 capful is approximately 17 grams

  • 1 packet is 17 grams

  • 1 teaspoon is approximately 4 gram

Other products used for constipation management includes stimulants such as senna that increase the motility of the bowel or mineral oil products. However these are not as strongly recommended.

On the Web

General Urology Websites

Canadian Urological Association  Extensive library of downloadable pamphlets on a wide range of urological conditions

Cleveland Clinic

Mayo Clinic

Medline Plus Produced by the US National Institutes of Health with information on virtually every health topic and extensive list of links

UrologyHealth.org The patient information site of the American Urological Association.