Chronic vs. acute constipation
The main difference between chronic and acute constipation is how long the constipation lasts.
In general, acute or short-term constipation is:
- infrequent, lasting only a few days
- brought on by a change in diet or routine,
travel, lack of exercise, illness, or a medication
- relieved by over-the-counter (OTC) laxatives, exercise, or a high-fiber diet
On the other hand, chronic constipation is:
- long-term, lasting for more than three months
and sometimes even continuing for years
- disruptive to a person’s personal or work life
- not relieved by a change in diet or exercise, so requires medical attention or prescription medications
Who is at risk for chronic constipation
Constipation is one of the most common chronic gastrointestinal disorders in adults. In the United States, more than 2.5 million people visit their doctor each year for constipation. Annually, Americans spend nearly $800 million on laxatives to treat constipation.
The following people are at a higher risk of experiencing chronic constipation:
- females
- people over the age of 65
- people who don’t engage in physical activity or
are confined to bed due to a physical disability such as a spinal cord injury
- women who are pregnant
Causes of chronic constipation
While poor diet and lack of exercise can lead to short-term tummy troubles, chronic constipation can be caused by other health conditions and medications, including:
- pelvic floor dysfunction, which may make it
difficult to coordinate muscle contractions in the rectum
- endocrine or metabolic problems, such as diabetes
and hypothyroidism
- neurologic problems, including multiple
sclerosis, Parkinson’s disease, spinal cord injury, and stroke
- tears in the anus and rectum
- narrowing of the colon (bowel stricture)
- mental health problems, such as depression,
eating disorders, and anxiety
- bowel diseases, such as Crohn’s disease, colon
cancer, diverticulosis, and irritable bowel syndrome
- physical disabilities that lead to immobility
Chronic constipation can also be caused by taking a prescription or OTC medication for another health condition. Some medications that can cause chronic constipation include:
- opiates
- calcium channel blockers
- anticholinergic agents
- tricyclic antidepressants
- Parkinson’s disease medications
- sympathomimetics
- antipsychotics
- diuretics
- antacids, especially antacids high in calcium
- calcium supplements
- iron supplements
- anti-diarrheal agents
- antihistamines
It isn’t always known what causes chronic constipation. Chronic constipation that happens for unknown reasons is called chronic idiopathic constipation (CIC).
Diagnostic criteria for chronic constipation
What is considered a “normal” bowel movement can change depending on the person. For some, it may mean going three times a week or twice a day. For others, it may mean going every day. There really isn’t a standard or perfect number for bowel movements.
Because of this, doctors have tried to put together a list of criteria to help them diagnose chronic constipation. The Rome IV diagnostic criteria for functional constipation require that symptoms must include two or more of the following:
- fewer than three spontaneous bowel movements per week
- lumpy or hard stools at least 25 percent of the time
- a sensation of incomplete evacuation for at least 25 percent of bowel movements
- a sensation of obstruction or blockage for at least 25 percent of bowel movements
- manual maneuvers (like using your fingers) to help at least 25 percent of bowel movements
The main criterion for chronic constipation, however, is that the symptoms have persisted for more than three months.
Diagnostic tests
Your doctor will ask you questions about your symptoms, medical history, and medications (prescription, OTC, and supplements) you’re taking. If you’ve been experiencing symptoms of constipation for more than three months and meet the other diagnostic criteria for chronic constipation, your doctor may want to perform a physical examination.
A physical examination may include blood tests and a rectal exam. A rectal exam means that your doctor will insert a gloved finger into your rectum to check for any blockages, tenderness, or blood.
Your doctor might want to do additional tests to identify the cause of your symptoms. These tests may include the following:
- Marker study (colorectal transit study): You ingest a pill that contains markers that will show up on an X-ray. Your doctor can see how food is moving through your intestines and how well the muscles of your intestines are working.
- Anorectal manometry: Your doctor inserts a tube with a balloon on the tip into your anus. The doctor inflates the balloon and slowly pulls it out. This allows your doctor to measure the tightness of the muscles around your anus and how well your rectum functions.
- Barium enema X-ray: A doctor inserts barium dye into your rectum using a tube. The barium highlights the rectum and large intestine, allowing the doctor to better view them on an X-ray.
- Colonoscopy: Your doctor examines your colon using a camera and a light attached to a flexible tube, called a colonoscope. This often involves a sedative and pain medication.
The takeaway
The main difference between chronic and short-term constipation is how long symptoms last. Unlike short-term constipation, chronic constipation can dominate a person’s work or social life.
Constipation lasting for more than three months that doesn’t get any better after eating more fiber, drinking water, and getting some exercise is considered chronic.
It’s important to visit a doctor for a more accurate diagnosis. A doctor will ask you questions about your bowel movements and use diagnostic tests to find out what’s causing your constipation. They can prescribe medications to help or may advise that you stop taking certain medications. If you have blood in your stool, unexplained weight loss, or severe pain with your bowel movements, see your doctor right away.
Diabetes and Constipation: What’s the Connection?
Constipation is a common complication in people with diabetes. Living with diabetes means paying careful attention to all systems of your body. Some complications of diabetes are easily avoided or managed with proper blood sugar control. Depending on the type of diabetes, medication may be required to manage blood sugars and to protect the heart, kidney, brain, and other organs affected by diabetes.
When it comes to managing constipation, though, diet and lifestyle changes may not be enough. Here’s what to know about why is occurs more often in people with diabetes and what you can do about it.
What causes diabetes constipation?
Damage to the nervous system is a known long-term complication of diabetes. High blood sugar levels from type 1 and type 2 diabetes can lead to diabetic neuropathy, or nerve damage. Damage to the nerves controlling the digestive tract can lead to constipation, diarrhea, and incontinence.
Poor blood sugar control over a long period of time may increase the likelihood and frequency of constipation.
In addition to lifestyle choices and neuropathy, people with diabetes sometimes take medications that can slow gut mobility and cause constipation. Talk to your doctor about the side effects of any medications you take.
Treating constipation
Natural options
Simple solutions are the best place to start. Try increasing your fiber intake, drinking more water, and getting more regular physical activity. All of these can help the digestive system function more smoothly.
While starting with natural solutions for constipation may prove helpful, people with diabetes could find that these solutions do little good if there are bigger underlying problems.
Laxatives
Laxatives may also provide relief, but you should use them carefully. Before moving on to laxatives as a potential treatment, consult with your doctor. Some laxatives are not intended for long-term use.
Your doctor may be able to find the least intensive treatment to ease your bowel movements. They may have you try:
- osmotic laxatives
- stool softeners
- bulk-forming laxatives
Blood sugar management
In many cases, proper blood sugar management is the best solution for regulating digestion and constipation in diabetes. It prevents nerve damage that can lead to constipation, no matter your diet or activity level.
The takeaway
While constipation can be a sign of poor long-term diabetes management, it could also be due to something as simple as not getting enough fiber. By moving from the simplest to the most intensive solutions with the help of your doctor, you may find that your constipation can be managed with lifestyle changes and without the need for medication.
Treatment for severe constipation
Severe constipation that doesn’t respond to dietary changes or traditional laxatives from the use of a laxative stimulant. If you find that you can’t pass a bowel movement without taking laxatives, talk with a doctor.
Biofeedback therapy may provide another option. This therapy may help you retrain the colon muscles to produce regular bowel movements.
Sometimes, severe constipation may be linked to an underlying medical condition that requires surgery, although this is typically considered a last resort. Examples include surgeries to correct a rectal prolapse or blockage or to remove the colon.
Lifestyle changes that can help you poop
The above advice can help encourage a quick bowel movement to relieve short-term discomfort. However, some of the following lifestyle changes can also keep your constipation at bay more permanently. For regularity, try to make these tips part of your daily habit:
- If possible, add more fiber to your diet. Add fiber by eating fresh fruits and vegetables, legumes, beans, and whole grains. You should consume at least 22 to 34 grams of fiber per day, depending on your age. If you need to take a fiber supplement for chronic constipation, start with a low dose and then increase it slowly. For some people, consuming a large amount of fiber can lead to bloating.
- Consider exercising most days of the week if you can. This can include a daily walk, jog, bike ride, or swim or another form of exercise. Light exercise helps maintain proper circulation and can keep the bowels healthy.
- Consume plenty of liquids (mostly water and other clear liquids) every day. Aim for at least eight 8-ounce glasses of clear liquids per day.
- Manage your stress.
- Avoid “holding in” your stool. Also try to have bowel movements around the same time each day.
Talk to Your Doctor
Keep your doctor updated about your diabetes symptoms. They may recommend you eat smaller meals more often to help your digestion.
Get your doctor's OK before you try laxatives. Some contain a lot of sugar, which can be dangerous with diabetes. Laxatives can make other digestive symptoms worse, like bloating. And not all of them are meant to be used long-term.
Also, ask your doctor whether any drugs you're taking might be making your constipation worse, and whether there's an alternative.
Sources:
https://www.healthline.com/health/diabetes/constipation-and-diabetes#takeaway
https://www.healthline.com/health/cic/what-does-it-mean#Chronic-vs.-acute-constipation
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Prepared by Viktorija Stučytė based on online sources