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Lower GI

Chronic Constipation

Chronic constipation is more than just infrequent stools — it includes straining, hard stools, incomplete evacuation, and impact on daily life. It has multiple causes and effective, individualized treatments.

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Symptoms

  • Fewer than 3 bowel movements per week
  • Straining, hard or lumpy stools
  • Sensation of incomplete evacuation or blockage
  • Abdominal discomfort and bloating

Possible causes

  • Slow-transit constipation
  • Pelvic floor dysfunction / dyssynergic defecation
  • Medication-induced (opioids, anticholinergics, iron, calcium)
  • Endocrine/metabolic (hypothyroidism, diabetes) or neurologic causes

How we diagnose

  • History and rectal examination
  • Lab and thyroid evaluation when indicated
  • Anorectal manometry and transit studies in refractory cases
  • Colonoscopy if red-flag features are present

Treatment options

  • Fiber and hydration optimization
  • Osmotic and stimulant laxatives titrated to response
  • Secretagogues (linaclotide, plecanatide) for select patients
  • Pelvic floor physical therapy for dyssynergia

Lifestyle & prevention

  • Regular toileting routine (usually 20–30 minutes after meals)
  • Adequate soluble fiber (psyllium)
  • Movement and hydration