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Address:#09-09 Gleneagles
Medical Centre 6 Napier Rd.
Singapore 258499
Phone:+65 6476 0181 
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What is Constipation?
Constipation is defined medically as less than 3 bowel movements per week. This is often confused with a related condition called dys-synergic defaecation, which refers to the need for excessive abdominal straining to defaecate even when the person can have a daily bowel movement.
However, many people who can have a bowel movement every two to three days still complain of abdominal bloating, cramps and hard stools which are difficult to evacuate. In my view, this is quite common and can be treated similar to patients with constipation.
A person with constipation may feel bloated from a distended abdomen or even intermittent abdominal cramping pain. If the constipation is severe, the sufferer may even develop a loss of appetite. While these people often have very hard stools, this is not a universal finding. People suffering from constipation often have to strain hard at bowel movement and may develop secondary problems such as bleeding from haemorrhoids or anal pain from anal fissures.
When should you see a doctor to evaluate the cause of constipation?
If you have infrequent bowel movement but do not have any symptoms from it, there is no urgency to seek medical advice. However, if the constipation is of recent or sudden onset, a medical consult would be needed. If you have abdominal or anal pain, bloating or anal bleeding, you should seek medical advice soon.
How is constipation evaluated?
A detailed history of your diet, daily schedule, lifestyle (including exercise habits) and medications is required. Occasionally, an abdominal x-ray may be required to determine the severity of your constipation.  Blood tests are often used to rule out other medical conditions which may present as constipation. If your doctor suspects a growth or cancer in the colon, he may recommend a colonoscopy. When all secondary causes of constipation have been ruled out, your doctor may request a colonic transit marker study.
What are the common causes of constipation?
Most patients with constipation have primary constipation (functional constipation) where no secondary causes can be found. The second group is secondary constipation, where the constipation is caused by use of medication or part of the presentation of another medical condition such as hypothyroidism.
There is a third group, congenital constipation. This involves infants who are born with constipation. These infants may have been born with fewer nerves in their bowels which do not allow the colon to function normally. An example of this category is Hirschsprung's disease.
What is a colonic transit marker study?
This is a simple outpatient test where you are asked to swallow a capsule containing 24 plastic markers. An abdominal x-ray is taken five days later and the location (as well as number) of retained markers are recorded. This test helps to identify the most severe cases of constipation which may require surgery.
Is my constipation treatable?
Nobody needs to suffer from constipation and it is very treatable. The aim of treatment is to relieve symptoms that the patient have. You do not need to have a bowel movement daily so long as you are not suffering any symptoms from constipation. Treatment involves modifications to your diet and lifestyle. Medications (such as laxatives) may be helpful to maintain a regular bowel habit.
In some patients, anorectal biofeedback (a form of pelvic floor rehabilitation physiotherapy) can provide dramatic improvement especially for patients with constipation and dys-synergic defaecation simultaneously. Surgery is rarely required except for the most severe cases.
Does constipation lead to cancer?
Constipation is not associated with an increased risk of cancer. However, as the incidence of constipation is high among the average population, it is not uncommon to find a patient with colorectal cancer who has a preceding history of long-standing constipation.
A note of caution must be mentioned for patients with sudden onset constipation. If you develop constipation over a few days to a few weeks but had normal bowel habits previously, you should see your doctor soonest to make sure you are not having a colorectal cancer causing partial bowel obstruction. In patients with partial bowel obstruction, they complain of abdominal distension and cramps relieved by passing bowel movement. They also have less stools passing through the narrowed part of the bowel hence fewer bowel movements (constipation).
Does taking laxatives regularly lead to dependence or worsening constipation?
Laxatives used at the prescribed dosages by your doctor are very safe. They are used to help constipated patients contract the bowel wall harder to push the stools toward the rectum and anus. Some laxatives also soften or liquefy hard stools so that it is easier to pass the stools. Please remember that laxatives are prescribed for patients with constipation or dys-synergic defaecation and not for people with normal bowel movements.
The term "laxative abuse" was coined a long time ago and refers to patients with normal bowel habits who take laxatives for reasons other than to regulate their (already) normal bowel habits. Examples of laxative abusers are anorexics and Munchausen Syndrome sufferers (people who fake an illness to get attention).
If you have to take laxatives to improve your constipation (and it works), you do not need to fear that you will develop worsening constipation in the future. A very good analogy is medication for patients with hypertension. Patients with mild hypertension are often advised to modify their diet and lifestyle first. If that does not work, medications (anti-hypertensive drugs) are started, usually a single low-dose medication at first. With time, some patients may need increasing doses of their anti-hypertensive drugs or a second drug in order to achieve good blood pressure control. Yet, nobody fears that the hypertension worsens if we prescribe even more drugs. The situation is very similar in managing constipation.
If you have feedback or would like to know more about treatment for these conditions, feel free to contact us or make an appointment.