Colonic Conditions That May Cause Constipation
1. Diverticular disease (diverticulosis) is a condition with pouches (diverticles) in the colonic wall, usually caused by repeating straining at defecation. Diverticles are often in lower part of the descending colon (in left lower abdomen), but may occur in any part of the colon. Symptoms may include:
- Often there is no symptoms
- Lower left abdomen my be bloated and tender to touch
- Left lower abdominal pain, fever and diarrhea when diverticles become inflamed (diverticulitis)
In severe chronic constipation, surgical removal of the affected part of the colon may be needed.
2. Crohn’s disease and ulcerative colitis are chronic inflammatory diseases, most often diagnosed in young people. Constipation may be caused by large polyps in the colon and by medications. Main symptoms include:
- Nausea, fatigue, low grade fever
- Diarrhea or constipation
- Abdominal pain
- Blood in the stool
Diagnosis can be confirmed by a colonoscopy, during which colonic and rectal ulcers or polyps may be found. Treatment is with anti-inflammatory drugs, but sometimes surgery is required.
3. Colonic strictures are bands of scar tissue within the colon that may remain after chronic inflammation or infection of the colon and may impede the passage of the stool. Strictures can be often resolved during colonoscopy.
4. Abdominal or pelvic adhesions, strands of scar-like tissue extending among abdominal organs, may develop after abdominal or pelvic surgery, pelvic inflammatory disease, endometriosis or other abdominal conditions, and may impede the passage of the stool through the colon. CT or MRI does not always show adhesions, so a laparsoscopy (endoscopy of abdominal cavity) may be required.
5. Colon polyps of any cause and colorectal cancer usually cause constipation only in advance stages. Chronic constipation is not a risk for developing a colon cancer. Diagnosis is made by colonoscopy; treatment is surgical.
6. Megacolon is a distended colon, which slows down the passage of the stool; main causes include:
- Diverticulosis (see above)
- Ulcerative colitis
- Pseudomembranous colitis caused by overgrowth of Clostridium difficile bacteria.
- In Chagas disease, occurring mostly in both Americas, a parasite Tripanosoma cruzi, transmitted by certain bugs, destroys nerves in the colonic wall, resulting in its distension. Treatment is with anti-parasite drug benznidazole, but sometimes a surgical removal of the colon is required. Megacolon may also develop as a complication of ulcerative or pseudomembranous colitis.
- Congenital disorders of the colon:
- Hirschsprung’s disease, an inborn abnormality of innervation of the last part of the colon. A disorder usually needs some time to develop fully, so constipation may occur in childhood or in early adulthood.
- Volvulus (twisting) of the colon
Here are some other disorders that may cause bowel obstruction.
7. Lazy colon is an unresponsive colon, usually resulting from long-term laxative abuse or long-term treatment with opiates or other painkillers. Treatment is with stopping laxatives, emptying the colon with enema guided by a doctor and then introducing a high fiber diet and active life style.
8. Rectal or anal pain caused by infection or inflammation, thrombosed hemorrhoids, anal fissure (tear), abscess or a foreign object may discourage the affected person to defecate.
You can check for other causes of constipation.
Article reviewed by Dr. Greg. Last updated on May 6, 2011