Types of Constipation
1. Atonic Constipation
Atonic (Gk. atonos = unaccented, without tension) constipation results from reduced muscle tone (tension) of the colon, abdominal wall or pelvic floor. Causes include:
- Habits, like sedentary life style, irregular meals, low-fiber diet, postponing bowel movement, overuse of laxatives resulting in a lazy colon that does not react to stimuli, like eating and presence of the stool in the rectum. Affected person simply does not feel the urge to defecate even when his colon is full of stool.
- Loose rectal muscles, mainly in old people
- Weak pelvic floor muscles, often in women after giving birth
- Damage of the intestinal nerves in long-term, poorly controlled diabetes or congenital disorders, like Hirschsprung’s disease.
Change of life habits, or surgery (in Hirschsprung’s disease) can help.
2. Spastic Constipation
Spastic constipation results from colonic spasms, triggered by stress, certain foods or medications, and is known as constipation-dominant irritable bowel syndrome (IBS-C). Symptoms include constipation, abdominal cramps, bloating and occasional diarrhea. Low-FODMAP diet, fighting with stress, and changing medications (if possible) may help.
Certain neurological disorders can also cause spastic constipation.
3. Obstructive Constipation
Obstructive constipation results from obstruction of the passage of stool. Causes include cystic fibrosis (in children), tumors, adhesions - scars formed in the abdomen but outside of the intestine (mostly after abdominal surgery), or strictures – scars firmed within the intestine (mostly caused by inflammation, like in Crohn’s disease), or damaged pelvic nerves (injuries, neurological diseases) that prevent relaxation of anal muscles. Surgical treatment is often needed.
Causes of Constipation
Causes of constipation can be put in six groups:
- Inappropriate diet
- Ignoring the urge to have a bowel movement
1. Inappropriate Diet
Lack of dietary fiber, dry foods taken with insufficient fluid, skipped meals, dehydration, carbonated and energy drinks and alcohol, obesity and starvation are main dietary causes of constipation. Here are more foods that may cause constipation. Here you can check what can be appropriate diet to relieve constipation.
- People with celiac disease should avoid wheat, barley and rye and other foods containing gluten.
- If you think, you have irritable bowel syndrome, you might need to avoid fructose and lactose (foods to avoid in IBS).
Sedentary life style, sitting work, depression and aging may cause or aggravate constipation.
3. Ignoring the Urge to Have a Bowel Movement
Ignoring the urge to have a bowel movement may result in chronic constipation.
Not stress itself, but not being able to cope with stress may result in constipation. Work overload, changing or losing the job, problems in relationships (common in children), anxiousness, travel or pregnancy may all aggravate constipation. Combination of stress and certain foods may cause irritable bowel syndrome (IBS) in sensitive people.
5. Diseases and Conditions
Diseases and health conditions that may cause constipation:
- Any heavy injury acute or chronic disease, even cold or flu, or other painful conditions may be accompanied by constipation, which may be additionally aggravated by medications (mainly painkillers) and bed rest
- Painful anal conditions, like hemorrhoids or anal fissure
- Intestinal parasites
- Colonic disorders: diverticulosis, Crohn’s disease, megacolon
- Other abdominal conditions: peptic ulcer, gastritis, appendicitis, gallstones, urinary stones, liver diseases, salpingitis, endometriosis, abdominal or groin hernia, large abdominal tumors, bowel obstruction (including abdominal adhesions)
- Atherosclerosis of intestinal arteries
- Neurological disorders
- Disorders of nerves (peripheral neuropathy) in long-term diabetes or alcoholism
- Brain disorders: stroke, spinal injury, Parkinsosn’s disease, cerebral palsy
- Hormonal disorders, like hypothyroidism and hyperparathyroidism
- Diseases in lower chest, like myocardial infarction, pneumonia, pleuritis may cause spasm of the transverse colon.
- Other health conditions: pernicious anemia, porphyria, uremia, systemic lupus erythematosus (SLE), scleroderma, vitamin B deficiency, lead poisoning.
Lack of physical activity, changed diet, pain, and painkillers may all aggravate constipation in a disease.
Many medications, supplements and illegal drugs can cause constipation as a side effect:
- Antacids (tums)
- Calcium channel blocking drugs (in heart disease)
- Iron supplements
- Laxative abuse
- Opiates, like morphine or codeine, also heroine, most other painkillers
Constipation in Infants, Children, Adults and Elderly
Causes of constipation may vary a lot among age groups:
- Infant constipation is mainly caused by congenital disorders , formula feeding or introduction of solid foods
- In children, psychological factors are important; celiac disease is also not rare
- In adolescents, irritable bowel syndrome and Crohn’s disease are common
- In adults, constipation is mainly caused by inappropriate diet and stress
- In old people, inactivity, chronic diseases, medications and dehydration are main causes
Article reviewed by Dr. Greg. Last updated on September 9, 2012