Constipation (as a cause of pain)

Constipation is defined in many different ways: not moving your bowels often enough, hard bowel movements, having to strain often, or frequently feeling there’s still some left inside.  I don’t consider it a problem unless it bothers a person.  Nobody has to have a bowel movement every day; 3 times a week can be normal.  But if moving the bowels hurts, or is uncomfortable, that’s not good.

I almost never attribute recent abdominal pain to constipation, unless the pain only occurs together with a need to move the bowels, or during a bowel movement.  The only time I might, would be if a patient developed new constipation, then began to feel discomfort (not real pain) in the left lower abdomen, and as time went on the discomfort became more bothersome, but felt better whenever they moved their bowels.  Such a situation is not common.

Otherwise, it’s too easy to say, “Oh, you always have constipation, now you have pain, that must be the cause.”  Quite the opposite; if there’s always constipation, a new pain is likely to be something else.  If constipation causes any symptoms, it’s usually chronic on-and-off discomfort.

The worst case of constipation is fecal impaction — stool that’s permanently stuck in the rectum and needs to be removed by enema and often by hand (i.e. by finger).  This almost only occurs in the elderly and debilitated, or persons with chronic spinal cord diseases or neurologic conditions.  Fecal impaction may actually cause “diarrhea,” which leaks out around the impacted stool.  It’s also a cause of mental changes in the very old.

If constipation did begin recently, & pain followed the pattern just mentioned, then it’s important not to just treat it, but to figure out why it began.  Constipation can be caused by:

We take a history for life-style changes and new medications.ย  Maybe we order a few basic lab tests.ย  Treatment obviously depends on the cause, although basic measures are quite helpful like increasing fiber, drinking more fluids, and increasing exercise.

See Irritable Bowel Syndrome for its own specific criteria for diagnosis.ย  See Constipation for our approach to the symptom in general.

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