Incidence
Constipation is very common, affecting about 1 in 3 women. Constipation can cause several problems including infrequent bowel movements, hard bowel movements, and the need to strain during bowel movements. Sometimes with certain types of constipation, women will need to press on the perineum (the area between the vagina and the anus) or on the back vaginal wall to help pass the bowel movement.
Constipation can occur for several reasons:
- Dietary problems – The most common reason for constipation is not having enough fiber in your diet. Some foods, especially foods high in starch such as white rice, pasta, or white bread are more likely to lead to constipation. It is important to drink enough fluids to keep the stools soft. When there is not enough fiber or water in your diet, the bowel movements are more likely to be hard or irregular.
- Pelvic floor disorders – Rectoceles and other forms of prolapse can sometimes lead to problems with bowel movements. Women who are unable to relax the pelvic floor muscles can also have problems passing bowel movements. This type of problem is more likely to cause problems moving the bowels than problems with irregularity or hard bowel movements. In turn, chronic constipation can cause pelvic floor disorders.
- Medical conditions – Constipation can also occur as a result of abnormal nerve function, usually causing severe irregularity. This can occur by itself or from certain medical conditions such as irritable bowel, thyroid disorders, or neurological conditions such as diabetes or spinal cord injuries, etc. that affect the function of the nerves in the intestines. These types of conditions usually will cause irregularity or hard stools. Many medications lead to constipation as a side effect.
- Intestinal blockage – Rarely, constipation can be caused by blockage from colon cancer, other tumors, or scar tissue from prior infections or surgeries. In this case, the constipation usually continues to get worse until the problem is treated.
Evaluation
Your primary care doctor, OB-GYN, urogynecologist, gastroenterologist, or colorectal surgeon can evaluate constipation. The evaluation should always begin with discussion of the symptoms and physical examination. Other tests that are sometimes necessary include:
- Colonoscopy – Colonoscopy is a procedure done with anesthesia using a scope to examine the colon. This is done to investigate possible blockage of the intestines from cancer or other masses. All women over age 50 should undergo regular colon cancer screening. The best form of colon cancer screening, particularly in women, is colonoscopy. This is recommended beginning at age 50, and then every ten years if the results are normal, more often if polyps are discovered. Other forms of colon cancer screening include sigmoidoscopy, barium enema, and testing of the stool for blood.
- Barium enema – This is an x-ray study that can be used to look for masses that block the intestines.
- CT scan – This is an x-ray study that can be used to look at the intestines or surrounding tissues for causes of constipation such as masses within or around the intestines.
- Nerve testing – These studies are sometimes done to test the nerves in the rectum to check for abnormal sensation that can cause constipation.
- Anal Manometry – This is done to check for normal or abnormal relaxation of the pelvic floor muscles.