What to Do When Nothing Works for Chronic Constipation
You may need to talk with your doctor about prescription medications or other treatments, such as pelvic floor therapy, biofeedback, or surgery.
The occasional bout of constipation happens to everyone at some point. Often the cause is obvious: traveling and being out of your normal routine, eating too much cheese, or possibly both. When in Rome, eh? But when constipation is a regular (no pun intended) occurrence and has no known cause, it’s called chronic idiopathic constipation (CIC).
Symptoms of CIC can last for months or longer. You may experience periods of abdominal pain, cramping, bloating, gas, passing hard and lumpy stools, feeling like you have to poo even though you just went or tried and couldn’t, and more. In other words, it’s no picnic, and it can greatly affect your quality of life.
Some lifestyle strategies may help you find relief, including:
- boosting your fiber intake
- drinking more water
- exercising
- taking over-the-counter (OTC) meds
But in some cases, lifestyle changes and OTC medications might not be enough to get — and keep — things moving. You may need further treatment, such as prescription medications, biofeedback, or a medical procedure.
Up to 17% of people in the world have CIC, making it one of the most common gastrointestinal disorders. In some people, CIC is considered refractory, which means it doesn’t resolve with first-line treatment options such as lifestyle changes or OTC laxatives. That’s when you might need more treatment.
Refractory CIC happens most commonly in people who have certain subtypes of CIC.
One of those subtypes is dyssynergic defecation, which happens when your pelvic floor nerves and muscles don’t coordinate or communicate correctly.
Some people with CIC have slow transit constipation, which involves colonic motility dysfunction. This means stool moves too slowly through your colon, leading to constipation.
If you have CIC, you may have tried all the usual go-tos for constipation relief. Are you getting enough daily fiber? Check. Are you drinking enough water each day? Check. Are you getting the recommended amount of exercise? Check. So what’s next?
One of the first recommended OTC treatment options for CIC is to take an osmotic laxative. Osmotic laxatives pull water into stool, helping poo pass.
Another option is to take a bulk-forming laxative, which is a soluble fiber supplement that adds volume and softness to stool to help cause a bowel movement. Sometimes you may need a stimulant laxative, which causes muscle contractions in your intestines to help move stool.
Keep in mind that some laxatives may be intended for only occasional or short-term use. And laxatives may simply not be enough to relieve CIC.
If you find that you’re relying on OTC laxatives often or that they aren’t working for you, talk with your doctor. They can find out whether your constipation has an underlying cause or diagnose your CIC subtype and help you find better options for relief.
Your doctor might also review any medications you take for underlying conditions to see whether those drugs have constipation as a side effect. Switching to a medication that doesn’t cause this side effect may be an option for you.
Prescription medications, such as secretagogues, can help rescue you from the discomforts and inconveniences of CIC when OTC options aren’t working.
Secretagogues get their name because they are substances that cause the secretion of another substance. In the case of CIC, secretagogues work by increasing intestinal fluid secretion, which can help produce a bowel movement. Secretagogues prescribed to treat CIC include:
- linaclotide (Linzess)
- lubiprostone (Amitiza)
- plecanatide (Trulance)
Your doctor may also prescribe prucalopride (Motegrity), a serotonin receptor agonist that works by helping stool move through your colon.
Medications aren’t the only option for crushing CIC. Your doctor can talk through all the possible treatments for your unique situation, but here are a few that might be options.
Pelvic floor rehabilitation
Pelvic floor rehabilitation is a noninvasive technique that helps the nerves and muscles of your pelvic floor better coordinate and communicate. This can help with dyssynergic defecation. Pelvic floor rehabilitation may be an option if you have a diagnosis of pelvic floor dysfunction.
For this treatment, you’ll likely need to see a physical therapist who is specially trained to address pelvic floor dysfunction.
Biofeedback
Biofeedback is a technique that involves learning how to manage bodily functions that are typically involuntary. It’s often used along with pelvic floor rehabilitation to treat pelvic floor dysfunction.
Biofeedback can help healthcare professionals find out what bodily behaviors are present along with your constipation, such as involuntary clenching (rather than relaxing) of your anal sphincter during a bowel movement. They can then teach you how to counteract the involuntary behavior.
Sacral nerve stimulation
This minimally invasive procedure involves stimulating the nerves of your rectum. It can heighten your body’s signals of needing to go.
Transanal irrigation
Transanal irrigation is the process of introducing water to your colon via your anus. The water helps empty your rectosigmoid colon, relieving constipation.
Surgery
Invasive surgical procedures are rarely necessary to treat CIC. But if you have an anatomical issue that’s leading to bowel obstruction, you may need surgery to remove the obstruction.
The usual treatments for temporary constipation, such as lifestyle strategies and OTC laxatives, may not work to treat CIC, which is an ongoing issue without a known cause. In some cases, you might need your doctor’s help to find additional treatments that can relieve your constipation.
