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Health Protocols


Signs and Symptoms

The symptoms of constipation are its defining characteristics: infrequent stools, often fewer than three per week, and difficulty passing them (Basilisco 2013). People with constipation may also report abdominal bloating and discomfort, hard or lumpy stools that require straining to pass, or a sensation that there is a blockage or some other problem preventing complete emptying of the bowels (UMMC 2013a; Jamshed 2011; Mayo Clinic 2013a). Delirium, anorexia, and general functional decline may be associated with chronic constipation in the frail elderly (Jamshed 2011). Hemorrhoids, which are swollen, inflamed veins in the anal or rectal region, may occur as a result of constipation. Hemorrhoids can cause itching, bleeding, and a sensation of swelling around the anus (NIDDK 2013; Mayo Clinic 2013b).

Other complications of chronic constipation include:

  • Anal fissures are small tears in the delicate lining of the anus (Mayo Clinic 2012).
  • Rectocele is a bulging of the rectum toward the vaginal wall (Mayo Clinic 2014b).
  • Rectal prolapse is a collapse and telescoping of the rectum through the anal canal (UMMC 2015b; MUSC 2015).
  • Fecal impaction occurs when a mass of dry, hard stool becomes lodged in the rectum, usually in individuals who have been constipated for an extended period of time (UMMC 2015a).
  • Fecal incontinence is involuntary passage of stool associated with chronic constipation. It can occur due to general anorectal muscular weakness as a result of chronic constipation, laxative use, severe hemorrhoids, rectal prolapse, or fecal impaction (UMMC 2014).
  • Acquired megacolon is an extremely enlarged colon that can result from prolonged severe constipation and that may require surgical treatment. Acquired megacolon occurs due to weakness and collapse of chronically stretched walls of the colon (Vieira 1996; Sparberg 1990; Pereira 1987).
  • Bowel perforation as a result of constipation is a very rare medical emergency that can cause the bowel contents to enter the abdomen (Leung, Riutta 2011; NLM 2014a).