Could pelvic floor issues be causing my constipation at 41?

Question

Hello doctor,

I am 41 and have been suffering from constipation for the past five months. My colonoscopy report was normal, but thyroid tests showed borderline TSH at 5.2.

I have tried increasing fiber and water, but I still have hard stools every three to four days. So my concerns are -

Are osmotic laxatives like Lactulose safe for long-term use?
Also, should I consider doing a motility study to see if slow transit is the cause?
Lastly, can pelvic floor dysfunction really contribute to constipation, and would biofeedback therapy actually help in such cases instead of just relying on medications?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is completely understandable to feel frustrated after months of dealing with this, especially when initial tests like the colonoscopy come back normal.

A TSH (thyroid-stimulating hormone) level of 5.2 is indeed in a borderline, or subclinical, range.

While it is not definitively diagnostic of hypothyroidism, it can absolutely be a contributing factor to your constipation, as thyroid hormone plays a key role in regulating our digestive motility.

I strongly recommend you discuss this result with your primary care physician or an endocrinologist. They may consider a trial of a low-dose thyroid hormone replacement to see if it helps not only with your digestion but also with any other potential symptoms like low energy or feeling cold. Treating this could be a crucial piece of the puzzle.

Osmotic laxatives are generally considered safe for long-term, supervised use. They work by drawing water into the colon to soften the stool, and they are not habit-forming in the way that stimulant laxatives can be.

They are a cornerstone of managing chronic functional constipation. The key is to use them under medical guidance to adjust the dose for comfort and effectiveness and to ensure adequate water intake.

Lactulose or similar agents (like Polyethylene glycol) are often a very reasonable and safe next step since increased fiber and water alone haven't provided sufficient relief.

Your insight here is absolutely correct. When basic measures fail and structural issues are ruled out, we must examine the functioning of the colon and pelvic floor.

I hope this helps.

Thank you and take care.

Regards.