I have been constipated for 4 months. How can I manage it?

Question

Hello doctor,

I have been dealing with chronic constipation for the past four months, passing stools only once every four to five days, and they are quite hard despite drinking plenty of water. My thyroid test (TSH 1.8) and calcium levels are normal, but my ultrasound showed mild fatty liver.

Could this be related? I have tried fiber supplements and laxatives, but the relief is only temporary. I have a few concerns, like:

Should I consider prescription medications such as prucalopride or lubiprostone?
Could there be an underlying motility disorder or irritable bowel syndrome with constipation (IBS-C) that requires testing?
Would you recommend a colonoscopy at this stage, or are there other less invasive tests I should start with?

Please help.

Thank you in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Chronic constipation is a common condition and can have several contributing factors, including diet, lifestyle habits, and bowel motility (how well the intestines move food along).

Fatty liver: The mild fatty liver noted on ultrasound is unlikely to be the direct cause of constipation. However, both conditions may share similar risk factors, such as low physical activity or an imbalanced diet.
Medications: If lifestyle changes and over-the-counter measures are not sufficient, prescription medications such as prucalopride (a drug that stimulates bowel movement) or lubiprostone (a medication that increases fluid in the intestines to soften stools) can be considered. These medicines should only be started under the guidance of a gastroenterologist (a stomach and intestine specialist) and after excluding secondary causes of constipation.
Further evaluation: Before moving on to colonoscopy (a test in which a camera is used to look inside the large intestine), less invasive tests can be helpful. These include stool occult blood test (to check for hidden blood in the stool), stool calprotectin (to look for intestinal inflammation), and sometimes a plain abdominal X-ray (to check stool loading in the intestines). Colonoscopy is generally recommended only if there are red-flag symptoms such as blood in the stool, unexplained weight loss, severe abdominal pain, or a family history of bowel cancer.

Irritable bowel syndrome with constipation (IBS-C) or motility disorder: It is possible that a functional bowel disorder, such as IBS-C (a condition in which the bowel is overly sensitive and moves slowly, leading to constipation and bloating), is contributing to the problem. A gastroenterologist may suggest additional motility studies (specialized tests that measure how the intestines contract and move food) if needed.

Lifestyle measures: Along with adequate hydration, it is important to maintain a high-fiber diet, engage in regular physical activity, and establish a fixed daily bowel routine. Sometimes, osmotic laxatives (medications that draw water into the intestines to soften stools, such as polyethylene glycol) are safer and more suitable for long-term use compared to stimulant laxatives (medications that force the bowel to contract, such as senna or bisacodyl).

I recommend consultation with a gastroenterologist for a tailored treatment plan and to discuss whether advanced medications are necessary. Meanwhile, please avoid starting strong prescription drugs on your own without medical supervision.

Follow-up: Please follow up after three days with any updates on your bowel movement pattern, test results (if available), and response to lifestyle measures.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.