Why have I had severe constipation and bloating for months?

Question

Hi doctor,

I am a 28-year-old female. For the past eight to nine months, I have been experiencing severe constipation. I only pass stool about twice a week, and it is often very hard and painful. I have to strain a lot, and at times it feels like my stool is stuck but not fully coming out.

I experience bloating almost daily, especially in the evening, and my stomach often looks like I am five months pregnant. While I do not see blood in my stool, I occasionally feel pain from small fissures.

I was advised that I might have IBS-C. I have been taking Isabgol powder at night and sometimes using Lactulose (15 ml), but the relief is only temporary.

I am curious why this issue continues despite drinking enough water. Is this condition something I will have to deal with for a long time? Could you please explain what causes IBS-C and whether a colonoscopy is necessary in my case, as I am feeling quite anxious?

Please help me.

Answer 1

Hi,

Welcome to icliniq.com.

I am deeply concerned about your worries.

Your symptoms strongly suggest irritable bowel syndrome with constipation predominance (IBS-C). In this condition, the intestine appears structurally normal, but its movement (motility) and sensitivity are altered.

The colon may move stool more slowly, allowing more water to be absorbed. This results in hard, dry stools that are difficult to pass, leading to infrequent bowel movements, straining, the sensation that stool is stuck, and bloating.

Even if you drink enough water, constipation can persist because the main issues are slow bowel movements and increased gut sensitivity, rather than dehydration alone. Bloating often intensifies in the evening as gas accumulates in the intestine throughout the day.

You are already using Lactulose and fiber supplements, such as isabgol (psyllium), which are commonly recommended treatments. However, some patients may require dose adjustments, daily use, or additional medications to improve bowel motility if fiber alone is insufficient.

IBS-C is typically a chronic condition, but it is manageable. Symptoms may vary based on diet, stress, hormones, and gut bacteria. Helpful strategies include gradually increasing soluble fiber intake, engaging in regular physical activity, maintaining consistent meal timing, and managing stress.

Regarding colonoscopy, at 28 years, and without any red-flag symptoms (such as blood in the stool, significant weight loss, anemia, or a family history of colon cancer), a colonoscopy is usually not needed immediately. Doctors only consider it when warning signs are present.

The pain from anal fissures is likely due to hard stools, and improving stool consistency can help them heal. With appropriate adjustments in treatment and lifestyle changes, most patients achieve good symptom control and more regular bowel habits.

I hope this helps address your query. Kindly revert with the answers.

Thank you.