Difficulty to evacuate is a very common disorder, which can be sporadic or a permanent condition. Professor Silvio Danese, Head of the Center for Chronic Intestinal Diseases at Humanitas, spoke in an interview with Corriere della Sera about what causes chronic and acute constipation. He also provided some tips on how to best prevent it.

“The simple fact of not evacuating every day does not mean that the person suffers from constipation, if this is done effortlessly and the stool is loose”, says Professor Danese. “In general, constipation occurs in the presence of fewer than three bowel movements a week, which are usually associated with straining during bowel movements, hard stools, or the feeling of incomplete evacuation“.


Causes of acute constipation

“It is necessary to distinguish between acute and chronic constipation. Sudden changes in bowel regularity can be caused by the onset of a drug therapy that may help on the resolution of another problem These may include antidepressants, anti-hypertensives or iron supplements. Alternatively, even a suddenly less frequent constipation may be the result of a structural alteration of the bowel in response to a stenosis, that is, a post inflammatory narrowing, which may even lead to occlusion”, explains Professor Danese.


Causes of chronic constipation

“On the other hand, the identification of possible causes of chronic constipation is more complex, and only a careful analysis of the patient’s history can put him on the right track. In some cases, chronic constipation is associated with reduced motility of the colon or a dysfunction of the pelvic muscles involved in stool evacuation. At other times, eating habits are incorrect with a particular reduced fiber intake. These fibers, especially the insoluble ones, determine the normal intestinal peristaltic conditions, promoting the progression of the fecal mass and its expulsion.

Chronic constipation may also be a consequence of careless use of laxatives, numerous diseases are associated with decreased gastrointestinal motility (hypothyroidism, Parkinson’s disease, systemic lupus erythematosus), as well as tumors of the colon and other abdominal organs that mechanically compress the bowel”, says Prof. Danese.


Tips to avoid chronic and acute constipation

“It is recommended that first you change your eating habits by increasing the consumption of dietary fiber to 20-35 grams per day. It is equally important to drink plenty of liquids as it helps to make the stool softer, facilitating the evacuation. If these measures are not enough, you can use laxatives to create the fecal mass, such as psyllium or methylcellulose. Other laxatives, which may be useful, are the osmotic types, such as polyethylene glycol. Recently, some new drugs, such as linaclotide and prucalopride, have been put on the market, but they must be taken under strict medical supervision. The first acts by promoting the secretion of water and chloride ions in the colon, the second stimulates intestinal peristalsis, when absent or inadequate”, concludes Professor Danese.