Chronic Constipation as a symptom of underlying diseases

The definition of Constipation based on international data

According to the American Society of Gastroenterology, constipation is defined as a combination of four factors. The first factor is related to the difficulty of emptying, when it is observed 1 in 4 times. The second is related to the frequency of bowel movements, the number of which may be two or less per week. Stool hardness combined with severe pain is the third factor, which is followed by a feeling of insufficient emptying.

Constipation is a very common phenomenon in Western societies. We have all been constipated at some point in our lives. It is usually occasional and does not foretell any serious danger, namely it is acute. The most common causes of acute constipation may include a low fiber diet or changes in our daily routine.


Chronic constipation as a symptom of underlying pathological conditions

There are more risks to our health when constipation is present for a long time. In this case, we are talking about chronic constipation, which can be expressed as a symptom of underlying pathological conditions.

This is a very common medical issue that needs thorough clinical investigation, as it may be the result of pathological diseases of the body or intestine, which prevent the smooth passage of feces through the intestine. By detecting the true cause(s) of constipation, an appropriate treatment can be proposed and individuals can be relieved.


Constipation in numbers

According to the National Health Survey, about 4.5 million people in the United States report having constipation most or all of the time. It is the most common gastrointestinal problem in the United States, with about $ 800 million spent on laxatives each year, while visits to doctors due to constipation amount to about 2 million per year. In Greece, at least 1 in 5 adults has experienced constipation, even once in their lifetime.

The association of Chronic constipation with various diseases

Chronic constipation, as mentioned earlier, can be associated with multiple health problems and it could be the result of an underlying disease. This claim is justified by the fact that these disorders contribute to the slowing of the movement of feces through the colon, rectum or anus. In this way, they may cause or worsen constipation.

Some of the most common medical conditions for which constipation is a symptom may be Hypothyroidism, Diabetes, Lupus, Scleroderma, Amyloidosis, Multiple Sclerosis, Dementia, spinal cord injuries, Adrenal insufficiency, Parkinson’s Disease and Inflammatory Bowel Disease.

In fact, Irritable Bowel Syndrome, also known as spastic colitis, afflicts many people and constipation is one of the symptoms by which it manifests. Certain individuals who suffer from constipation for many years and do not respond to standard treatment may suffer from chronic idiopathic, unknown etiology, constipation, which is also known as functional constipation.

Chronic constipation may be the result of local abnormalities that prevent the passage of stool, such as stretch marks, abscesses, intestinal ischemia, Hirschsprung disease, rectal prolapse and solitary ulcer syndrome.

Chronic constipation can also be caused by other problems, such as low blood magnesium levels, hypokalemia and high calcium levels in our body. In many cases, it is caused by the use of certain medications (antidepressants, antiepileptics, antihistamines, antihypertensives, diuretics, bone medications, neurological drugs, etc.).



A visit to the doctor is necessary if symptoms, such as unexplained weight loss, fatigue, anal pain during defecation or fever after emptying are present. In the first stage, a complete medical history is requested, in which the patient is asked to describe the duration of symptoms, the frequency of bowel movements, the composition of the stool (soft or hard) and the presence or absence of blood in the stool, as well as factors which are related to eating habits and drug use.

Based on the symptoms and the history of each patient, the tests that need to be performed are determined Specialized diagnostic tests are nowadays available, that  analyze the intestinal microbiome and its functions in a painless and non-invasive way. The combination of all these innovative laboratory tests helps to detect the real causes that lead to the appearance of certain pathological conditions, such as chronic constipation.


Personalized treatment

Based on the diagnostic findings, a personalized treatment can be developed, which can eliminate the underlying causes of  constipation. This is where the role of Modern Medicine lies, the fundamental view of which is that a disease can have many causes or that one cause can cause many diseases.

This means that if ten people have constipation, the causes may be different for each of them. The main goal, then, is to identify the cause of constipation for each individual. This is why personalized treatment becomes so important. Now, there are many different therapeutic approaches depending on the underlying causes that aim to treat constipation.



Dr. Nikoleta Koini, M.D.

Doctor of Functional, Preventive, Anti-ageing and Restorative Medicine.
Diplomate and Board Certified in Anti-aging, Preventive, Functional and Regenerative Medicine from A4M (American Academy in Antiaging Medicine).


  • Basilisco, Guido; Coletta, Marina (2013). “Chronic constipation: A critical review”. Digestive and Liver Disease. 45 (11): 886–893. doi:10.1016/j.dld.2013.03.016. PMID 23639342.
  • Leung FW (February 2007). “Etiologic factors of chronic constipation: review of the scientific evidence”. Dig. Dis. Sci. 52 (2): 313–6. doi:10.1007/s10620-006-9298-7. PMID 17219073.
  • “Celiac disease”. World Gastroenterology Organisation Global Guidelines. July 2016. Archived from the original on 17 March 2017. Retrieved 23 April 2017.
  • McCallum IJ, Ong S, Mercer-Jones M (2009). “Chronic constipation in adults”. BMJ. 338: b831. doi:10.1136/bmj.b831. PMID 19304766.
  • Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM (January 2012). “Chronic constipation in the elderly”. The American Journal of Gastroenterology (Review). 107 (1): 18–25. doi:10.1038/ajg.2011.349. PMID 21989145.
  • Gyger G, Baron M (2015). “Systemic Sclerosis: Gastrointestinal Disease and Its Management”. Rheum Dis Clin North Am (Review). 41 (3): 459–73. doi:10.1016/j.rdc.2015.04.007. PMID 26210129.
  • Barish CF, Drossman D, Johanson JF, Ueno R (April 2010). “Efficacy and safety of lubiprostone in patients with chronic constipation”. Dig. Dis. Sci. 55 (4): 1090–7. doi:10.1007/s10620-009-1068-x. PMID 20012484.
  • Bharucha AE (2007). “Constipation”. Best Practice & Research Clinical Gastroenterology. 21 (4): 709–31. doi:10.1016/j.bpg.2007.07.001. PMID 17643910.

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