Chronic constipation usually results from some deficiency in the three elements necessary for normal bowel activity: dietary bulk, fluid intake, and exercise. Other possible causes can include habitual disregard of the impulse to defecate, emotional conflicts, overuse of laxatives, or prolonged dependence on enemas, which dull rectal sensitivity to the presence of stool. Certain medications (tranquilizers, anticholinergics, opioids, antacids) can cause it, and patients with certain disorders (Parkinson’s disease, multiple sclerosis, hypothyroidism, scleroderma, lupus erythematosus) are more prone to develop it.

The patient typically strains to produce dry, hard stool accompanied by mild abdominal discomfort. Straining can aggravate other rectal conditions such as hemorrhoids.

A patient history of dry, hard stool and infrequent bowel movements suggests chronic constipation due to an inactive colon. A digital rectal examination reveals stool in the lower portion of the rectum and a palpable colon. Analoscopy may show an unusually small colon lumen, prominent veins, and an abnormal amount of mucus. Diagnostic tests to rule out other causes include an upper GI series, barium enema, and examination of stool for occult blood from neoplasms.

Colonoscopy may be performed for inactive colon. Manometric studies may be done to exclude Hirschsprung’s
disease, and internal and external sphincters may be evaluated.