The different types of constipation
Consider the following statistics about constipation:
There are many different underlying causes for constipation
The correct treatment for your particular constipation will depend on its exact underlying cause
It is hard to determine this exact underlying cause because constipation symptoms tend to be misleading
And that’s what makes treating constipation so difficult. Two patients with the same constipation symptoms can have completely different underlying problems and require completely different treatments. On the other hand, two patients with the same underlying problem can exhibit completely different symptoms because of how much variability there is in the way each person experiences constipation.
This is why doctors try to specifically diagnose constipation by different types and sub- types to identify its actual underlying cause. Knowing what exact type of constipation you have can help you find out what exactly has gone wrong inside your gut and can help you fix that problem more accurately.
So, let’s take a look at what these different types of constipation are and see the root cause of each one…
Primary constipation (Functional constipation)
This is simply a way to describe constipation that presents itself as a stand-alone problem and is not caused by a secondary issue such as a medical condition or medication/drug use.
There are 3 types of primary constipation:
Normal transit constipation
During this type of constipation the gut’s muscle contractions seem to be normal and the stool moves through the colon at a normal pace but the sufferer still finds it difficult to pass their stool. Patients with this kind of constipation often complain of having to strain to have a bowel movement and may even have abdominal bloating or pain, however their frequency of bowel movements is often normal. It is believed that this particular type of constipation may be caused by changes in the water content of the colon or from stools over-filling the rectum (increased rectal compliance) .
Slow transit constipation
This type of constipation is the result of a slowdown in your large intestine’s ability to move stools. It is believed to be caused by either by an abnormality in your gut’s muscles (myopathy) or your gut’s nerves (neuropathy). Symptoms of this type of constipation include infrequent bowel movements, lack of the urge to pass stools, straining while passing stools, lumpy or hard stools, nausea or decreased appetite.
Outlet constipation (evacuation disorder, obstructed defecation, pelvic floor dysfunction)
The process of having a bowel movement involves a complex interplay of muscles in the rectum, anal canal and the lower abdomen. Outlet constipation happens when something interferes with how these different muscles coordinate with each other. This can happen either when there is a physical abnormality with the anorectal region (for ex. rectal prolapse, megarectum, etc.) or when there is a functional issue with the muscles involved in having a bowel movement (for ex. a neurological disorder or a dysfunction of your pelvic floor muscles or anorectal muscles). People with outlet constipation often experience symptoms such as needing to go to the bathroom frequently, having to push really hard to pass your stool, pain or pressure in the rectum, heavy feeling in the pelvis, having to change positions on the toilet or having to use your hands to facilitate a bowel movement.
Secondary constipation
This is the result of your constipation being caused by some other independent issue that is interfering with your digestive system’s function. In other words, there is a second, separate problem that is causing your constipation.
Normally there are 6 causes of secondary constipation:
Medications/drugs
These can include OTC medications (for ex. Antacids), prescription medications (for ex. Antidepressants, Calcium channel blockers) and even illicit drugs (for ex. narcotics, opioids)
Deficiencies
Vitamin B12 deficiency or Vitamin D deficiency
Neurological
conditions
Parkinson’s disease, Hirschsprung’s disease, multiple sclerosis, etc
Psychological
conditions
Anxiety, depression, somatization, etc.
Metabolic
conditions
Diabetes, hypothyroidism, uremia, etc
Myopathic
conditions
Scleroderma, Amyloidosis, myotonic dystrophy, etc.
Part of the reason why your doctor takes a detailed medical history when diagnosing your constipation is to identify if it is being caused by one of these secondary issues. If it turns out that you indeed have secondary constipation, the treatment will then also focus on addressing the secondary cause.
Irritable Bowel Syndrome with Constipation (IBS-C)
A syndrome is a condition that produces many symptoms but does not have an identifiable cause. Irritable bowel syndrome is one such a condition that describes a group of symptoms such as abdominal pain, cramping, gas and bloating. It can be caused by bacterial overgrowth in your gut, a past gut infection, early life stress, ongoing emotional stress, a very sensitive colon or even an overactive immune system. IBS-C is a specific type of IBS that happens with constipation. It is a long-term condition that exhibits all the symptoms of typical IBS plus has other symptoms such as straining during a bowel movement, hard or lumpy stools, infrequent stools or feeling that your bowels are not completely empty after going to the bathroom. One of the main things that differentiates IBS-C from the other types of constipation mentioned above is that the abdominal discomfort improves after passing your stools.
Now that we have covered the different types of constipation, note that each type has its own particular treatment. However, here is where things get tricky. Identifying the specific cause of your constipation is still not easy:
One of the most common constipation diagnosis given to patients is something called “idiopathic constipation” – Idiopathic means that we simply can’t identify the underlying cause of the problem.
There is a lot of overlap of symptoms between the different types of constipation – This gets in the way of differentiating which exact type of constipation you have
You can have more than one type of constipation at the same time – For example, it is very common for constipation sufferers to have both slow transit constipation and outlet constipation concurrently.
This is why doctors still have to rely on taking an educated guess to treat the patient’s constipation (empirical therapy), often using a trial an error approach to see what works. It is also why constipation treatments have such poor success rates. On its face, it may almost look like knowing about the different types of constipation isn’t of much help. However, it turns out that there are two missing pieces to this puzzle that can give you a complete picture of constipation.
Most importantly, by simply becoming aware of these 2 additional facts you will now know exactly how to successfully treat your constipation on your own and be able to return your gut to a healthy state:
The 2 Missing Pieces of the Puzzle
Puzzle Piece #1: All the different types and sub-types of constipation are connected -
As we saw above, not only do different types of constipation often share common symptoms, clinical evidence has even shown that one type of constipation can trigger a different type to get started in our gut. For example, slow transit constipation (caused by a sluggish digestive tract) can cause your stools to become hard and stretch your rectum, which in-turn can compress the nerves around the rectum and damage them, which in- turn can end up causing outlet constipation (where the reflexes involved in having a bowel movement are affected).
The truth is, while we have discussed the various types of constipation as separate problems, in reality they are all connected and they are all part of a common condition called a functional bowel disorder.
Functional Bowel Disorder
Think of this disorder as a continuous spectrum with all the different types of constipation seamlessly running into each other. What this really means is that treating your constipation rarely comes down to targeting a single type of constipation. Your treatment approach should be far broader than what traditional over-the-counter products offer and must focus on resolving the underlying functional bowel disorder.
Which brings us to our next point…
Puzzle Piece #2: The only way to find fast and long- lasting relief is to treat all the types and sub-types of constipation simultaneously -
It’s true, there is no way for someone to tell which exact type of constipation they have just from their symptoms. However, as long as you realize that all the different types of constipation are connected by a common condition called a functional bowel disorder, it becomes clear why a multi-pronged approach is necessary.
To put it more precisely, your treatment should do 10 things to be able to reliably overcome your constipation problem and reverse the underlying functional bowel disorder behind it:
Unless your treatment is able to address all 10 of these therapeutic targets at the same time, your underlying functional bowel disorder will keep progressing, your constipation will keep recurring, the condition of your gut will continue to deteriorate and you will become increasingly vulnerable to all the long-term dangers of constipation. On the flip side, any treatment that accomplishes all 10 of these therapeutic goals will give you fast and longlasting relief no matter what specific type or sub-types of constipation you have.
And what about fecal impaction?
In addition to all the different types of constipatio mentioned above, there is yet another type of obstructive bowel condition known as a fecal impaction that is a completely distinct and a far more serious problem. Understanding this difference between the two is critical for protecting yourself from the many serious complications of fecal impaction and treating it effectively. So next, let’s take a look at how a fecal impaction differs from constipation, how it damages your gut and how it can be successfully treated
