Chronic constipation is diagnosed by a medical professional through a combination of patient history, physical examination, and diagnostic tests. The goal is to identify the underlying cause and determine the most effective treatment plan.

1. Patient History and Symptom Assessment: The diagnosis begins with a detailed discussion of the patient’s symptoms, including the frequency and consistency of bowel movements, the presence of straining, and any associated pain or discomfort. The doctor will also inquire about the patient’s diet, hydration habits, exercise routine, medication use, and any other relevant health conditions. Understanding the duration and pattern of symptoms helps distinguish chronic constipation from occasional bouts of constipation.

2. Physical Examination: A physical exam is typically conducted to assess the general health of the patient and look for signs that might indicate the cause of constipation. This may include an abdominal examination to check for bloating, tenderness, or any palpable masses. A digital rectal exam (DRE) may also be performed, where the doctor inserts a gloved finger into the rectum to check for abnormalities such as blockages, haemorrhoids, or signs of muscle dysfunction.

3. Diagnostic Tests: Depending on the findings from the history and physical examination, further diagnostic tests may be ordered to rule out other conditions or to gain more insight into the cause of constipation. These tests can include:

• Blood Tests: To check for metabolic or endocrine disorders like hypothyroidism or electrolyte imbalances that could contribute to constipation.
• Stool Tests: To detect blood in the stool, infections, or other abnormalities.
• Colonoscopy or Sigmoidoscopy: These procedures involve using a flexible tube with a camera to visually examine the inside of the colon and rectum. They are typically recommended if there are red flags such as unexplained weight loss, rectal bleeding, or a family history of colorectal cancer.
• Imaging Studies: X-rays, CT scans, or MRI might be used to identify structural issues in the intestines, such as obstructions, strictures, or other anatomical abnormalities.
• Colonic Transit Studies: This test measures how long it takes for food to move through the colon. It can help identify slow transit constipation, where the bowel movements are abnormally slow.
• Anorectal Manometry and Balloon Expulsion Test: These tests evaluate the function of the muscles and nerves in the rectum and anus, helping to diagnose issues related to pelvic floor dysfunction, which can contribute to chronic constipation.

4. Diagnosis and Treatment Planning: Once the underlying cause of chronic constipation is identified, the doctor will work with the patient to develop a tailored treatment plan. This may include dietary and lifestyle changes, medications, and in some cases, referrals to specialists such as gastroenterologists or colorectal surgeons for further management.

Early diagnosis and treatment are crucial to prevent complications and improve the patient’s quality of life. If you experience persistent constipation, it’s important to seek medical advice to ensure proper care.

Treatment for constipation by a medical professional involves a multi-faceted approach tailored to the severity of the condition and its underlying causes. Here are some common methods used in the management of constipation:

1. Increasing Fibre Intake: A primary recommendation for managing constipation is to increase dietary fibre. This involves consuming more fruits, vegetables, whole grains, and legumes. Fibre adds bulk to the stool and helps it pass more easily through the digestive tract. A typical goal is 25-30 grams of fibre per day.

2. Hydration: Adequate fluid intake is essential. Water is the best option, and patients are usually advised to drink at least 8 glasses a day to keep stools soft and promote regular bowel movements.

3. Regular Exercise: Physical activity stimulates intestinal activity and can help relieve constipation. Regular exercise, such as walking, jogging, or swimming, can be beneficial.

4. Laxatives: There are several types of laxatives available, each with a specific mechanism of action:

• Bulk-Forming Laxatives: These add bulk to the stool and include substances like psyllium and methylcellulose.
  
• Stool Softeners: These help moisten the stool and include docusate sodium.
  
• Osmotic Laxatives: These draw water into the intestines to soften stool, such as polyethylene glycol and lactulose.
  
• Stimulant Laxatives: These stimulate the intestinal muscles to propel stool, including senna and bisacodyl. They are generally recommended for short-term use.
  

5. Prescription Medications: In cases where over-the-counter options are ineffective, a doctor may prescribe medications such as lubiprostone, linaclotide, or prucalopride, which specifically target chronic constipation.

6. Bowel Training: Establishing a regular bowel movement routine can be helpful. This involves setting specific times each day to try to have a bowel movement, often after meals.

7. Biofeedback: For patients with pelvic floor dysfunction, biofeedback therapy can teach them how to better coordinate the muscles used for bowel movements. This non-invasive therapy uses sensors and computer displays to provide real-time feedback about muscle activity.

8. Manual Removal: In severe cases where stool impaction occurs, manual removal of stool may be necessary. This is done by a healthcare professional using gloved hands to gently remove the blockage.

9. Enemas and Suppositories: IEnemas can help clear out the rectum and colon and are often used in cases of severe constipation. Glycerin or bisacodyl suppositories can stimulate bowel movements and soften the stool.

10. Surgical Intervention: In rare, severe cases where other treatments fail, surgery may be considered. Procedures can include removing part of the colon (colectomy) or rectum (proctectomy) to alleviate chronic constipation due to structural issues or severe slow transit constipation.

By addressing lifestyle factors, using medications appropriately, and considering advanced treatments when necessary, healthcare professionals can effectively manage and alleviate constipation, improving the patient’s overall quality of life.