Chronically constipated: Are my intestines blocked?

Dear Constipated for Life,

Just like how everything in your digestive system is physically connected, intestinal blockages, constipation, and fecal impaction are medical conditions that are all connected! An intestinal blockage may lead to constipation, which in turn may lead to fecal impaction. However, fecal impaction may also cause a person to feel constipated. While it's unlikely that your intestines will become “lined with fecal matter” that is never removed via a bowel movement, any one of the three conditions previously mentioned could be causing you to feel blocked up. To get to the bottom of what’s bothering your bottom and to seek treatment, it may be helpful to understand the causes of intestinal blockages, constipation, and fecal impaction. 

An intestinal blockage (also referred to as an intestinal obstruction) happens when something blocks food or liquid from traveling through your intestines. Sometimes the actual structure of the digestive tract itself interrupts movement: for example, hernias, adhesions that develop in the abdomen after some types of surgeries, or a narrowing of the intestine caused by a condition such as Crohn’s disease may all lead to blockages. Certain medications or illnesses such as colon cancer may also cause intestinal obstructions. The blockage prevents waste from passing through, and the resulting backup may result in uncomfortable digestive symptoms such as cramps, bloating, loss of appetite, or constipation. Furthermore, if left untreated, complete intestinal blockages may result in serious or life-threatening medical issues, such as tissue death and infection.

Constipation, while sometimes a symptom associated with intestinal blockage, is a different condition that refers to a lack of regular bowel movements. Though uncomfortable, it's typically less serious than intestinal blockages and is able to be self-managed. More specifically, constipation occurs when someone has difficulty passing stools or has less than three bowel movements a week. Stools may be hard or lumpy in texture, and a person may have to strain themselves to expel them from the body. While many people experience occasional constipation as a result of dietary changes or dehydration, others struggle with chronic constipation that lasts several weeks or longer and may interfere with daily life. They may deal with hemorrhoids, anal fissures, or even rectal prolapse if they don't receive treatment. Chronic constipation has many potential causes, including unaddressed intestinal blockages, nerve conditions that affect the muscles in the colon, pelvic muscle problems, and hormone imbalances.

If constipation becomes severe and is left unmanaged, it may lead to fecal impaction. Over time, unpassed stool begins to build up in the large intestine, resulting in abdominal pain, bloating, stomachaches, and fatigue. Fecal impaction is most common in elderly individuals, children, people with mobility impairments, and people with neurological conditions such as Alzheimer’s disease, Parkinson’s disease, and dementia. Unlike constipation, which refers to difficulty passing stool, fecal impaction refers to the accumulation of stool inside the colon that occurs from the build-up of unpassed stool. Fecal impaction is also not always caused by constipation; those who have slow-working colons or take certain medication may also struggle with an excess of waste in the intestines.

So how can you prevent intestinal blockages, constipation, and fecal impaction to ensure that your digestive system continues to operate smoothly? Though the conditions themselves are all related, the prevention measures vary. 

To prevent an intestinal blockage from forming, you may consider taking the following steps:

• Eat small amounts of foods frequently throughout the day as opposed to fewer, larger meals.
• If part of the colon is scarred or narrowed (and so is at higher risk for blockages), limit high-fiber foods such as raw vegetables and fruits with indigestible skins, husks, strings, or seeds, which could become stuck in the narrowed area of the colon.
• Drink plenty of water throughout the day.
• Get regular exercise, which improves digestion and increases muscle activity in the intestines.

To avoid becoming constipated or struggling with fecal impaction, you may want to try some of these approaches:

• Increase the amount of high-fiber foods in your diet. Whereas fiber might make preexisting intestinal blockages worse, it is beneficial to those struggling with constipation by increasing the weight of stool and making it easier to move through the colon.
• Drink plenty of water throughout the day.
• Get regular exercise.
• Don’t ignore the urge to have a bowel movement or rush yourself in the bathroom. Taking your time allows you to avoid straining your intestines.

However, if you do find yourself suffering from an intestinal blockage, constipation, or fecal impaction, there are treatments to get your bowels moving regularly again. Occasional constipation is often alleviated with at-home remedies, such as laxatives or other over-the-counter medications. Though several different types of laxatives exist, they all have the same end goal of making stools easier to pass through the colon. You may also consider taking fiber supplements or increasing the amount of fiber-rich foods in your diet. In more severe cases of chronic constipation, a health care provider might prescribe medication that helps to draw more water into the intestine, softening any stools. 

Fecal impaction and intestinal blockages are more serious and require the support of health care providers. Fecal impaction is generally treated in three steps: disimpaction, colon evacuation, and bowel regimen. First, health care providers remove the build-up of stool in the colon. This process may involve laxatives, enemas, physical removal by a professional, or surgery depending on severity. Next, any remaining waste in the intestines is cleared out of the digestive system with fluids. Finally, your health care provider will discuss regular bowel movement frequency with you to help prevent future impactions. Intestinal blockages usually require hospitalization. Depending on how severe the blockage is, your health care provider may recommend surgery to remove the material obstructing your intestine along with any dead or damaged tissue. If surgery isn’t medically necessary, your provider may recommend staying in the hospital for a couple days while you receive food and fluids through an IV and medication to stimulate intestinal muscle contractions.

The good news is that all three of these conditions can not only be remedied but are typically avoidable with some precautions. For most people, maintaining a balanced diet, staying hydrated, and including some physical activity during the day will be enough to ensure that their digestive system stays healthy. However, if you’ve found that taking these measures hasn’t been enough to keep your stools moving regularly, a conversation with your health care provider might be a helpful option in determining what you can do to improve your symptoms. 

Hoping everything comes out well in the end,