Constipation Treatment in Hyderabad, India

PACE Hospitals is regarded as the Best Hospital for constipation treatment in Hyderabad, providing expert care for chronic and severe constipation in children and adult, irritable bowel syndrome (IBS), anorectal disorders, and slow-transit constipation. Our team includes the best gastroenterologist specialists who diagnose and manage a range of gastrointestinal conditions.

We use advanced diagnostic tools to identify the root cause and offer tailored treatment options including diet modifications, medications, biofeedback therapy, and surgical interventions when necessary.

Our goal is to relieve symptoms, improve bowel function, and enhance overall quality of life.

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Constipation Treatment

Why Choose PACE Hospitals for Constipation Treatment?

The diagnosis of constipation requires a thorough and thoughtful evaluation. Initially, the physician conducts a comprehensive assessment, including, a detailed history and physical examination helps identify any alarming signs or secondary causes. If symptoms are severe, persistent, or unresponsive to standard treatments, it is best to refer the patient to a gastroenterologist for further evaluation and specialized testing. This process reveals any underlying conditions. This careful approach confirms the diagnosis and rules out serious complications like bowel obstruction, neurological disorders, or metabolic diseases. It also ensures that an appropriate and effective treatment plan is put in place to improve the patient’s quality of life.

The following are included in the diagnostic evaluation:

• Risk assessment
• Medical history and Physical examination
• Laboratory tests
• Imaging and endoscopic evaluations
• Functional assessment
• Staging and classifications

Risk assessment

To identify individuals with contributing factors such as a low fibre diet, inadequate fluid intake, sedentary lifestyle, use of certain medications (such as opioids, antidepressants), or underlying medical conditions like diabetes, hypothyroidism, or neurological disorders that can lead to constipation.

Medical history and physical examination

To diagnose constipation, the gastroenterologist may take detailed information, including questions about bowel habits, stool frequency and consistency, duration and onset of symptoms, dietary and fluid intake, medication use, and any family or personal history of gastrointestinal or metabolic disorders. The gastroenterologist also asks about associated symptoms such as straining, incomplete evacuation, blood in the stool, and lifestyle factors.

Physical examination is performed separately and includes checking vital signs, assessing dehydration, abdominal inspection and palpation for tenderness, swelling, or masses, and listening to bowel sounds.

Laboratory tests

Laboratory tests are important in diagnosing constipation, especially when symptoms are chronic or do not improve with treatments. These tests help to find out underlying causes, metabolic or systemic disorders, rule out other conditions that can mimic constipation, and guide appropriate treatment. The following laboratory tests are commonly performed in patients with persistent or severe constipation:

• Complete blood count (CBC) : It measures the red blood cells, white blood cells, and platelets. This test helps find anemia, which may show chronic blood loss, malnutrition, or systemic disease. It also detects elevated white blood cell counts that could indicate inflammation or infection contributing to bowel dysfunction. Although CBC findings don't directly diagnose constipation, they can uncover underlying problems that may explain symptoms.
• Thyroid-Stimulating Hormone (TSH): TSH is measured to evaluate thyroid gland function. Intestinal motility is one of the many body functions that are slowed down by hypothyroidism, or an underactive thyroid. Stools may become hard and difficult to pass as a result of this. Since hypothyroidism is a common and treatable cause of chronic constipation, TSH testing is crucial.
• Blood glucose: This test evaluates how well the body regulates blood sugar. Diabetes mellitus, especially if poorly controlled, can damage the nerves that control the bowel (autonomic neuropathy), leading to slowed intestinal transit and constipation. Screening for diabetes is therefore an important part of assessing unexplained constipation.
• Serum calcium: This test evaluates for hypercalcemia (elevated calcium levels), which may interfere with the intestinal muscles ability to contract normally and decrease motility. Identifying elevated calcium is important because treating the underlying cause can resolve the constipation.
• Serum electrolytes: An electrolyte panel measures key salts in the blood, such as sodium and potassium. Abnormal levels of these electrolytes can impair muscle and nerve function in the gut. For example, low potassium (hypokalemia) is a well-known cause of reduced bowel motility and can contribute to severe constipation.
• Faecal occult blood test (FOBT): FOBT is a simple, non-invasive test that checks for hidden blood in the stool, which is not visible with the naked eye. This test is suggested for patients with alert signs such as blood in stool (hematochezia), family history of colon cancer, anemia or unexplained weight loss.

This test is mainly used to screen colorectal cancer and other causes of bleeding in the digestive tract, such as polyps, ulcers, diverticulosis, or hemorrhoids. If blood is found, it means there is bleeding somewhere in the digestive system.

• Urine tests:
• Urine tests play an important role in diagnosing the underlying cause, but do not diagnose constipation itself, because constipation is primarily a gastrointestinal issue. However, they play a valuable supportive role in the overall evaluation by helping to:
• Rule out systemic conditions like diabetes mellitus, which can cause autonomic neuropathy affecting bowel motility.
• Detect kidney problems or electrolyte imbalances that might indirectly contribute to constipation.
• Identify metabolic or endocrine disorders (e.g., hypothyroidism) that can slow gastrointestinal transit.

Imaging and Endoscopic Evaluations

These help to assess structural or functional abnormalities in patients with suspected constipation when clinical evaluation is inconclusive. These tests help to rule out the main cause of constipation.

Imaging studies include:

• Computed tomography (CT Scan)
• Magnetic resonance imaging defecography
• Abdomen X-ray
• Barium enema or lower GI series
• Colonoscopy

Computed tomography:  CT scans give detailed images of the abdomen and can help identify complications or rule out more serious causes if the standard treatments are not working or if the patient has unusual symptoms.

MRI defecography:  MRI defecography is a special type of imaging test that uses magnetic resonance imaging (MRI) to take detailed pictures of the pelvic area. This test is especially helpful for diagnosing the causes of constipation that don't improve with usual treatments. MRI defecography can show if there are problems with the muscles or structures in the pelvic area, such as weakness or poor coordination of the pelvic floor muscles, rectocele (a bulge of the rectum into the vagina), rectal prolapse (when the rectum slips out of its normal place), intussusception (when part of the intestine slides into another part) and problems with how the anus or rectum opens.

Abdominal X-ray: It is a quick test that takes a picture of the abdomen to check for large amounts of stool or blockages in the colon. This test is performed when there is suspected blockage, but it is not a routine test for diagnosing constipation.

Barium enema (lower gastrointestinal series):  This is a more detailed test where a liquid called barium is put into colon through the rectum. is used to check for structural problems in the large intestine, such as growths (polyps), narrowing (strictures), or twisting (volvulus) that can cause constipation or other symptoms. It is mainly recommended when a gastroenterologist suspect there may be significant underlying causes, like polyps, cancer, inflammation, or other abnormalities in the colon or rectum.

Colonoscopy: It is a procedure that examines the entire colon. This test is not routinely used to diagnose constipation alone; instead, it is reserved for patients with alarming symptoms such as gastrointestinal bleeding, worsening of constipation, unexplained weight loss, anemia, or a family history of colorectal cancer.

Colonoscopy in these cases helps to rule out serious conditions like colorectal cancer, polyps, and inflammatory bowel disease (IBD).

Functional Assessment

This assessment is for patients with chronic or unexplained constipation. This assessment has the following tests:

• Anorectal manometry with balloon expulsion test
• Colorectal transit studies

Anorectal manometry with balloon expulsion test:  Anorectal manometry with the balloon expulsion test is a set of tests used to find out why someone might be having trouble with constipation. These tests are especially recommended if a patient has chronic constipation that does not improve with usual treatments, or if a general physician or a gastroenterologist suspects a problem with pelvic muscles. They are useful for diagnosing a condition called dysynergic defecation is a condition where the pelvic floor muscles and anal sphincter don't coordinate properly during a bowel movement, making it difficult or impossible to pass stool), where the muscles do not relax or contract properly when trying to pass stool. Anorectal manometry with balloon expulsion helps rule out other causes of constipation, such as structural blockages or tumors, and can clearly show if the problem is due to muscle or nerve dysfunction. This information is important for selecting the best treatment for a specific type of constipation.

Colorectal studies:  Colorectal transit studies are diagnostic tests used to evaluate constipation by measuring how materials move through the colon. This process helps determine whether constipation is due to slow transit throughout the colon (slow transit constipation), a problem with the rectum and pelvic floor (outlet dysfunction or dyssynergia), or a combination of both. By identifying the underlying motility pattern, colorectal transit studies help rule out or distinguish between different types of constipation, guiding further management and treatment decisions.

For people with simple constipation, diagnosis relies on medical history, physical examination, and basic tests. Colonoscopy is mainly used to exclude structural or malignant causes when warning signs are present, rather than to diagnose functional constipation itself.

Staging and Classifications

Based on the severity and duration, constipation can be described as mild, moderate, severe, or chronic. And chronic constipation usually means symptoms have been present for at least three months.

Based on the findings, constipation is also classified as either primary constipation (which is due to problems with how the colon or pelvic muscles work) or secondary constipation (this is due to a medical condition or medications).

Constipation Differential Diagnosis

Figuring out whether someone has constipation can be challenging because many other conditions can cause similar symptoms, test results, or physical findings. The most important conditions to tell apart from simple or functional constipation include secondary causes, such as medication side effects, metabolic or endocrine disorders (like hypothyroidism or diabetes), and neurological diseases (such as Parkinson's disease or multiple sclerosis).

Other conditions to consider include:

• Abdominal hernia: Can cause constipation if the hernia leads to partial bowel obstruction, especially when a loop of intestine is trapped, resulting in abdominal pain, distension, and reduced passage of stool.
• Appendicitis: Can sometimes present in constipation and abdominal pain, acts as functional constipation. It is most common in young males, with pain that starts around the umbilicus and moves to the right lower quadrant.
• Diverticulitis: Can present with bowel habit changes, and constipation is seen in most cases. Constipation in this context is due to inflammation and localized peritonitis. The diagnosis is confirmed by CT abdomen with contrast, which also distinguishes uncomplicated from complicated diverticulitis requiring more intensive management.
• Bowel obstruction: Can mimic or cause constipation, particularly when accompanied by obstipation (inability to pass stool or gas). Small bowel obstruction is generally due to post-surgical adhesions, hernias, or malignancy.
• Cauda equina syndrome:  It is a rare neurological emergency that can present with severe constipation due to parasympathetic denervation of the sigmoid and rectum.
• Megacolon, or abnormal dilation of the colon with impaired peristalsis, can lead to severe and persistent constipation.
• Bowel perforation: It is a life-threatening condition that can rarely result from severe or chronic constipation, particularly when a hard faecal mass (faecaloma) causes ischemic necrosis of the rectosigmoid wall, known as stercoral perforation. Although constipation itself is not a typical symptom of perforation, conditions associated with constipation, such as diverticulitis, obstruction, or hernias, increase the risk.
• Anal fissure: Painful tears in the anal lining make defecation uncomfortable, leading patients, especially children to withhold stool, which worsens constipation and may cause blood-streaked stools.
• Hypothyroidism: Can cause constipation due to reduced gastrointestinal motility from insufficient thyroid hormone levels.
• Inflammatory bowel disease (IBD), including ulcerative colitis, Crohn's disease, generally presents with diarrhea but can cause constipation when complications like strictures or tumor develop. Chronic inflammation can lead to bowel narrowing and obstruction, presenting with abdominal pain, distension, and reduced bowel movements.

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Managing constipation starts with changes to lifestyle and diet, followed by medication if needed. Treatment is individualized to the patient's symptoms, underlying causes, and how they respond to therapy. In some cases, patients may need more specific treatments for long-term relief and to improve their condition.

Treating constipation includes various supportive and therapeutic strategies, such as the following approaches:

• Lifestyle and dietary modification
• First-line pharmacological therapy
• Second-line and adjunctive therapies
• Special considerations
• Non-pharmacological and advanced interventions

Lifestyle and dietary modification

Lifestyle and dietary changes are the first-line, evidence-based interventions for constipation, improve long-term results, and are an essential part of any comprehensive constipation management plan.

The following measures improve bowel motility and stool consistency naturally, often reducing the need for medications and preventing the recurrence of symptoms.

• Ensuring dietary fiber intake to approximately 35 grams per day. Sources are fruits, vegetables, and grains.
• Adequate hydration helps soften stools.
• Encourage regular physical activity to stimulate bowel motility.
• Proper bathroom routines, especially after meals.

First-line pharmacological therapy

When lifestyle and dietary modifications fail to relieve constipation, first-line pharmacological treatment is aimed at promoting regular bowel movements and improving patient quality of life.

• Bulk-forming agents: absorb water in the intestine, which makes the stool swell, get softer, and become bulky. The colon's natural peristaltic movement is stimulated by this increased bulk, which facilitates easier and more frequent bowel movements.
• Osmotic laxatives: Work by drawing water into the intestines through a natural process called osmosis. This extra water softens the stool and increases its volume, making it easier to pass. The increased fluid in the intestines also stimulates the muscles of the bowel, which helps promote more regular and comfortable bowel movements.
• Stimulant laxatives: Activate the nerves that control the colon's muscles by acting directly on the intestinal wall. This helps move stool through the colon by increasing intestinal contractions, or peristalsis. They are generally advised for infrequent, as-needed use or in cases where bulk-forming or osmotic agents prove unsuccessful.

Second-line and adjunctive therapies

When constipation fails to respond to initial treatments, such as fibre supplements and lifestyle modifications, second-line and adjunctive therapies are introduced. These options target persistent symptoms and help restore normal bowel function. Selection is tailored to individual needs, severity, and treatment response.

• Secretagogues and prokinetic agents: Increase the intestinal lumen's absorption of water and electrolytes. They cause the intestinal lining to open up certain channels, such as guanylate cyclase receptors or chloride channels, which increases the amount of water that enters the intestine, making stools soft and increasing their volume, making it easier to pass and promoting normal bowel movements. In particular, these medications work well for irritable bowel syndrome with constipation (IBS-C) and chronic or refractory constipation.
• Suppositories and enemas: Suppositories and enemas help relieve constipation by stimulating the muscles and nerves in the lower bowel, which increases movement and speeds up the passage of stool. Suppositories and enemas are used especially when constipation is due to slow movement or difficulty emptying the lower bowel.

Special considerations

Certain patient groups need specialized methods for managing constipation because of particular physiological characteristics or side effects from medications. These include pregnant women and those suffering from opioid-induced constipation (OIC).

• Opioid-induced constipation: May require combination therapy with osmotic and stimulant laxatives or peripherally acting opioid receptor antagonists. These agents work by drawing water into the bowel and stimulating peristalsis. Avoiding bulk-forming laxatives can worsen the symptoms.
• Pregnancy: Prefer fiber, bulk-forming agents, osmotic laxatives, or stool softeners; stimulant laxatives only occasionally and under medical supervision.

Non-pharmacological and advanced interventions

Strong evidence supports the use of non-pharmacological therapy, such as behavioral therapies with lifestyle modifications, as the cornerstone of initial management to improve bowel function and lessen symptom burden.

• Biofeedback therapy: Biofeedback therapy is effective for constipation than conventional therapies or laxatives, making it especially beneficial for constipation brought on by pelvic floor dyssynergia (the muscles in the pelvic floor become uncoordinated). Biofeedback is less effective for slow transit constipation, but first the first-line therapy for pelvic floor dysfunction-related constipation.
• Surgical intervention: Rarely needed, reserved for refractory cases with structural abnormalities or severe slow-transit constipation unresponsive to medical therapy.

Constipation Prognosis

The prognosis for constipation varies depending on its cause, severity, and response to treatment.

The prognosis for constipation is generally good, as most patients respond well to management strategies, which include dietary changes, lifestyle modifications, and appropriate use of medications. However, a small proportion of adults may experience severe, persistent symptoms that significantly impact their overall quality of life. In children, up to 30% may continue to have symptoms into adulthood.

Factors associated with a prognosis are older age at onset, female gender delayed initiation of treatment, and prolonged colonic transit time.

Recurrence is common, often due to poor adherence to dietary and lifestyle recommendations. In rare cases where medical therapies are ineffective, surgical intervention such as total abdominal colectomy may be considered, but careful patient selection is crucial for success.

Patients who are dependent on laxatives and unwilling to modify their habits tend to have the most challenging outcomes. but, with timely and consistent management, most individuals with constipation can be improved.

Frequently Asked Questions (FAQs) on Constipation

What is constipation, and what causes constipation?

Constipation is a condition marked by infrequent, hard, or difficult-to-pass stools, often fewer than three times per week. It can be caused by, inadequate fluid intake, low-fiber diet, physical inactive, ignoring the urge to defecate, certain medications (like opioids and iron supplements), and medical conditions such as diabetes, hypothyroidism, or irritable bowel syndrome. Changes in routine, aging, and pregnancy can also contribute to constipation.

How to relieve constipation in newborns?

Research shows that formula with added magnesium can help improve stool softness and make bowel movements more regular in constipated infants compared to regular formula. If changes in diet do not help enough, mild laxatives such as lactulose or polyethylene glycol are considered safe and effective options for infants. Giving more fluids and, for babies older than six months, offering juices that contain sorbitol may also be helpful. All treatments should be done under the guidance of a pediatrician.

What drugs cause constipation?

Drugs like anticholinergics, antipsychotics, tricyclic antidepressants, opioid painkillers, iron supplements, calcium channel blockers, antihistamines, and some antacids that include calcium or aluminium can all contribute to constipation. By decreasing intestinal secretions or slowing down bowel motions, these medications make it more difficult to pass faeces.

Can constipation cause loss of appetite?

Yes, constipation can lead to loss of appetite. When stool builds up in the colon, it causes abdominal discomfort, bloating, and a feeling of fullness. This physical discomfort can make eating less appealing and reduce hunger signals, leading to decreased appetite until the constipation is relieved.

What is idiopathic constipation?

Constipation without a known underlying cause, even after a comprehensive medical evaluation, is referred to as idiopathic or functional constipation. Both adults and children frequently have it, and it is diagnosed after other potential causes, such as drugs or diseases have been ruled out. Hard, infrequent stools and trouble passing stool are common symptoms. Clinical criteria and medical history are used to make the diagnosis, and dietary modifications, lifestyle modifications, and occasionally laxatives are used to treat the condition.

What is the difference between diarrhea and constipation?

Constipation is marked by infrequent, hard, and difficult-to-pass stools, often fewer than three times per week, with straining or incomplete evacuation. Diarrhea, involves frequent, loose, or watery stools, usually three or more times daily, often with urgency and abdominal cramps. Both conditions affect bowel habits but in opposite ways regarding stool consistency and frequency.

What is chronic constipation?

Chronic constipation is a long-term condition which is characterized by infrequent or difficult bowel movements lasting several weeks or longer. It involves symptoms such as hard stools, straining, and a sense of incomplete evacuation. Chronic constipation can affect over all quality of life and may require ongoing management with dietary changes, medications, or further medical evaluation if standard treatments are not effective.

Can probiotics cause constipation?

Yes, constipation can occasionally result from taking probiotics, particularly in the initial weeks as the gut microbiota gets used to the new bacterial strains. Other digestive symptoms like gas or bloating may accompany this typically transient effect. These side effects usually go away as the digestive system adjusts, and most people tolerate probiotics well.

Can iron deficiency cause constipation?

Constipation is not a direct result of iron deficiency. However, it is widely known that many people experience constipation as a side effect of taking oral iron supplements, which are used to treat iron deficiency. This is believed to happen because unabsorbed iron in the gut might disrupt the gut microbiota and produce changes in gut motility and tougher stools.

Can constipation cause increased urination?

Yes, constipation may result in more frequent or intense urination. This happens because of their close anatomical proximity, which allows faeces to physically press against the bladder as it accumulates in the colon, particularly in the rectum. Urge to urinate more frequently or urgently increases as a result of the pressure that results from the bladder's decreased capacity to hold urine.

Can pomegranates cause constipation?

Pomegranate is generally not known to cause constipation. It contains fiber, which can help promote regular bowel movements. For most people, eating pomegranate in moderation supports digestive health and does not contribute to constipation.

Can ragi cause constipation?

Ragi (finger millet) is a good source of dietary fiber and usually helps prevent constipation. However, if consumed in excess without adequate water intake, it may contribute to constipation in some individuals. Drinking enough fluids with ragi is important for digestive health.

Does constipation cause stomach pain?

Yes, constipation can cause stomach pain or discomfort. When stool builds up in the colon, it can lead to abdominal cramping, bloating, and a feeling of fullness or pressure. This pain usually resolves once the constipation is relieved.

How to avoid constipation during pregnancy?

Research shows that pregnant women can help prevent constipation by staying active, drinking enough water, and eating a balanced diet rich in fiber from vegetables, yogurt, and whole grains. However, studies suggest that fiber and beneficial bacteria alone may not always prevent constipation because of changes that happen in the body during pregnancy. If lifestyle changes are not enough, osmotic laxatives are considered a safe and effective option to relieve constipation during pregnancy.