University of Utah Health Care gastroenterology specialists provide comprehensive diagnosis and treatment of conditions caused by constant constipation and irritable bowel syndrome. The most important factor in treating patients with constant constipation and IBS is accurately diagnosing the cause of the disorder. For our patients, we provide the latest in diagnostic testing, and our team approach brings together physicians from multiple disciplines who work together to create individualized treatment plans for our patients.

Treatments

  • Dietary modifications
  • Medications 
Articles

Constipation

What is constipation?

Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week. However, normal stool elimination may consist of having a bowel movement three times a day or three times a week; it depends on the person.

About 4 million people in the United States have frequent constipation. Constipation is the most common gastrointestinal complaint, resulting in 2.5 million doctor visits annually.

What causes constipation?

Hard, dry stools are the result of the colon absorbing too much water. Normally, as food moves through the colon (also known as the large intestine) the colon absorbs water while forming stool (waste products). Muscle contractions then push the stool toward the rectum, and, by the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.

When the colon's muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed. Some of the most common causes of constipation include the following:

  • Medications

  • Lack of exercise

  • Not enough liquids

  • Not enough fiber in the diet

  • Irritable bowel syndrome

  • Ignoring the urge to have a bowel movement

  • Changes in habits or lifestyle, such as travel, pregnancy, and old age

  • Problems with intestinal function

  • Abuse of laxatives

What are the symptoms of constipation?

The following are the most common symptoms of constipation. However, each individual may experience symptoms differently. Symptoms may include:

  • Difficult and painful bowel movements

  • Bowel movements fewer than three times a week

  • Feeling bloated or uncomfortable

  • Feeling sluggish

  • Abdominal pain

The symptoms of constipation may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is constipation diagnosed?

The tests performed by a doctor will depend on the duration and severity of the constipation, since most persons experience constipation at one time or another. The doctor will also take into account the patient's age, and whether there is blood in the stool, recent changes in bowel habits, or weight loss.

Diagnosing constipation may include:

  • Medical history. The doctor will ask for a description of the constipation, including duration of symptoms, frequency of bowel movements, and other information to help determine the cause of the constipation.

  • Physical examination. A physical examination may also include a digital rectal examination (DRE), in which the doctor inserts a gloved, lubricated finger into the rectum to evaluate the tone of the muscle that closes off the anus. This examination also helps detect tenderness, obstruction,  blood, amount and caliber of stool, and if enlargement of the rectum is present.

Other diagnostic tests may include:

  • Abdominal X-ray

  • Lower GI (gastrointestinal) series (also called barium enema). A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

  • Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

  • Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

  • Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers which are visible on X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed.

  • Anorectal function tests. These tests diagnose constipation caused by an abnormal functioning of the anus or rectum.

Treatment for constipation

Specific treatment for constipation will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of this condition

  • Your opinion or preference

Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms and help prevent the condition. Treatment may include:

  • Diet modifications. A diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. While adding foods such as beans, whole grains, bran cereals, fresh fruits and vegetables is helpful in adding fiber to the diet. Limiting foods such as ice cream, cheeses, meats, and processed foods, which contain little or no fiber can also be helpful.

  • Laxatives. Laxatives may be prescribed after diet and lifestyle changes have failed to be effective.

  • Eliminating or changing medication

  • Biofeedback. Biofeedback is used to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control release of bowel movements.

Lifestyle changes, such as increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements can be helpful.

What are good fiber sources?

Foods

Moderate fiber

High fiber

Bread

Cereal

Vegetables

Fruits

Meat substitutes

Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn

 

Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Muslix, granola, oat bran

All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran

Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado

 

Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins

Cooked prunes, dried figs

Peanut butter , nuts

Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

What are complications of constipation?

Constipation can cause complications, such as hemorrhoids, which occur by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding.

Sometimes, straining also causes rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening. Constipation may also cause fecal impaction, which occurs mostly in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.

Articles
Articles

Irritable Bowel Syndrome (IBS)

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is an intestinal disorder that causes the following:

  • Crampy pain

  • Gassiness

  • Bloating

  • Changes in bowel habits

IBS has inaccurately been called by many names, including the following:

  • Colitis

  • Mucous colitis

  • Spastic colon

  • Spastic bowel

  • Functional bowel disease

IBS is a functional disorder because there is no sign of disease when the colon is examined. Because doctors have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen IBS symptoms, research suggests that other factors also are important.

IBS often causes a great deal of discomfort and distress, but it is not believed to:

  • Cause permanent harm to the intestines.

  • Lead to intestinal bleeding of the bowel.

  • Lead to a serious disease such as cancer.

It has not been shown to lead to serious, organic diseases, nor has a link been established between IBS and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

What causes irritable bowel syndrome?

The digestion and propulsion of nutrients and fluids through the gastrointestinal system (GI) is a very complicated and very well-organized process. The GI tract has its own intrinsic muscles and nerves that connect, like an electrical circuit, to the spinal cord and brain. Neuromuscular events occurring in the GI tract are relayed to the brain through neural connections, and the response of the brain is also relayed back to the gastrointestinal tract. As a result of this activity, motility and sensation in the bowel are generated. An abnormality in this process results in a disordered propulsion of the intestinal contents, which generates the sensation of pain.

The exact cause of IBS is unknown. One theory is a person with IBS may have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not affect others. The colon muscle of a person with IBS then begins to spasm after only mild stimulation or ordinary events such as the following:

  • Eating

  • Distention from gas or other material in the colon

  • Certain medications

  • Certain foods

Women with IBS seem to have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

What are triggers for IBS?

The most likely triggers for IBS are diet and emotional stress. Scientists have some clues as to why this happens. Consider the following:

  • Diet. Eating causes contractions of the colon, normally causing an urge to have a bowel movement within 30 to 60 minutes after a meal. Fat in the diet can cause contractions of the colon following a meal. With IBS, however, the urge may come sooner, accompanied by cramps and diarrhea.

  • Stress. Stress stimulates colonic spasm in people with IBS. Although not completely understood, it is believed to be because the colon is partly controlled by the nervous system. Counseling and stress reduction techniques can help relieve the symptoms of IBS; however, this does not mean IBS is the result of a personality disorder. It is at least partly a disorder of colon motility.

What are the symptoms of IBS?

The following are the most common symptoms of IBS. However, each individual may experience symptoms differently. Symptoms may include:

  • Crampy abdominal pain

  • Constipation and diarrhea

  • Mucus may be in the bowel movement

Bleeding, fever, weight loss, and persistent, severe pain are not symptoms of IBS, but indicate other problems. The symptoms of IBS may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is irritable bowel syndrome diagnosed?

Your doctor will obtain a thorough medical history, perform a physical examination, and obtain screening laboratory tests to assess for infection and inflammation. More than likely, all the screening tests and physical examination will be normal. In most cases  IBS  is a diagnosis of exclusion. The laboratory tests, imaging studies, and procedures to be performed will be dictated by the history and physical examination. Tests and procedures that your doctor may order may include the following:

  • Blood tests. These are done to determine if you are anemic, have an infection, or have an illness caused by inflammation or irritation.

  • Urine analysis and culture. These are done to help diagnose urinary tract infections.

  • Stool culture. This checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by your doctor's office. In two or three days, the test will show whether abnormal bacteria are present.

  • Fecal occult blood test. This checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the doctor's office or sent to a laboratory. If blood is present, it may suggest an inflammatory source in the gastrointestinal tract.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum (the first part of the small intestine where absorption of vitamins, minerals, and other nutrients begins). A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through the scope for the removal of a sample of tissue for biopsy (if necessary).

  • Abdominal X-rays. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film.

  • Abdominal ultrasound. A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video recording of the test is also made so it can be reviewed in the future.

  • Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

What is the treatment for IBS?

Specific treatment for IBS will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Changes in diet. Eating a proper diet is important with irritable bowel syndrome. In some cases of IBS, a high-fiber diet can reduce the symptoms. Keeping a list of foods that cause distress, and discussing the findings with a doctor or registered dietitian, can help. Fiber supplements may also be used.

  • Medication. There are both prescription and non-prescription medicines for IBS including:

    • Medications for constipation 

    • Medications for diarrhea

    • Tricyclic antidepressants

    • Antispasmodic medicines

What are good fiber sources?

Foods

Moderate fiber

High fiber

Bread

Cereal

Vegetables

Fruits

Meat substitutes

Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn

 

Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Mueslix, granola, oat bran

All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran

Beets, broccoli, brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado

 

Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins

Cooked prunes, dried figs

Peanut butter, nuts

Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

Articles

Matthew H. Steenblik, M.D.

Dr. Matthew Steenblik completed his medical degree and Internal Medicine residency training at the University of Utah. He then served as chief medical resident in the Department of Medicine before completing his gastroenterology fellowship at the University of Utah where he also served as chief fellow. He is ... Read More

Ashok K. Tuteja, M.P.H., M.D., MRCP(UK)

Ashok K. Tuteja, M.D., M.P.H., M.R.C.P. received his medical degree from Delhi University. He did his internal medicine residency in England where he was awarded Membership in the Royal College of Physicians (M.R.C.P.). He received his Masters in Public Health from Oregon Health Sciences University. He complet... Read More

Specialties:

Constipation, Diarrhea, Endoscopy, Fecal Incontinence, GI Motility, Gastroenterology, Irritable Bowel Syndrome

Locations:

Redwood Health Center
Gastroenterology
(801) 213-9797
University Hospital
Gastroenterology, Clinic 3
(801) 213-9797
Veterans Administration Medical Center (801) 584-1236
University Hospital
Clinic 3
50 North Medical Drive
Salt Lake City, UT 84132
Map
Appointments
(801) 213-9797
Redwood Health Center 1525 West 2100 South
Salt Lake City UT 84119
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Appointments
(801) 213-9797
Redstone Health Center 1743 W. Redstone Center Dr.
Park City, UT 84098
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(801) 213-9797
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84095
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Appointments
(801) 213-9797