Constipation

What it is

Constipation is persistent difficulty having bowel movements: hard stools, straining, a feeling of incomplete emptying, or fewer than three bowel movements a week. It is much more common in women and is related to a diet low in fiber, insufficient water intake, a sedentary lifestyle, hormonal changes, pregnancy, medications and, in many cases, a pelvic floor dysfunction that prevents proper relaxation during bowel movements. Besides the discomfort, constipation contributes to hemorrhoids and fissures. At Femi Saúde, the coloproctology team investigates the type of constipation, rules out warning signs, and puts together a plan that combines dietary guidance, bowel habits, medication when needed and pelvic physical therapy, in coordination with nutrition and gynecology.

Most common symptoms

• Fewer than three bowel movements per week
• Hard, dry or pellet-like stools
• Excessive straining during bowel movements
• A feeling of incomplete emptying
• Bloating and abdominal pain
• Needing maneuvers to have a bowel movement

Causes and risk factors

• A diet low in fiber and insufficient water intake
• A sedentary lifestyle and irregular routine
• Pelvic floor dysfunction
• Hormonal changes, pregnancy and menopause
• Medications such as iron, opioids and antidepressants
• Hypothyroidism and other conditions

How it is diagnosed

The coloproctologist evaluates a detailed history of bowel habits, diet, medications and associated symptoms, and performs a physical exam with a digital rectal exam, which can already suggest whether there is difficulty relaxing the pelvic floor. Warning signs — such as bleeding, weight loss, anemia, recent onset after age 45, or a family history of colorectal cancer — lead to a colonoscopy. In persistent cases, tests such as anorectal manometry, the balloon expulsion test or defecography differentiate slow-transit constipation from obstructed defecation.

How we treat it at Femi Saúde

Treatment starts with adjustments: gradually increasing fiber, adequate hydration, physical activity, a regular time to have a bowel movement, and correct posture on the toilet, with foot support. When this isn't enough, bulk-forming or osmotic laxatives, or, in selected cases, specific medications, are recommended under guidance. If the evaluation shows pelvic floor dysfunction, biofeedback physical therapy is the most effective treatment. Throughout the process, the coloproctology team at Femi Saúde monitors the response, treats any associated hemorrhoids and fissures, and works together with nutrition and pelvic physical therapy.

What we offer