Constipation refers to the passage of less than three stools per week, often associated with abdominal bloating, pain, hard stool, and straining. In patients with inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) or Crohn’s disease (CD), constipation is rare, and patients more commonly experience significant diarrhea. However, there are specific situations in which constipation can be a major symptom of IBD.
Ulcerative colitis and constipation
People with UC limited to the rectum, referred to as proctitis, can experience constipation during a flare of the disease. Management of constipation in this setting involves treating the active UC, rather than treating the constipation itself. Mesalamine enemas and suppositories are very effective in treating mild to moderate flares of proctitis. Steroid foam suppositories can also be used in more severe cases or in those who do not respond to mesalamine. A probiotic called VSL#3 has been shown to also induce remission in patients with mild to moderate UC flares and where constipation is a symptom.
**Crohn’s disease and constipatio **
Constipation in the setting of CD can be very serious. Individuals with CD can experience constipation when strictures form within the small or large intestines. Strictures form as a result of long-term inflammation that leads to scarring and narrowing of the intestines. As a result of this narrowing, they can partially, or even completely, block the passage of stool. If a blockage is complete, hospitalization and surgical intervention may be required. Management of CD with strictures is complicated, with best outcomes resulting from treatment with immunomodulator medications and biologic agents that interfere with the inflammatory response in the gut. In addition, treating constipation with fiber supplements may worsen blockages if strictures are present. Therefore, it is imperative to differentiate constipation from active, stricturing CD that can occur from functional abnormalities of the colon.
What if my IBD is in remission?
When IBD is well controlled and in remission, constipation may occur as a result of a functional abnormality of the colon, also known as irritable bowel syndrome (IBS). Patients with IBD oftentimes also have related IBS. Management of constipation in this setting is based on relieving symptoms with fiber supplementation (Benefiber, Citrucel, Metamucil), which absorbs water in the colon, bulking up the stool for easier passage. Miralax, a polyethylene glycol, also works well to treat constipation related to IBS. Again, it is important to discuss any symptoms you are experiencing with your doctor to ensure that starting a constipation regimen of fiber supplementation is safe and appropriate for your condition.
How do I prevent from getting constipated?
Most importantly, you should continue your IBD medications as prescribed by your doctor to maintain disease remission. Maintaining a healthy diet, drinking plenty of fluids, and avoiding foods that might affect your disease or related IBS will help prevent constipation. Finally, maintaining an active lifestyle and exercising will promote gut motility and help keep your bowel movements regulated. You should work closely with all of your health care providers (gastroenterologist, nutritionist, dietician, etc) to maintain healthy gut function.
Constance Pietrzak, M.S., M.D., is a gastroenterologist with Advocate Medical Group in Chicago. Through her work with HealthCentral, she strives to expand knowledge on gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD). Follow Constance on Facebook and Twitter for timely updates on IBD, and more.