Digestion is a complex system of chemical reactions to break down food particles to water-soluble molecules.
Once broken down, these molecules can be absorbed by the blood, thereby feeding nutrition to our bodies.
A bite of a sandwich will take a long and fascinating journey from the mouth, down the esophagus, into the stomach, along the small, but lengthy intestine, and finally to the colon, or large intestine.
The large intestine is where final water absorption occurs and waste is passed through the rectum.
Particles of that bite of sandwich must pass through chambers (called sphincters) by a wavelike contractions of the muscles of the intestine until finally arriving in the descending colon where waste is evacuated from the body, also known as a bowel movement.
Healthy bowel movements can vary from person to person as often as three times a day to as little only once every few days.
Constipation, on the other hand, an inability to move or fully evacuate your bowl, can be a frustrating and painful experience.
Manifesting as hard, dry stools requiring excessive straining to pass, abdominal bloating, or the feeling of incomplete evacuation, this common condition can affect children adults alike.
According to the Harvard Medical School, constipation affects 80% of people at some time in their lives and the U.S. alone spends over $800.000.000 a year in over-the-counter remedies per year.(1)
Why do we become constipated?
What are the contributing factors to constipation? Is medical intervention always necessary? If so, how do we know when to call our doctor?
Why am I constipated?
Constipation can result from a number of reasons including too little fiber consumption, stress, depression, a sedentary lifestyle, not enough water in the diet, or even as a side effect of some medications.
The characteristics of constipation include:
- Straining with bowel movements.
- Excessive time needed to pass a bowel movement.
- Hard stools.
- Pain with bowel movements secondary to straining.
- Abdominal pain.
- Abdominal bloating.
- The sensation of incomplete bowel evacuation.
Although the above factors outline the characteristics of constipation, it’s important to note that constipation can be further broken down into occasional and chronic categories.
- Occasional Constipation: Symptoms are usually sudden and last for a short duration of a few days. Common reasons for occasional constipation are due to change in diet, exercise or medications.
- Chronic Constipation: Above-noted symptoms of constipation will last for longer periods of time up to a few weeks and can return with frequency. According to Dr. Ananya Mandal, chronic constipation presents slightly more often in women and affects Caucasians more than other ethnicities.(2)
Remedying occasional constipation can be as simple as bulking up on fiber intake with nuts and whole grains, fresh fruit and vegetables, and fiber-dense dried fruits such as raisins, prunes and apricots.
In addition, increasing clear fluid consumption to ensure the bowel has plenty of water to absorb and introducing good bacteria (probiotics) into your system will encourage bowel regularity.
More stubborn constipation may require over-the-counter laxatives that can help draw water into the colon or stimulate peristalsis in order to move the bowel.
Although effective, the Mayo Clinic advise these methods be used as a last resort as overuse can lead to electrolyte imbalance, diarrhea and cramping.(3)
For chronic (idiopathic) constipation, a patient should seek physician’s care to ensure there is no underlying disease.
An office visit will typically include a thorough exam with imaging and blood tests to rule out underlying pathology or bowel impaction.
In addition to over-the-counter remedies, your physician may treat with prescription medications to stimulate a bowel movement.
Often times constipation itself is not the disease, rather the symptom and indication of a more complex pathology.
However, because of the nature of this bowel complication and the ramifications, if left untreated, it’s important to treat constipation with the same expediency as the underlying disease itself.
Some of these diseases may include:
- Diabetes Insipidus.
- Cystic Fibrosis.
- Multiple Sclerosis.
- Parkinson’s Disease.
- Colorectal Cancer.
- Diverticular Disease.
In these cases, the physician overseeing the care of the underlying disease will be the best source for the proper relief of a patient’s constipation.
When Should I see a Doctor?
According to the American Gastroenterology Society, you should seek medical attention when experiencing the following:(4)
- Constipation lasting more than three weeks.
- Stomach pain when passing stool.
- Stools are consistently thinner.
- Blood in your stool.
- Black or tarry-looking stool.
- Feeling weak and tired.
- Unintentional weight loss.
Back Pain and Constipation
Constipation and back pain commonly go hand in hand.
Pathology of the musculoskeletal system, particularly the spine, can impact bowel regularity. In addition, constipation can sometimes induce back pain.(5)
When dealing with both back pain and constipation congruently, deciphering which is the cause and which is the effect may feel similar to chasing the chicken and the egg question. (Which came first?)
So how do you answer this question?
Firstly, it’s important to gather a bit of understanding of the anatomy of the colon and the spine to see how they work together.
Anatomy of the Colon
The large intestine also known as the colon is the final step in digestion with a primary job of absorbing water into the undigested food and expelling waste from the body.
The colon is divided into five basic sections, labeled ascending, transverse, descending, sigmoid, and rectum. When waste reaches the sigmoid colon the sensation of an urgency to pass the waste is felt.
The Spinal Cord
The gastrointestinal system is regulated by the autonomic nervous system, or the unconscious nervous system that regulates most organs in our body through the central nervous system (brain and spinal cord).
This cord runs through openings in the spinal column which is divided into four sections; cervical, thoracic, lumbar and sacral.
The lower spinal region (lumbar and sacral) is the primary location for nerves involved with controlling the large intestine.
Because the lower portion of the spine and the sigmoid colon are both located in the sacral region, it’s easy to understand why back pain may be felt with constipation.
One simple reason for experiencing back pain from constipation could be due to the straining involved with difficult-to-pass stools.
According to Dr. Victor Marchione, this straining can put pressure on the back, aggravating discs in the lower region of your spine.(6) When these loosened discs (slipped disc or herniation) become exacerbated, the pain will be evident.
In addition, sometimes lower back pain may be felt due to pressure on the sacral nerve due to fecal impaction.
Fecal impaction, or a severe blockage in the colon, would require a trip to the doctor. In addition to sharp or stabbing back pain, symptoms of abdominal distention or bloating, cramping, nausea and even fever may be present along with high or low blood pressure and dizziness.
This condition would require urgent care to completely eliminate the blockage.
Distress of the Low Back
It’s also important to note, however, that constipation can arise from the pathology of the lower back including muscles and the nervous system.
As stated by Dr. Edward Group from the Global Healing Center, when discussing constipation due to back injuries, “When the lower back muscles spasm and interfere with the autonomic nerves responsible for the intestinal action that cause bowel movements.”(7)
In other words, when the back is already in distress, straining to defecate may only exacerbate the painful symptoms.
In addition, many pain-relieving medications often given for muscular sprain or strain, particularly opioid medications (i.e., codeine, hydrocodone, and oxycodone), are known to elicit constipation.
Spinal Cord Injuries
Also, of note, is that that digestion is regulated by the autonomic nervous systems, originating from the spinal cord.
Because of this, it’s easy to see why those with spinal cord injuries or diseases of the central nervous system such as multiple sclerosis or Parkinson’s disease may inhibit regular bowel movement.
According to the Mayo Clinic this interruption of communication between the central nervous system and the bowel (termed as neurogenic bowel) can be managed with medications, anal irrigation and surgical intervention including colorectal reconstructive surgery.(8)
Because of the complex nature of the digestive system in conjunction with the central nervous system, identifying the underlying reasons for constipation and back pain is not always simple and straightforward, and a trip to the doctor may be warranted.
The Final Word
In conclusion, consumption of adequate fiber and water, daily exercise and avoidance of long-term opioid use can aid in keeping the colon healthy and bowel movements regular.
And when constipation arises, although painful and frustrating, symptoms can oftentimes be remedied by a change in diet, lifestyle, over-the-counter stool softeners, or bulking agents.
This occasional bowel irregularity should not cause worry or concern.
Also, with the help of a physician, chronic constipation can be managed with prescription drugs and additional medical intervention.
As noted, however, constipation when accompanied by symptoms of severe back and abdominal pain, blood in the stool, black or thin stools, fever, or dizziness should be considered acute and seek urgent medical care.