Constipation occurs when bowel movements become difficult or less frequent. Constipation is not a disease, but a symptom related to a family of diseases generally classified as defecation disorders.

The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. In general, if you experience two or more of the following symptoms during bowel movements for at least three months, you may be suffering from chronic constipation:

• fewer than three bowel movements per week
• the need to strain at least 25 percent of the time
• a feeling of incomplete evacuation of the bowels at least 25 percent of the time
• hard or lumpy stools at least 25 percent of the time

Many people who fit the medical definition for constipation do not consider themselves to be constipated. In a clinical study, 33 percent of women who met the above symptom criteria for constipation did not regard themselves as constipated.⁴

Constipation is one of those topics few people like to talk about, but those who suffer from the condition know it can be both painful and frustrating. Almost everyone suffers from constipation at some time. Studies show up to 16 percent of women in the United States meet symptom criteria for chronic constipation. Moreover, people tend to suffer with the condition for a long time. In one study, 45 percent of individuals with constipation reported having the condition for five years or more. ⁴

You do not have to be uncomfortable any longer; you may be suffering from a treatable form of constipation.

Most of the time, chronic constipation can be relieved using a combination of diet, exercise, and medication. However, in some extreme cases, chronic constipation may be a symptom of a more serious bowel problem that may require a surgical procedure.

If diet and exercise do not relieve your chronic constipation, you should discuss treatment options with a physician. You may be able to use therapies such as biofeedback to retrain your muscles, or you may be suffering from a form of chronic constipation, Obstructed Defecation Syndrome (ODS), a functional disorder or spasm of pelvic floor muscles that may be resolved with a surgical procedure.

People suffering from ODS can sometimes use biofeedback to retrain the muscles that control the release of bowel movements. Biofeedback uses sensors and a computer to monitor anal muscle activity and show patients when they are using the correct anal muscles.

If you have chronic constipation and also have one or more of the following symptoms at least 25 percent of the time during bowel movements, you may have ODS:

• Multiple trips to the bathroom
• Prolonged straining
• Incomplete elimination, and/or prolonged time to have a bowel movement
• Routine use of laxatives or enemas
• The need to press around your genitals or anus to have a bowel movement

Proper diagnosis is the key to successful treatment of defecation disorders, such as ODS. Diagnosis can be complex and requires evaluations by your primary care physician, gastroenterologist, and colorectal surgeon to be sure the actual cause – or causes – of the disorder is identified. In addition to a physical exam, some of the diagnostic tests that may be performed are:

• Colonoscopy — allows a doctor to look at the interior lining of the large intestine (rectum and colon) through a thin, flexible viewing instrument called a colonoscope. The test looks for abnormalities, including narrowing or obstructions and inflammatory diseases such as Crohn’s disease and ulcerative colitis.
• Colonic marker studies — the patient swallows small radiopaque, or markers, which can be seen on x-ray films. During a period of seven days, the patient is x-rayed to track the progress of the markers and see how quickly they are moving through the digestive tract.
• Electromyography (EMG) — tests for weakness in the pelvic floor muscles and the muscles surrounding the anus to determine how well they are working.
• Anorectal manometry — tests how well the muscles surrounding the anus are working.
• Dynamic defecography — during this test, the patient sits on a special toilet and strains while being viewed under x-ray. Images are taken while a paste mixture passes through the bowel. This allows your doctor to assess bowel function.

ODS is treatable. If you do not respond to conservative treatment (diet, exercise and medication), you may consider a surgical procedure. Some surgeons can treat ODS with a new procedure called Stapled Transanal Rectal Resection (STARR).

STARR is a surgical procedure that is performed through the anus, requires no external incisions, and leaves no visible scars. Using a surgical stapler, the procedure removes excess tissue in the rectum and reduces the deformities that can cause ODS. Patients undergoing STARR are typically hospitalized one to three days and experience minimal recovery time after leaving the hospital.

As with any surgical procedure, individuals respond differently. However, in a recent clinical study, chronic constipation symptoms significantly improved in all patients undergoing the STARR procedure. Overall patient satisfaction with the STARR procedure was high, with 90 percent of patients rating the results as either good or excellent.³

You should check with your insurance provider.

To find a local surgeon who performs the STARR procedure, use our Find A Surgeon tool or call 800-USE-ENDO. As with any surgical procedure, there are risks and complications that accompany STARR. Consult your physician to see if the procedure is right for you.