Secondary Constipation – Associated Conditions

Constipation may be Primary (related directly to the functioning of the large intestine), or Secondary (related to other factors such as diet & lifestyle, medications, or other conditions. There are quite a few conditions associated with constipation – and some of them may surprise you!

What Are The Top Conditions Associated With Constipation?

See below for a list of the most common conditions associated with constipation, descriptions of the conditions, key symptoms, and assessment approaches to diagnose them.

Hypercalcemia

Hypercalcemia means the calcium level in your blood is too high. This can lead to: weak bones & increased risk of fractures, kidney stones, and problems with heart and brain function. Hypercalcemia is most commonly due to overactive parathyroid glands. Other causes may include cancer, certain other medical disorders, some medications (like lithium), or taking too much supplemental calcium or vitamin D.
Symptoms: Aside from constipation, symptoms may include excessive thirst and frequent urination, stomach upset, nausea and vomiting, bone pain, muscle weakness, depression, confusion, lethargy and fatigue, palpitations and fainting, lightheadedness or other heart problems.
Assessment: Serum calcium level elevated

Hypothyroidism

Hypothyroid symptoms are highly variable, and may develop slowly over a period of years – you may simply attribute them to aging. The thyroid is largely responsible for our metabolism, and when it’s underactive (in Hypothyroidism), things tend to slow down – including digestion and elimination.
Symptoms: A common symptom of hypothyroidism is CONSTIPATION. Other symptoms might include: fatigue, sensitivity to cold, weight gain or difficulty losing weight, dry skin, coarse or thinning hair, muscle or joint pain or stiffness, depressed mood, and impaired memory.
Assessment: Hypothyroid symptom questionnaire, Thyroid Function Tests (TFTs) abnormal, low basal body temperature

Nervous System Impairment

The Autonomic Nervous System (ANS) is responsible for digestive function. Less commonly, constipation may be associated with damage to the nervous system seen in spinal cord injury or Parkinson’s Disease. Diabetes may also fall into this category.

Diabetes

A disorder of blood sugar regulation, diabetes has profound long term consequences throughout the body. Excess sugar acts almost like granules of glass – scraping and causing microscopic damage to the linings of blood vessels and delicate nerve fibres. Because blood vessels & nerves run throughout the body, the implications of this damage can show up almost anywhere in the body. If nerves in the autonomic nervous system (part of the nervous system that controls digestion) are damaged, this may result in altered bowel function, including constipation, diarrhea, or alternations between the two. High blood sugar may also contribute to dehydration, which in turn may cause constipation.
Symptoms: Increased thirst or urination, weight change, extreme fatigue, blurry vision, frequent or difficult to resolve infections, slow healing bruises or cuts, numbness or tingling in hands or feet, alterations to bowel habits. Again, symptoms are highly variable because damage may occur anywhere in the body.
Assessment: Fasting blood glucose (FBG), Hemoglobin A1C (HbA1C)

Proctitis, Anal Fissure, Hemorrhaids, Stricture of Colon, Volvulus, Diverticulitis or Colorectal Cancer

These may be conditions or symptoms conditions that affect the structure of the colon – making it difficult to pass stool.

  • Proctitis is inflammation of the anus and lower 6 inches of rectum, which may cause pain and a persistant sensation of needing to defecate (even though nothing or very small amounts at a time are passed). IBD (Inflammatory Bowel Disease – Crohn’s Disease & Ulcerative Colitis), Sexually Transmitted Infections (STIs) and radiation therapy may be causes of proctitis.
  • Anal fissures are small tears in the tissue lining the anus. It typically causes burning or stinging pain, and there may be bleeding noticed after a bowel movement. They are typically the result of passing hard or large stools, and are often associated with straining, or spasm in the anal sphincter.
  • Hemorrhoids are swollen veins in the rectum (internal) or anus (possibly external or protruding) that may become painful, especially on defecation. External hemorrhoids may be visualized as pink or reddish small moist bumps around the anus. Hemorrhoids are typically caused by constipation with excessive straining or the passage of large and dry stool. Hemorrhaids may also be caused be obesity, weight gain or straining during pregnancy, sitting for long periods or circulatory problems. Hemorrhoids may develop blood clots, which lead to burning, itching or bright red blood on passing stool. Hemorrhoids are typically caused by constipation, but their discomfort may also inhibit the passage of stool.
  • Strictures of the colon are a narrowing of the inside of the large intestine, that may present with a gradual onset of changes in bowel habits, thinner bowel movements and difficult evacuation of stool. In the extreme, strictures may lead to bowel obstruction – requiring immediate emergent attention, and characterized by: severe crampy abdominal pain often coming in waves, trapped gas and abdominal distension (protruding belly), nausea or vomiting, and inability to pass stool. Strictures may be caused by IBD, hernias (a protrusion of the intestines through the abdominal wall that can cause it to become pinched), scarring & adhensions secondary to diverticular disease, surgeries of the appendix, reproductive organs or colon, or tumors pressing on the bowel and pinching it closed.
  • Volvulus is when a segment of bowel twists around itself pinching off passage and leading to obstruction. This is most commonly seen in adults over 65 with chronic constipation.
  • Diverticulitis is an outpouching of the tissue lining the large intestine. These pouches are at risk of infection which leads to inflammation that is called diverticulitis. Subsequent healing may lead to scarring and adhesions in the colon that may contribute to stricture formation and obstruction.
  • Colorectal Cancer accounts for about 50% of large bowel obstructions. It may cause a gradual narrowing of the large intestines lumen (inner diameter) that leads to intermittent constipation and possibly bowel obstruction over time.

Assessment
Physical exam including digital rectal exam for proctitis, anal fissures and hemorrhoids.
Endoscopic exam, barium enema or CT scan may be warranted in the other instances.

Assessing for conditions associated with constipation may be an important tool in determining the cause of your constipation, and consequently getting the right treatment for your constipation.

Related Reading:
Chronic Constipation Assessment & Diagnosis (How to screen for and diagnose different types of constipation)
Alarm Features of Chronic Constipation (When to visit the ER or get a referral for colonoscopy)