Can constipation kill you?

Constipation is characterized by persistent difficulty in defecating. It is a common disorder in the community particularly affecting the elderly and those with intellectual disabilities and neuropsychiatric disorders. It can also be caused by numerous medications including analgesic, antidepressant, antihypertensive and anticholinergic agents. It may be asymptomatic or it may produce abdominal pain/cramps, bloating, nausea and anorexia progressing to urinary incontinence and fecal impaction, or paradoxical diarrhea due to overflow.

This review demonstrated that constipation may also kill you. A wide range of mechanisms associated with constipation may result in death including:

• bowel obstruction,
• stercoral colitis with ulceration,
• perforation and peritonitis,
• respiratory compromise,
• abdominal compartment syndrome,
• venous thrombosis with pulmonary thromboembolism.

Moreover, constipation may exacerbate pre-existing diseases and treatments such as laxative and enemas may be lethal. The autopsy examination of a case with constipation and megacolon should take into account all of the pre-existing conditions, as well as the possibility of underlying disorders such as Hirschprung disease. Review of the decedent’s medical and drug history and level of supportive care will be important. Toxicological evaluations may be useful.

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Constipation is defined as having fewer than three bowel movements per week or experiencing difficulty in passing stool. The condition is common and often difficult to treat. WebMD recommends diet and lifestyle changes, such as:

• Drink an extra two to four glasses of water a day, unless your doctor tells you to limit fluids for another reason.
• Try warm liquids, especially in the morning.
• Add fruits and vegetables to your diet.
• Eat prunes and bran cereal.
• Exercise most days of the week. When you move your body, the muscles in your intestines are more active, too.
• Don’t ignore the urge to poop. Listen to your body when it’s telling you it’s time to go.
• Eat foods with probiotics such as yogurt and kefir.
• ​​Skip processed meats, fried foods, and refined carbs such as white bread, pasta, and potatoes. You can eat lean meats such as poultry and low-fat dairy products.
• Keep a food diary and make a note of any foods that constipate you.
• Adjust how you sit on the toilet. Raising your feet, leaning back, or squatting may make it easier to poop.
• Take an over-the-counter fiber supplement (Metamucil®, MiraLAX®, Citrucel® or Benefiber®). Start with a small amount at first.
• Avoid reading or using your phone or other devices while you’re trying to move your bowels.
• Drink less alcohol and caffeinated drinks, which can make you dehydrated.
• Talk to your doctor about bowel training. It can help train your body to pass stool shortly after breakfast every morning.
• Don’t rush when going to the bathroom. Give yourself time to relax, which can help your digestive muscles relax.
• Talk to your doctor about any medications that could be causing your constipation.

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Because conventional options are often not as successful as hoped, many sufferers turn to so-called alternative medicine (SCAM). But is SCAM really a solution?

A recent review found that “acupuncture or electroacupuncture and herbal medicine are effective in treating constipation, whereas findings on massage and moxibustion are inconclusive.” Our own assessment [‘Oxford Handbook…’ (2008)] of the evidence disagrees and rated as follows:

• Beneficial: Psyllium
• Likely to be beneficial: abdominal massage, biofeedback, fibre
• Unknown effectiveness: acupuncture, aloe vera, ayurvedic medicine, meditation, Padma Lax, probiotics, herbal tea.

Whichever way we turn it, constipation is a more serious condition than many of us think, and neither conventional healthcare nor SCAM are convincingly successful in helping those who suffer from it.