Chronic Constipation Treatment in Katy, TX
When fiber and over-the-counter laxatives are not enough, we look for the reason and match the treatment to it.
Understanding Chronic Constipation
Constipation is one of the most common digestive problems, affecting about 1 in 6 adults. It is not only about how often you go. Doctors also look at how hard your stools are, how much you strain, and whether you feel you have fully emptied. Constipation is usually called chronic when two or more of these symptoms happen often and have been present for at least three months, starting at least six months ago.
Symptoms of chronic constipation
- Fewer than three bowel movements a week
- Hard, dry or lumpy stools
- Straining, or spending a long time on the toilet
- A feeling that the bowel has not fully emptied
- A feeling of blockage in the rectum
- Needing to use a finger, or press around the anus or vagina, to pass stool
- Bloating and abdominal discomfort
Types of chronic constipation
Finding the type of constipation helps choose the right treatment:
- Normal transit constipation, the most common type, where stool moves through the colon at a normal speed but is still hard or difficult to pass
- Slow transit constipation, where stool moves through the colon more slowly than normal
- Dyssynergic defecation, a pelvic floor problem in which the muscles that should relax during a bowel movement tighten instead. It is common, often missed, and does not respond well to laxatives alone.
- Constipation-predominant IBS, where constipation comes with belly pain that is linked to bowel movements
What causes constipation?
- A low-fiber diet, not drinking enough fluids, or too little physical activity
- Ignoring the urge to go, or changes in routine and travel
- Medicines, including opioid pain medicines, some antidepressants, iron and calcium supplements, some blood pressure medicines, antihistamines, medicines for overactive bladder, and some weight-loss and diabetes medicines
- Pregnancy
- Medical conditions such as an underactive thyroid, diabetes, high calcium levels, Parkinson’s disease or multiple sclerosis
- Problems with the pelvic floor muscles or the rectum
When to see a gastroenterologist
Book a visit if constipation has lasted more than a few weeks, keeps coming back, or has not improved with fiber and over-the-counter laxatives, or if you rely on laxatives or enemas to go. See a doctor promptly if constipation comes with:
- Blood in the stool or black, tarry stools
- Weight loss you cannot explain
- Anemia on a blood test
- A new change in bowel habits that starts at age 45 or older
- Stools that have become much thinner
- A family history of colon cancer or inflammatory bowel disease
Go to the emergency room or call 911 if you cannot pass stool or gas and also have severe belly pain, a swollen belly or vomiting, or if you have heavy bleeding from the rectum or feel faint.
Our approach to Chronic Constipation
Many patients come to us after trying several laxatives with little success. Our gastroenterologists start with a detailed history, including your diet, medicines and bowel habits, and an exam that includes a gentle rectal exam. This can give early clues about whether the pelvic floor muscles are working properly.
Finding the cause
Many people need no special tests. Depending on your symptoms, your evaluation may include:
- Blood tests for anemia, thyroid function, calcium and blood sugar
- A colonoscopy if you have warning signs or are due for colon cancer screening
- Anorectal manometry and a balloon expulsion test, which measure how well the rectum and pelvic floor muscles work together. These are the key tests for dyssynergic defecation.
- A colon transit study, which measures how quickly stool moves through the colon
Colonoscopies are performed by our own physicians at Zazen Surgery Center, in the same building as our clinic.
Treatment matched to the cause
- Diet changes with a registered dietitian, including adding fiber slowly, especially soluble fiber such as psyllium, and foods that can help, such as prunes and kiwifruit. Fiber helps many people, but it may not help, and can add to bloating, in slow transit constipation or pelvic floor problems.
- Over-the-counter laxatives used the right way. Osmotic laxatives such as polyethylene glycol (PEG) and magnesium, and stimulant laxatives such as senna and bisacodyl, are safe and effective for many people. We will tell you which one to use, how much and for how long. People with kidney disease should not take magnesium laxatives unless their doctor approves.
- Prescription medicines when over-the-counter options are not enough. These include linaclotide, plecanatide, lubiprostone, prucalopride and lactulose, and tenapanor for IBS with constipation. They work in different ways to draw water into the bowel, soften stool or speed up the colon.
- Biofeedback therapy for dyssynergic defecation. A specialized physical therapist teaches you to relax and coordinate the pelvic floor muscles during a bowel movement. It is the recommended first treatment for this type of constipation and works better than laxatives in studies.
- Treatment for medicine-related constipation, including reviewing your medicines with you and your prescribing doctors. For constipation caused by opioid pain medicines, we start with regular laxatives and add prescription medicines made for this problem if needed.
- Good toilet habits, such as going after meals when the colon is most active, not delaying the urge, and using a footstool to raise your knees.
Surgery is rarely needed for constipation and is only considered after careful testing.
Constipation is not just about eating more fiber. For many patients the problem is how the pelvic floor muscles work, and once we find that, treatment can finally make a difference.
Dr. Vivian Asamoah, MD
Board-Certified Gastroenterologist, Integrative Medicine
Key Facts
What you need to know
Everything you need to know before your appointment.
Who should consider this
Anyone with constipation that has lasted for months or has not improved with fiber and laxatives.
Learn more
What to expect
A detailed first visit, a careful exam, and testing only when it will change your treatment.
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Recovery and results
Many people improve within weeks, and pelvic floor therapy usually takes a few months.
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Why our team
Gastroenterologists and registered dietitians who look beyond fiber to find what is really causing constipation.
Learn moreWhat Our Patients Say
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Dr. Asamoah is a wonderful doctor with an excellent bedside manner who cares about what you're going through and leaves no stone unturned I highly recommend.
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From the moment of entering the Surgical Center, I felt like I was an individual and my needs were of concern. The actual procedure experience was great. Dr. Asamoah has a way of making you feel at ease. She's gathered a staff of people who do the same thing. Highly recommend.
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I was very impressed with both doctors' expression of authentic interest in and concern with my health concerns. A rare experience.
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Highly recommend. The office staff and Dr. Asamoah were helpful, friendly and very accommodating! We left feeling like we have answers and are hopeful.
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First time visit. Impressed by the clean and nice environment. Friendly staff. Doctor takes her time to hear you and answer any questions you have. Great experience.
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Wow!!! Absolutely amazed by the facility and doctor! Dr. Vivian Asamoah is extremely educational, professional, and so sweet! I went in feeling extremely anxious because of my health issues, and she put me at ease by explaining every detail! Xiomara, her MA, was so helpful and thorough. Honestly, she is by far one of the best doctors I've seen. God bless this office and everyone in it! I most definitely recommend her!
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I went in to check on issues I was having with my colon. I was in a panic and was not feeling my best. Dr. Asamoah was kind and very understanding, with great patient-relationship skills. She is genuine and truly professional. Her staff is great and wonderful. I will recommend my family and friends.
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Had a great experience. The doctors are very understanding and comforting. They listen to all of your needs. Loved their music. Very relaxing.
Individual results vary.
Ready to talk with a specialist about your constipation?
Schedule a consultation with our team. We are here to help you find lasting relief.
Expert GI. Whole-person care. All under one roof.Common questions about Chronic Constipation
Doctors usually call constipation chronic when you have two or more symptoms, such as fewer than three bowel movements a week, hard stools, straining or a feeling of incomplete emptying, and they have been present for at least three months, starting at least six months ago.
See a doctor if constipation lasts more than a few weeks, keeps coming back, or does not improve with fiber and over-the-counter laxatives. See a doctor promptly for blood in the stool, weight loss, anemia, or a new change in bowel habits starting at age 45 or older.
For most people, polyethylene glycol (PEG) is safe to take every day for a long time. Stimulant laxatives such as senna and bisacodyl can also be used regularly if your doctor recommends it. There is no good evidence that they damage the colon, but the label says not to use them for more than a week without asking a doctor. Avoid magnesium laxatives if you have kidney disease, unless your doctor says they are safe. Talk to your doctor about the best option for you, especially if you have kidney or heart problems.
It is a common pelvic floor problem in which the muscles that should relax during a bowel movement tighten instead. It often causes straining and a feeling of incomplete emptying, and it is best treated with biofeedback therapy rather than laxatives alone.
Foods with fiber, such as whole grains, beans, fruits and vegetables, can help, along with enough fluids. Prunes and kiwifruit have been shown to help with constipation. Add fiber slowly to avoid gas and bloating.
Yes. Common causes include opioid pain medicines, some antidepressants, iron and calcium supplements, antihistamines, medicines for overactive bladder, some blood pressure medicines and some weight-loss and diabetes medicines. Do not stop a prescribed medicine on your own. Talk to your doctor about other options.
Yes. Constipation is one of the most common causes of bloating and abdominal discomfort. Treating the constipation often relieves these symptoms too.
Not always. A colonoscopy is recommended if you have warning signs such as bleeding, weight loss or anemia, or if you are 45 or older and due for colon cancer screening. Many people with constipation do not need one.
Yes. Straining and hard stools put pressure on the veins around the anus, which can cause hemorrhoids and anal fissures. Treating constipation is one of the best ways to prevent them.
A gastroenterologist can find the type and cause of your constipation, test for pelvic floor problems, recommend the right laxative or prescription medicine, and arrange biofeedback therapy when needed.
Houston Gastro Institute diagnoses and treats chronic constipation at our clinic on Kingsland Boulevard in Katy, TX. Patients come to us from across west Houston, including Cinco Ranch, Fulshear, Richmond, Brookshire, Sugar Land and Cypress. Colonoscopies are performed at Zazen Surgery Center in the same building.