What diseases can cause constipation?

From the Guidelines

Constipation can be caused by various diseases, including neurological conditions, endocrine and metabolic disorders, gastrointestinal diseases, systemic conditions, and psychiatric disorders, as well as certain medications, with the most recent evidence suggesting that chronic small intestinal dysmotility can also lead to constipation in its early stages 1.

Causes of Constipation

• Neurological conditions: Parkinson's disease, multiple sclerosis, and spinal cord injuries disrupt normal nerve signals to the intestines
• Endocrine and metabolic disorders: hypothyroidism, diabetes, and hypercalcemia slow intestinal motility
• Gastrointestinal diseases: irritable bowel syndrome, diverticulosis, colorectal cancer, and anal fissures directly impact bowel function
• Systemic conditions: scleroderma and amyloidosis affect smooth muscle function throughout the body, including the intestines
• Psychiatric disorders: depression and eating disorders can contribute to constipation through various mechanisms
• Medications: opioid pain relievers, antidepressants, iron supplements, calcium channel blockers, and antacids containing aluminum or calcium can worsen constipation as a side effect

Management of Constipation

The management of constipation involves a combination of dietary changes, bulk forming laxatives, osmotic laxatives, and stimulant laxatives, with the most recent evidence suggesting that 5HT 4 receptor agonists (prucalopride) can be effective in treating chronic constipation in women when other laxatives have failed to provide an adequate response 1.

Key Considerations

• The underlying mechanism of constipation typically involves disruption of normal intestinal muscle contractions, alterations in fluid balance within the intestines, or interference with the neurological signals that regulate bowel movements
• Certain medications, such as opioid pain relievers, can worsen constipation as a side effect, and alternative treatments should be considered when possible
• The management of constipation should be individualized and based on the underlying cause and severity of symptoms, with the most recent evidence guiding treatment decisions 1.

From the FDA Drug Label

Uses Relieves occasional constipation (irregularity) Generally causes bowel movement in 6 to 12 hours The FDA drug label does not answer the question.

From the Research

Diseases that Cause Constipation

• Neurological diseases such as Parkinson's disease 2, 3, 4, 5, 6
• Spinal cord injury 3, 4, 5, 6
• Multiple sclerosis 3, 4, 5, 6
• Stroke 4, 5, 6
• Cerebral palsy 4
• Diabetic polyneuropathy 4
• Alzheimer's disease 6
• Traumatic spinal cord injuries 4
• Spina bifida 4
• Hirschsprung's disease 5
• Intestinal neuronal dysplasia 5
• Primary chronic autonomic failure (pandysautonomias) 5
• Degenerative, ischaemic or neoplastic disorders affecting the central nervous system 5, 6

Specific Conditions

• Irritable bowel syndrome 3
• Slow transit constipation 3
• Pelvic floor dysfunction 3
• Colorectal symptoms in patients with neurological diseases 4

Key Findings

• Constipation is a common symptom in patients with neurological diseases, affecting over 50% of patients with Parkinson's disease 2
• The prevalence and severity of constipation in Parkinson's disease tend to parallel the course of both motor and nonmotor phenomena such as cognitive decline and depression 2
• Management of constipation in patients with neurological diseases may be complicated by several patient factors, including dysphagia, cognitive impairment, depression, and weak sphincter tone 2, 6