Can constipation cause colitis?

From the Guidelines

Colitis is not typically caused by constipation, as they are separate digestive conditions with different underlying mechanisms. Colitis refers to inflammation of the colon, usually caused by infections, inflammatory bowel diseases like ulcerative colitis or Crohn's disease, or medication side effects. Constipation, on the other hand, involves infrequent bowel movements and difficulty passing stool. While chronic constipation can cause complications like hemorrhoids or anal fissures, it doesn't directly cause colitis. According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1, proximal constipation is considered a differential diagnosis at the time of diagnosis and when there is an incomplete response to treatment or flare.

If you're experiencing symptoms of either condition, it's essential to address them separately. For constipation, increase fiber intake gradually to 25-30g daily, drink plenty of water (at least 8 glasses daily), exercise regularly, and establish a regular bathroom routine. Over-the-counter options include fiber supplements like psyllium (Metamucil), stool softeners like docusate sodium (Colace), or osmotic laxatives like polyethylene glycol (MiraLAX).

• Key considerations for managing constipation include:
  • Gradually increasing fiber intake
  • Staying hydrated
  • Regular exercise
  • Establishing a regular bathroom routine
• If symptoms of colitis are present, such as diarrhea, abdominal pain, or blood in stool, these require different treatments and medical evaluation, as outlined in the guidelines 1. Some important points to consider when evaluating colitis symptoms include:
  • Infection, including sexually transmitted
  • Proximal constipation
  • Crohn's disease
  • Co-existent irritable bowel syndrome
  • Rectal prolapse/solitary rectal ulcer The distinction between colitis and constipation matters because treating constipation won't resolve colitis, and some treatments for constipation could potentially worsen colitis symptoms in certain cases, highlighting the need for careful evaluation and management based on the underlying condition, as recommended by the guidelines 1.

From the Research

Colitis from Constipation

• There is no direct evidence to suggest that constipation causes colitis, but constipation can be a symptom of underlying conditions that may lead to colitis 2, 3.
• Constipation is present in 80% of children with corrected anorectal malformations, usually associated with rectal dilation and hypomotility 3.
• Senna, a stimulant laxative, has been shown to be effective in treating constipation in children with anorectal malformation, and may help prevent complications such as colitis 3.
• Polyethylene glycol (PEG) has been suggested to protect against pathogen colonization by improving colonic barrier function, and may ameliorate experimental colitis in rats 4.
• The management of acute colitis in adults depends on the establishment of the cause, and most forms of infectious colitis are treatable with antimicrobials 5.
• Acute severe ulcerative colitis (ASUC) is a distinctive ulcerative colitis flare presentation characterized by the presence of systemic inflammation as well as bloody diarrhea, and occurs at least once in 25% of patients with ulcerative colitis during their disease course 6.

Treatment and Management

• The goals of treatment in ulcerative colitis are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 2.
• The choice of treatment depends on disease extent, severity, and the course of the disease, and may include topical 5-aminosalicylic acid (5-ASA) drugs, oral and topical 5-ASA drugs, corticosteroids, and tumor necrosis factor-α antibodies (infliximab) 2.
• Senna and polyethylene glycol may be used as laxative therapy in children with constipation related to anorectal malformation 3.
• Enteral nutrition in combination with intravenous steroids, and the use of JAK inhibitors, may be promising options for the management of acute severe ulcerative colitis 6.