On 13 Dec, 2025, Seniors Today hosted their weekly Health Live Webinar with a Senior Gastroenterologist, Dr Vinay Dhir who spoke on and answered questions about When Constipation is a Warning Sign: Red Flags and Diagnosis
Dr Vinay Dhir is Director, Department of Gastroenterology, at the SL Raheja Hospital (A Fortis Associate), Mumbai. He has over 3 decades of experience, specialising in interventional endoscopy. He has authored several highly cited publications in international medical journals and has been invited as faculty at numerous international courses focused on interventional endoscopy. In addition to his clinical and academic contributions he’s been very actively involved in advancing endoscopic intervention in India. He played a key role in establishing a school dedicated to endoscopic ultrasound and has been engaged in promoting structured teaching and training programmes in the field. He is currently associated with the SL Raheja Hospital (A Fortis Associate), Mumbai.
- We are all happy and comfortable if we make a motion, preferably soon after we wake up. However, constipation, unfortunately, is not very uncommon.
- The definition of constipation varies.
- Commonly it is thought that you’re constipated if you’re not passing stools everyday.
- The consistency of the stools is hard, causing you to strain while passing them.
- You can also be constipated if you are passing stools everyday but you still feel like you haven’t cleaned your bowels.
- In very difficult cases of constipation, there may arise the need for manual removal of stools.
- A variety of these symptoms can constitute constipation. Having constipation for 4-5 days is not uncommon, but if the problem lasts longer (lasting for months) and is reoccurring, it is chronic constipation.
- Chronic constipation is problematic and requires treatment.
- The Bristol Stool chart helps classify the stools based on their colour, appearance, consistency. If your stools appear to between type1 to type 3, you have constipation.
- These are hard stools and difficult to pass.
- In India, more than 1 in 4 adults suffers from constipation, making it a very common problem.
- It is more common in women
- Constipation is more common over the age of 65 years.
- Approximately 28% of people suffer from constipation in India.
The causes for constipation can be many. Some of the causes are:
- The cause for constipation is usually idiopathic. This is called primary constipation and is caused due to transient problems.
- Irritable bowel syndrome is accompanied with the complaint of constipation.
- Pelvic floor dysfunction
It is the secondary causes of constipation that are worrisome. Constipation can be secondary to:
- Ano rectal disease- piles, fissures, polyps
- Colonic diseases such as colonic polyps, cancer of the colon, diverticulitis
- Neurological illnesses
- Endocrine diseases
- Multiple medication
- Many drugs cause constipation as a side effect. Some of which are in the class of anti depressants, anti psychotics, antacids, anti hypertensive.
- It is general knowledge that constipation is due to an issue in the colon- part of the large intestine where the stool is stored and eventually passed out through the anus. We believe that the gut movement is slow.
- However, studies show that almost 60% of people who have constipation have a normal transit of the colon. Which means that majority of cases of constipation do not have slow transit. In fact, only 13% of the cases will have constipation due to the slow movement from the colon.
- It is more commonly due to the normal transit to rectum but ineffective evacuation. Causing collection of the stools in the rectum without it getting evacuated.
- Gut transit is an important part of constipation.
- Normal transit constipation is also called functional constipation wherein the stool is moving normally, the frequency is normal, however the patient feels constipated. This is either because complete evacuation is not possible or the stool has become hard.
- Along with this, there may also be bloating, abdominal pain, discomfort.
If you are suffering from constipation, consult with your gastroenterologist and have it evaluated. Mostly not many investigations are needed.
Treatment also includes simple modalities such as:
- Lifestyle modifications
- Dietary intake of fibre
- Plenty of oral fluids
- Laxative can be added for a brief while
Normal transit constipation is normal and easy to treat.
- Slow transit constipation requires further investigation- including making you take radiopaque markers followed by consecutive x ray films which see how many markers you have passed over a period of 72 hours.
- It is slightly more difficult to treat. It is more commonly seen in patient suffering from other neurological diseases such as paralysis, neuromuscular disorders.
- Improper expulsion of stools from the rectum constitutes a very common but rather difficult to diagnose this form of constipation. This is called pelvic dysynergia.
- It can be very effectively treated.
- You can have ano rectal fissure, rectocoele, dysynergia.
Symptoms of defecatory disorders include:
- Long duration of sitting while passing stools
- Unsatisfactory expulsion of stools
- Heaviness in lower abdomen
- Straining while passing stools
- Unusual posture while passing stools
Correct/ ideal toilet posture:
- The position we sit in in an Indian commode is an ideal position.
- The position we sit on the western commode is not ideal.
- In an ideal position, your knees need to be higher than your hips, lean forward and place your elbows on your knees, bulge your abdomen and straighten your spine.
- When you’re using a western commode and you are suffering from constipation, use a footrest so your knees are above your hip.
