Chronic constipation matters because it can be a symptom of common, treatable conditions and, less often, a sign of more serious disease. If bowel habits are slow for weeks to months, include blood in the stool, cause weight loss, or significantly reduce daily activity, we evaluate those symptoms as your gastroenterologist and recommend the appropriate tests and treatments.
What chronic constipation is and how we define it
Chronic constipation is persistent difficulty passing stool or infrequent bowel movements for at least three months. Common features include hard stools, straining, a sensation of incomplete evacuation, and fewer than three bowel movements per week. Clinicians use frameworks such as the Rome criteria to describe patterns and guide testing. We evaluate both the symptom pattern and how symptoms affect your daily life.
Why chronic constipation matters locally
In and around Warwick, chronic constipation affects daily functioning, work, travel and quality of life for many people. From our practice in Goshen we see patients whose symptoms stem from diet, medications, or lifestyle, and others whose constipation signals nerve or muscle problems in the colon, structural issues, or metabolic causes.
Addressing constipation early prevents complications such as fecal impaction, chronic pain, or worsening mobility. It also avoids delays in diagnosing conditions that sometimes present with constipation, including certain metabolic disorders and, rarely, obstructing lesions in the colon.
Key concepts we use when evaluating constipation
- Alarm features. Blood in the stool, unintentional weight loss, new symptoms after age 50, or a family history of colon cancer prompt expedited evaluation.
- Primary versus secondary constipation. Primary is usually functional or due to slow transit or pelvic floor dysfunction. Secondary arises from medications, metabolic issues, neurologic disease or structural problems.
- Tests are targeted. We choose stool tests, blood work, colonoscopy, transit studies or anorectal manometry based on history and exam.
- Treatment tiers. Lifestyle and diet are the first steps. Prescription medications, bowel retraining, or procedures follow if conservative care fails.
How we evaluate chronic constipation step by step
- History and medication review. We ask about bowel habits, diet, fiber intake, over the counter and prescription medicines, and any alarm symptoms.
- Focused physical exam. This includes abdominal and a limited rectal exam when indicated.
- Basic tests. We often order blood work to check for metabolic causes and stool tests to look for infection or inflammation.
- When appropriate, colonoscopy. We recommend a colonoscopy to evaluate for structural problems, polyps, or cancer when alarm features exist or when patients are due for screening. Learn more about our approach to colonoscopy on our Colonoscopy service page, where we explain indications and what to expect.
- Physiologic testing. If transit or pelvic floor dysfunction is suspected, we may order transit studies or anorectal manometry, often coordinated through specialized labs.
Pro tip: Keeping a simple bowel diary for two weeks helps us see stool frequency, consistency and triggers. Bring the diary to your visit so we can make targeted recommendations.
Common causes and clues we look for
- Diet and lifestyle. Low fiber, low fluids, and inactivity are frequent contributors.
- Medications. Opioids, certain antacids, iron supplements and some antidepressants commonly slow bowel transit.
- Slow transit constipation. The colon moves stool more slowly than normal and often requires specialized testing.
- Pelvic floor dysfunction. Poor coordination of pelvic muscles can make evacuation difficult despite normal colonic transit.
- Metabolic or neurologic causes. Hypothyroidism, diabetes and certain neurologic disorders can contribute to constipation.
Tests you might expect and why we choose them
| Test | What it checks | When we use it |
|---|---|---|
| Stool tests | Infection, inflammation markers | If there is diarrhea, blood, or suspicion of infection |
| Blood tests | Metabolic causes such as thyroid or electrolytes | Routine when symptoms are persistent or unexplained |
| Colonoscopy | Structural lesions, polyps, inflammation | Alarm features, age appropriate screening, or unexplained symptoms |
| Bowel transit study | Rate of stool movement through the colon | When slow transit constipation is suspected |
| Anorectal manometry | Pelvic floor muscle coordination | When defecatory dysfunction is suspected |
Treatment approaches and what good outcomes look like
We start with conservative measures and move to targeted therapies if needed. Conservative care includes systematic changes to fiber, fluids and activity, and review of medications that cause constipation. When conservative care is insufficient, we consider prescription medications that increase bowel motility or soften stool, biofeedback for pelvic floor dysfunction, and in rare cases, referral for surgical evaluation.
Good outcomes are symptom control with minimal side effects, predictable bowel habits, and restoration of daily function. We measure success by frequency, stool consistency, ease of passage and the patient sense of improvement.
When to see a gastroenterologist now
See a specialist if you have
- Blood in the stool or black tarry stools
- Unexplained weight loss or persistent abdominal pain
- New constipation after age 50
- Symptoms that do not improve after reasonable diet or medication changes
- Repeated episodes of fecal impaction or use of daily laxatives to have a bowel movement
Related services and pages we recommend
For patients who need diagnostic procedures or coordinated care, we link to our related services and topics so you can read more about what each involves. Read our topic page on chronic constipation for deeper background. For procedural care such as colonoscopy, see our Colonoscopy service page. To view practice locations and which towns we serve, see our locations page.
We also link patients to general information from trusted organizations. The National Institutes of Health provides an overview of constipation and management options, and the American College of Gastroenterology offers patient focused guidance on evaluation and treatment.
External references: National Institutes of Health MedlinePlus on constipation, American College of Gastroenterology patient information on constipation.
How we approach care at our practice
When you see Dr. Alan R. Plumer, MD, we focus on understanding how symptoms affect your life and tailoring tests and treatments to your needs. We do a careful medication review, screen for alarm features, and recommend the least invasive tests likely to give useful answers. If you need a colonoscopy or advanced physiologic testing, we explain the reasons, the process, and the expected outcomes before any procedure.
We collaborate with local therapists and specialized labs when pelvic floor retraining or motility testing is indicated. That team approach helps patients return to normal function with fewer unnecessary procedures.
Key takeaway
Chronic constipation is common but not always simple. As gastroenterologists we determine whether symptoms reflect lifestyle factors, medication effects, functional disorders, or conditions that require procedures. Early, focused evaluation improves comfort and reduces the chance of complications.
Frequently asked questions
How long should I try diet and over the counter remedies before seeing a gastroenterologist?
If simple measures such as increased fiber and fluids, regular activity, and short term over the counter laxatives do not improve symptoms within a few weeks, or if you have alarm features, you should see a gastroenterologist for a full evaluation.
Will I need a colonoscopy for constipation?
Not always. We recommend colonoscopy when alarm features are present, when you are due for routine colon cancer screening, or when a structural cause is suspected. The decision is individualized and explained before scheduling.
What is pelvic floor dysfunction and how is it treated?
Pelvic floor dysfunction means the muscles that help empty the bowel do not coordinate properly. Treatment often includes biofeedback with a trained therapist, bowel retraining, and sometimes medication. We refer to specialists when testing confirms this diagnosis.
Are there medications specifically for chronic constipation?
Yes. There are prescription medications that target stool softness, fluid secretion in the bowel, or nerve signaling to the colon. We choose medication based on the suspected cause and your overall health.
What tests check how fast stool moves through the colon?
Bowel transit studies, including radiopaque marker tests or scintigraphic transit studies, measure how quickly stool moves. We use these tests when slow transit constipation is suspected and when the results would change management.
Learn more and see our patient information
Read patient reviews and directions on our Google Business Profile, and explore related pages on our site for more detail about procedures and conditions. For more information about our services as a gastroenterologist, visit the Gastroenterologist service page and our topics index.