Everything You Need to Know About Constipation
Constipation, a common functional gastrointestinal disorder, has become a matter of concern for many people around the world, affecting the elderly more than the younger population. In most cases, however, it is a mild condition that can be effectively treated with basic care by controlling symptoms at a reasonable cost.
Constipation is a condition marked by painful or delayed bowel movements. A person is typically considered to be constipated when their bowel motions result in the passing of only tiny amounts of hard, dry stool, often less than three times per week. However, it varies widely from person to person. Some people have bowel movements several times a day, while others have them only one to two times a week. A bowel movement pattern is unique and normal for every person as long as it is continuous without any significant change.
What are the symptoms of constipation?
Symptoms of constipation include:
- Having less than three bowel movements a week.
- Stools are dry, hard and/or lumpy.
- Stools are difficult or painful to pass.
- Stomach ache or cramps.
- Feeling bloated and nauseous.
- After a bowel movement, it seems as though not all of the bowels have been emptied.
How does constipation occur?
Normally, nutrients are absorbed as food passes through the digestive system. The small intestine’s leftover partially digested food (waste) travels to the large intestine, often known as the colon. This waste is turned into a solid substance called stool by the colon, which absorbs water from it. Food may transit the digestive tract too slowly in the case of constipation. Because of the additional time the colon is given, the water in the waste might become absorbed. It gets harder to push the stool out as it becomes dry and firm.
What are the causes of constipation?
There are many causes of constipation. These include:
- Consuming low-fibre meals.
- Not enough water consumption (dehydration).
- Not enough physical activity
- Disturbances to your regular schedule, such as travelling, eating, or going to bed at a different hour.
- Consuming a lot of milk or cheese.
- Resisting the urge to have a bowel movement.
What are the risk factors for constipation?
There are certain factors that can increase the risk of constipation. These include:
- Age: Older adults typically have a slower metabolism, less strength in their muscles along their digestive tract, and a decreased level of activity.
- Pregnancy: A woman is more likely to experience constipation due to hormonal changes. The baby inside the womb squishes the intestines, which delays the movement of stool.
- Diet: When enough dietary fibres are not included in the daily diet then it may lead to constipation. Consuming lots of caffeinated drinks or alcohol can also cause constipation.
- Certain medications: Constipation is one of the most common side effects of certain medications like iron supplements, calcium supplements, vitamin D supplements, antacids, NSAIDs such as Ibuprofen, antidepressant medications, etc.
- Neurological diseases: Multiple sclerosis, Parkinson’s illness, spinal cord injuries, and the neuromuscular disorder muscular dystrophy are all conditions that are more likely to cause constipation. These diseases might make it difficult for a person to relax the muscles in their pelvic floor, which makes it difficult to push stools out.
Cancers of the large and small intestines: Cancers in the large and small intestines narrows the intestinal lumen and can cause constipation. Most of the time, this is associated with blood in the stool.
Complications caused due to constipation
Constipation can lead to certain disorders like:
- Haemorrhoids: A condition wherein veins in the rectum are swollen and inflamed.
- Anal fissures: A small tear in the mucosa, a delicate, moist tissue that lines the anus, is known as an anal fissure.
- Diverticulitis: Small, protruding pouches develop in the digestive system’s lining as a result of this disorder.
- Faecal impaction: As a result of persistent constipation, immobile mass of faeces can form in the rectum.
- Stress urinary incontinence: The need to urinate more frequently and the possibility of more bladder leaks rise with constipation because the colon enlarges and puts more pressure on the bladder.
Diagnosis of Constipation
The doctor may or may not order any tests depending on the symptoms, medical history and overall health.
- Lab Tests: Blood and urine tests are done to reveal signs of hypothyroidism, diabetes and anaemia. The presence of cancer, inflammation, and infections is examined in a stool sample.
- Imaging Tests: Tests like CT scans, MRIs, etc, are done to check for underlying conditions that may be causing constipation.
- Colonoscopy: Also known as sigmoidoscopy is done to evaluate the internal condition of the colon. Biopsy is also done to rule out cancer.
- Defecography: Anal and rectal X-rays are taken during this procedure. It evaluates how well the rectal muscles are functioning and how well faeces exits the body.
- Anorectal Manometry: It is a test performed to determine the pressures in the anus and rectum and to assess their functioning.
Treatment of Constipation
Constipation can be treated in the following ways based on the severity of the disease:
- Self Management:
Most of the mild or moderate constipation can be handled at home. Few changes in the lifestyle can easily cure constipation. These include:
- Drinking lots of water
- Avoiding alcohol,caffeine, etc
- Adding high fibre foods to the diet like fruits and vegetables, whole grains, etc.
- Natural Laxatives(stool softeners) like prunes, Isabghol etc.
- Exercising daily
- Medications: In cases of severe constipation the doctor may prescribe medicines such as lubiprostone, prucalopride, plecanatide, lactulose, linaclotide, etc.
- Biofeedback: This is useful in pelvic floor dyssynergia.In this training will be given to the patient for pelvic muscle coordination during stool passage.
Surgery: In very rare cases if there is any structural deformity in the colon or the patient is diagnosed with cancer, the doctor may suggest surgery.
Certain healthy habits, when acquired, can help in avoiding constipation. Eating a well-balanced diet with plenty of fibre-rich foods, drinking 8-ounce glasses of water a day, avoiding too many caffeinated drinks, avoiding alcohol, exercising regularly, not delaying the urge to move the bowels, etc can all prevent constipation. In some cases, constipation can be due to underlying conditions like cancer or deformity in the colon, etc., wherein urgent medical care should be sought.
Constipation: A Global Perspective
Does neurological disorders cause constipation?
Can Constipation Cause Urinary Incontinence?
Medications that cause constipation
Constipation in neurological diseases
About Author –
Dr. D. Chandra Sekhar Reddy
Consultant Gastroenterologist, Hepatologist and Therapeutic Endoscopist , Yashoda Hospitals - Hyderabad
MD, DM (Gastroenterology)