Constipation

Constipation is a common condition but chronic constipation can hamper your daily activities.

Constipation could be an apparent sign of an underlying health problem and a clear reason may not always be evident.

Defining chronic constipation may not always an easy task. What’s the normal frequency of evacuation can be a case of constipation for the other. Generally, constipation refers to less than three stool evacuations per week.

Chronic constipation is defined as lower than normal bowel evacuation or having difficulty while passing stools and these symptoms persist for several weeks or longer.

The common signs and symptoms of constipation are:

• Less than three stool evacuations per week
• Passing hard stools
• Straining while passing stools
• Uneasy feeling that complete evacuation is not possible
• Trying hard to facilitate passage of stool such as pressing your abdomen and using a finger to remove stool from your rectum
• You are said to have chronic constipation if two or more of the symptoms last for three months.

When to see a doctor

Talk to your doctor if you experience any abnormal changes in your bowel habits that last longer.

Most often, constipation occurs due to reduced movement of stool along the gastrointestinal tract, causing it to become hard and dry.

It may result due to any of the following causes:

• Blockages in the colon or rectum: Passage of stool can be delayed due to obstructions in the colon or rectum.

Causes include:

1. Bowel obstruction
2. Colon cancer or other abdominal cancer that presses on the colon
3. Narrowing of the colon (bowel stricture)
4. Rectal cancer Rectocele

• Neurological causes: Neurological disorders such as autonomic neuropathy, multiple sclerosis, Parkinson's disease, spinal cord injury, stroke affects the normal functioning of nerves in the colon and rectum causing them to contract.
• Abnormal functioning of muscles involved in elimination: Your pelvic muscles may not relax properly affecting the bowel movement (anismus)) or there is an improper coordination between pelvic relaxation and contraction (dyssynergia), both of which contribute to chronic constipation. Sometimes, weakened pelvic muscles may also be the.
• Hormonal imbalances: Your hormones are responsible for maintaining fluid balance in the body. When the levels of these hormones fluctuate due to conditions like diabetes, overactive parathyroid gland (hyperparathyroidism), pregnancy, underactive thyroid (hypothyroidism), you may have chronic constipation.

Making a diagnosis of constipation is done by performing several tests and procedures.

Your doctor may refer you to a specialist in digestive disorders (gastroenterologist) if further details are required.

How to prepare yourself for the visit

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

• List out all the symptoms
• Write down your key medical information.
• Write down the names of all your medications, vitamins or supplements.
• Make a list of the questions to ask your doctor.

Some typical question can be:

• What are the causes for my symptoms?
• What other causes could be behind these symptoms?
• What are the tests that I need to have?
• What are treatments for my condition?
• When will my symptoms start fading?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did you begin experiencing the symptoms and how severe are your they?
• Does any factor improve or worsen your symptoms?
• Do your symptoms include abdominal pain?
• How many meals do you eat per day?
• What’s your daily fluid intake?
• Have you seen blood in your stool?
• Do you have difficulties like straining while passing stool?
• Is there a family history of digestive problems or colon cancer?

Tests and procedures used to diagnose chronic constipation include:

• Examination of the rectum and lower, or sigmoid, colon (sigmoidoscopy): A lighted, flexible tube is inserted into anus to examine interior of rectum and the lower portion of your colon.
• Examination of the rectum and entire colon (colonoscopy): This procedure is similar to sigmoidoscopy but involves examination of the entire colon.
• Evaluation of anal sphincter muscle function (anorectal manometry): A narrow, flexible tube fitted to a small balloon, is inserted into anus and rectum. The balloon is then inflated and the device is pulled back through the sphincter muscle. This helps to determine how well your sphincter is working.
• Colonic transit study: This test determines how long the food takes to exit the colon once it has entered it. It involves ingesting a capsule loaded with a marker that helps to visualize colonic movements that are recorded on abdominal X-rays.
• Defecography: This test allows doctor to observe the rectum during defecation, and evaluate pelvic muscle coordination and rectum function during defecation.

The treatment for constipation primarily consists of diet and lifestyle changes. If these modifications are the effective, your doctor may recommend medications or surgery.

• Diet and lifestyle changes:

1. Take a fiber rich diet: Dietary fiber helps to increase the stool volume and water content of stool, making it soft and easy to expel. Include a sizeable amount of fresh fruits and vegetables, whole-grain breads and cereals in your daily diet. Try to take 14 grams of fiber for every 1,000 calories in your daily diet. A sudden increase in fiber intake may cause symptoms like bloating and gas. So, gradual increase of fiber is recommended.
2. Exercise: A daily exercise has numerous health benefits including increased muscle activity in your intestines.
3. Don’t hold on when you want to defecate.
4. Take your time in the bathroom: Spend sufficient time in bathroom and don’t rush.

• Laxatives: Fiber supplements. Fiber supplements increase the amount of stool and make it easier to expel. Some common ingredients of laxative preparations are methylcellulose, psyllium, calcium polycarbophil and guar gum.
• Stimulants: These agents stimulate the intestine and promote the movement of stool downwards. Stimulants should be used regularly.
• Osmotics: Osmotic laxatives like milk of magnesia, magnesium citrate, lactulose, polyethylene glycol and sodium phosphate, attract water towards the colon thus making the stool soft and easy to expel.
• Fleet Enema: A fleet enema delays loss of water from the stool, which softens the stool.
• Lubricants: Lubricants increase the weight of stool and promote easy evacuation.
• Stool softeners: Stool softeners moisten the stool by drawing water from the intestines.
• Other medications: There are various prescription medications that can be prescribed when you have chronic constipation.Some of them are:

1. Medications that draw water into your intestines: Medications like lubiprostone and linaclotide attract water into your intestines and promote defecation. These medications may be used on prescription when over-the-counter medications do not work.
2. Medications in clinical trials: Many studies are being carried out to find a potential drugs to treat chronic constipation.

• Training your pelvic muscles: You may consider biofeedback exercises designed to relax and contract the pelvic muscles. Consult a therapist to find the appropriate exercises that can help you.
• Surgery: Surgery is the last resort to treating chronic constipation when other treatments have failed and your chronic constipation is caused by other conditions such as rectocele, anal fissure or stricture.

You can prevent chronic constipation through simple yet effective ways like taking fiber-rich diet, exercising regularly and drinking more water.

A few alternative remedies are used for constipation.

You may try common items found in your kitchen like sesame seeds, molasses, mint or ginger tea.

There are several risks and complications associated with constipation.

Risks

• Being old
• Being women
• Taking very little water and other fluids
• Taking very little fiber
• Not exercising enough
• Taking medications like sedatives, narcotics or certain blood pressure lowering agents

Complications

• Swollen veins in your anus (hemorrhoids): Veins around the anus can get swollen due to regular straining during bowel evacuation.
• Torn skin in your anus (anal fissure): A large or hard stool may put an excess stress on the anus causing tiny tears.
• Stool that can't be expelled (fecal impaction): People who have been constipated for a long time can have lump of hard stool stuck in their rectum.
• Intestine that protrudes from the anus (rectal prolapse): Heavy straining during bowel evacuation may cause protrusion of rectum from the anus.