Constipation-Everything you need to know about
Constipation is defined as the infrequent passage of hard, pallet like stools, usually less than three times a week. Typically constipated people have to strain excessively to evacuate the faces. Even then, after defecation, they may have a sensation of incomplete emptying of the rectum. In some instances, people even clear their stools from the rectum using their own hands.
Causes of constipation
The commonest cause of constipation, irrespective of the age, is poor food habits. These include,
- Reduced water intake – makes the stools hard
- Not consuming enough fiber-rich foods (e.g. fruits and vegetables)
- Consuming too much fast food
- Irregular bowel practices
- Busy lifestyle and stress may also cause constipation.
Less common causes are,
- Anal fissures
- Colonic tumors
- Intestinal obstructions
- Rectocele – Rectum bulges to the front through the posterior wall of the vagina
- Nerve diseases
Types of constipation
It can be classified according to the behavior of the intestines. Based on that, there are three main categories.
First is the normal transit constipation. This means a normal functioning bowel. Transit time of stools and stool frequency are within normal ranges but the person experiences constipation, bloating and discomfort.
The other category is slow transit constipation. In this type, intestinal transit time is increased and the intestinal motility is reduced.
The other category is defecatory dysfunction. This is more common in older adults and women. There is a problem in the anus or in the rectum, that causes impairment in rectal clearance. Pelvic floor dyssynergia is an example of such type where the inappropriate contraction of the pelvic floor muscles and external anal sphincter hinders the defecation.
Constipation during pregnancy
It is a common occurrence in pregnancy both during the early and late periods. One reason for this is the hormonal changes occurring in pregnancy. High oestrogen level in the blood slows down the movement of stools. This increases the water absorption from the stools making them hard and difficult to pass. In the latter part of the pregnancy, the uterus is enlarged. It may add pressure on the bowel impairing the passage of stools.
When constipation is an emergency
It is generally a short-term problem, but if it is associated with one of the below symptoms it highlights the need for urgent medical attention.
- Constipation with abdominal pain and vomiting. The vomitus may smell feculent
- Severe abdominal bloating
- Blood in stools or melena (tarry colored stools)
- Persisting constipation in spite of doing all the lifestyle and dietary changes
Vomiting with the hard passage of stool is typical to intestinal obstructions. The underlying cause of blood in the stools may anal fissures, peptic ulcers, or colonic cancer. So if you have any of these symptoms immediately seek medical attention.
Foods relieving constipation
The number one point is to drink enough water. If you are hydrated enough, constipation would not be a frequent problem.
Eat enough fiber-rich food; grains, lentils, beans, cereals, fruits, and vegetables. Fibers absorb water and make the stools soft in consistency.
Eating fruits with the peel (e.g. – apple) is a good way to increase the dietary intake of fibers.
Treatments for constipation
In most of the people, constipation relieves without any intervention. Initial treatment includes lifestyle and dietary changes. The patients are advised to have a routine to pass stools. Having a constant place and time to defecate for a period of time will improve constipation. Also, regular exercises improve bowel motility and thereby reduces the occurrence of constipation.
Medicines for constipation
Medical management should only be used if the lifestyle and dietary modifications have failed. The drugs that are used to clear the bowels are called laxatives or purgatives. They relieve constipation by various mechanisms.
Stimulant laxatives make the muscles in the intestines work faster, thus increasing the rhythmic contractions of the bowel. Bisacodyl is a common drug in this class. However, drugs in this class should not be used continuously since it can cause a serious complication known as the atonic nonfunctioning colon.
Bulk-forming laxatives are non-absorbable, un-digestible material which attracts water and forms the bulk of the stools. When these laxatives are taken you should always remember to drink plenty of water. Otherwise, intestinal obstructions and fecal impaction may occur. Bran and Isphagula husk are common bulk laxatives. Many of these drugs can be purchased over the counter.
Osmotic laxatives are ion salts. They absorb water and increase the fluidity of the stools. Magnesium salts belong to this group. These are commonly used before surgeries or radiological investigations if prior bowel preparation is needed.