What is constipation?

Constipation is a condition in which the person passes small amounts of hard dry stools less than three times a week. The individual also finds it troublesome and painful to have a bowel movement. He also has a feeling of incomplete evacuation of the bowel.

Constipation is the most common digestive complaint and can last for a few days or a few weeks. It depends on the cause and efficacy of the treatment taken. In most cases, it is temporary and is usually due to poor diet and lack of exercise.

You cannot call constipation a disease. It can be a symptom of an underlying problem. However, constipation is mostly caused by the intake of improper foods, which do not contain dietary fiber.

Fiber-rich foods help improve digestion and proper evacuation of the bowels. However, too much fiber can worsen existing constipation in a normal situation. Adults should get 22 to 34 grams of fiber a day.

Digestive habits vary from person to person. Most persons normally have one to three bowel movements every day. In some people, having three bowel movements in a week is normal.

How common is constipation?

Constipation is one of the most common gastrointestinal conditions in the United States. It is common among people of all ages in the United States.

About 16 out of 100 adults and 33 out of 100 older adults above 60 years experience symptoms of constipation. At least 2.5 million people see their doctor each year for treating their constipation.

How does constipation happen?

Constipation happens because your colon (the large intestine) absorbs too much water from digested food that is moving through it. This makes the stool dry and hard in consistency and difficult to evacuate.

The food that we eat is mainly digested in the stomach and the small intestine as it moves forward. It is the partially digested food (waste) that moves from the small intestine and enters the large intestine.

The large intestine absorbs water from this partially digested food and forms a semi-solid stool.

In certain conditions, food may move too slowly through the digestive tract. This gives the colon more time to absorb water from its content. The stool, therefore, loses more water and becomes dry, hard, and difficult to evacuate causing constipation

Who is more likely to have constipation?

Certain people are at a higher risk of becoming constipated. They include:

  • women, during pregnancy or after childbirth
  • older adults above the after of 60 years
  • non-Caucasians
  • people whose diet contains little to no fiber
  • people who live a sedentary life
  • people who take certain medicines such as anticholinergics, antispasmodics, calcium-containing antacids, iron supplements, etc.
  • people with certain health problems, such as celiac disease

Symptoms

Symptoms of constipation include:

  • Less than three bowel movements a week
  • Dry and hard stools
  • Passing of stools is difficult and/or painful
  • You have abdominal pain or cramps.
  • A bloated and nauseous feeling.
  • An unsatisfied feeling of bowel evacuation after passing stools.

 A standard set of criteria has been set,  which state that at least two of the above symptoms be present for three months to categorize constipation.

What causes constipation?

Constipation has many causes and more than one cause may be present at the time.

Causes include

Certain medicines and dietary supplements

  • Calcium and aluminum antacids
  • Anticholinergics and antispasmodics
  • Anticonvulsants
  • Calcium channel blockers for hypertension
  • Diuretics
  • Iron supplements
  • Narcotic pain killers
  • Antidepressants

Certain health and nutrition changes and problems

  • Pregnancy
  • Lack of fiber in the diet
  • Inadequate intake of fluids
  • Dehydration
  • Sedentary lifestyle

Medical and health conditions that can cause constipation include:

  • functional gastrointestinal disorders, such as irritable bowel syndrome
  • celiac disease
  • Parkinson’s disease
  • spinal cord or brain injuries
  • metabolic conditions such as diabetes
  • hypothyroidism
  • inflammation linked to diverticular disease or proctitis
  • intestinal tract obstructions

When should you see a doctor?

You should see a doctor right away if you have constipation and any of these associated symptoms

  • fever
  • bleeding per rectum
  • hematemesis (blood in your stool)
  • constant abdominal pain
  • inability to pass gas
  • vomiting
  • lower back pain
  • loss of weight without apparent cause

 How do doctors diagnose the cause of constipation?

Your medical and family history, a physical exam, and some medical tests help the doctor to diagnose the cause of your constipation.

Medical and family history

A medical history will include questions such as

  • Whether you have ever had gastroenterology surgery
  • Whether you have recently lost or gained weight
  • Whether any member of your family has had colorectal cancer

Your doctor will question you about your symptoms, such as

  • How often do you pass stools?
  • Since when have you had constipation?
  • What is the appearance of your stools?
  • Are they blood-stained?

Your doctor is likely to ask questions about your lifestyle, such as

  • Your eating habits
  • Level of your physical activity
  • What medicines and supplements are you taking

Clinical examination

During a clinical examination, a healthcare professional may

  • check your vital parameters such as blood pressure, temperature, and heart rate
  • rule out dehydration
  • will look for peristaltic sounds in your abdomen with a stethoscope
  • palpate your abdomen for lumps, tenderness, swelling
  • perform a rectal exam and use a proctoscope to examine your rectum

Lab tests

Your doctor may use one or more of the following lab tests to look for signs of certain diseases and conditions that may be causing your constipation

  • Blood tests to rule out anemia (CBC), hypothyroidism (Thyroid function tests), and celiac disease (serologic tests).
  • Stool tests to look for occult blood
  • Urine tests can help rule out diseases like diabetes

Endoscopy

Your doctor may perform a colonoscopy and/or flexible sigmoidoscopy to look inside your anus, rectum, and colon for signs of problems in these areas.

During this procedure, he may also take a biopsy to rule out colorectal cancer.

Colorectal transit study

This test shows how well food travels through the colon. The patient swallows capsules containing small markers which are radio-opaque.

The movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed. his study is usually used in patients who are suffering from chronic constipation.

Anorectal manometry tests

These tests diagnose constipation caused by an abnormal functioning of the anus or rectum. This test checks how sensitive your rectum is, and how well it and the anal sphincters work

Treatment of constipation

You can most often treat your constipation at home by doing the following:

  • Eat more fiber-rich foods or take a fiber supplement. Depending on your age and sex, adults should get 22 to 34 grams of fiber a day.
  • Drink plenty of water and other liquids if you eat more fiber or take a fiber supplement.
  • Get regular physical activity.
  • Practice bowel training.
  • Stop taking certain medicines or dietary supplements that can cause constipation. Talk to your doctor, he will give you a substitute drug that will cause constipation.

Take over-the-counter medicines

Your healthcare professional may recommend using a laxative for a short time. He will tell you what type of laxative is best for you.

Prescription medicines

Your doctor may prescribe one of the following medicines for constipation

  • lubiprostone makes your stool softer and increases the frequency of the bowel movements
  • linaclotide regularizes your bowel movements and is of help especially if you have irritable bowel syndrome with constipation
  • prucalopride helps your colon propel your stool forward

 Biofeedback therapy

Biofeedback is used to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that are responsible for controlling bowel movements.

Surgery

Surgery may be an option if you have a lower G.I. tract blockage, rectocele, or stricture.

For people who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option.

How can I prevent constipation?

You can help prevent constipation by following some bowel-friendly habits.

  • Get enough fiber in your diet
  • Drink an adequate amount of water and other liquids every day
  • Exercise regularly
  • Try to have a bowel movement at the same time every day