Constipation

Constipation is a common health problem that causes difficulty in passing stools and emptying the bowels. Almost everyone goes through constipation at some point in their lives. While constipation is uncomfortable, it is usually considered a symptom rather than a disease in itself. The various causes of constipation include diet that is not sufficient in fiber content, inadequate fluid intake, sedentary lifestyle, stress or sometimes an effect of some underlying medical condition of intake of specific medicines.

Causes #

Poor dietary habits #

• One of the common causes of constipation is poor dietary habits that can affect bowel movements.

• If your diet fails to include foods rich in fibre such as fruits and vegetables in the right quantity, it can affect digestion and passing of stools.

• This is because fibre acts as a natural laxative, which holds water in the stool, increases its bulk and makes it easy to pass.

Insufficient fluid intake #

• Lack of sufficient water in the body can lead to dehydration is another factor that can cause constipation.

• When you suffer from dehydration, the body tries to conserve water by removing water from the stools.

• As a result, the stools contain less amount of water, which makes it harder to pass them from rectum.

Use of certain medicines #

Constipation can be caused as a side-effect of certain medicines such as iron salts, opioids, sedatives, over the counter antacids and some of the drugs used to lower blood pressure. So if you are taking any of these medicines, then do consult your doctor. He may either change the dosage of the medicines or help you treat constipation with medicines or laxatives.

The list of certain medicines that can cause constipation include:

• Paracetamol - if more than seven tablets are taken in a week

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen

• Iron and calcium supplements

• Aluminum-containing antacids

Anticholinergic agents or medicines that oppose the actions of the neurotransmitter acetylcholine. These include drugs for Parkinson’s disease, depression, delusions, hallucinations, and muscular spasms.

• Anticonvulsants (drugs used to treat seizures) such as carbamazepine, phenobarbital, and phenytoin.

• Cancer drugs such as vinblastine, vincristine, vindesine, and vinorelbine

• Calcium-channel blockers such as verapamil

• Water pills (diuretics) such as furosemide

Underlying medical conditions #

Constipation can be caused by various health conditions like the following:

• Irritable bowel syndrome

• Endocrine disorders like Diabetes, Hypothyroidism, Hyperparathyroidism, Hypercalcemia, Hypokalemia, insufficient production of pituitary hormones

• Tumor of the adrenal gland

• Delayed emptying of the colon caused by pelvic floor disorders and colon surgery

• Diverticular disease

• Bowel obstruction

• Narrowing of colon or bowel stricture

• Colorectal cancer

• Other abdominal cancer that presses on the colon

• Rectal cancer

• Lazy bowel syndrome in which there is slow movement of waste through the digestive tract

• Neurogenic disorders like spinal cord injury, stroke, multiple sclerosis, Parkinson’s disease, brain injury etc.

• Structural defects in the digestive tract like fistula, imperforate anus, malrotation etc.

• Diseases like amyloidosis, lupus erythematosus, and scleroderma

Overuse of laxatives #

• Laxatives are common medicines used to treat constipation.

• In most cases, people with this condition do not consult a doctor but use laxatives to get rid of constipation. However, it is reported that overuse of laxatives is not good for your health.

• People who use laxatives frequently tend to lose the ability to pass stools without such aids. Hence, in the long run, it can lead to more use of laxatives and an increased risk of constipation.

Symptoms #

The symptoms of constipation include:

• Reduced bowel movement of less than three times a week

• Passing hard and lumpy stools

• Straining while passing stools

• Feeling of fullness, even after passing stools

• Feeling of not able to completely evacuate the stools from the rectum

• Feeling of a blockage in the rectum that prevents passing of stools

• Some people may even need digital evacuation of stools

• Bloating

• Feeling sluggish

• Abdominal pain

Diagnosis #

Physical examination #

This may include

• Abdominal examination in which the abdomen may be examined for distension. The enlarged or swollen bowel may point towards constipation.

• Rectal examination may be done to look for scars, hemorrhoids, fistulas or fissures around the perineum, the area between anus and scrotum (in males) or vulva (in females).

Laboratory test #

These tests may be done to look for underlying conditions that cause constipation. These may include:

• Blood tests to check for hemoglobin, thyroid stimulating hormone (TSH), calcium, and glucose levels to reveal signs of risk factors like anemia, hypothyroidism, hyperparathyroidism, diabetes etc.

• Stool Examination to check for any signs of infection, inflammation, and cancer.

• Radiology tests such as Abdominal X-ray, CT scan or MRI of the colon to assess the length and width of the colon or any lesion that may cause obstruction.

• Barium enema study is an imaging study that uses x-rays along with an enema (containing barium) to detect abnormalities inside the colon. The contrast solution containing barium is injected into the rectum. Barium enema produces better images as compared to other imaging studies.

• Defecography is a modification of the barium enema examination. A thick paste of barium is inserted into the rectum of a patient through the anus. This procedure then examines the process of defecation and gives information about anatomical abnormalities of the rectum and pelvic floor muscles during defecation.

• Magnetic resonance imaging defecography is one of the latest tests for evaluating defecation. It is similar to barium defecography, however, MRI is used instead of X-rays to provide images of the rectum during defecation.

• Colonic transit (marker) studies involve consuming a small amount of a radioactive substance usually in the form of a pill, and then tracking the amount of time and how the substance moves through the colon.

• Colonoscopy or endoscopy of the colon is a diagnostic method in which a long, flexible, lighted tube is inserted through the rectum to get an internal view of the colon. During this procedure, biopsy may also be taken to test for cancer or any other problem.

Prevention #

• Eat a high fiber diet comprising fruits, vegetables, legumes and whole grains. Restrict foods with low amounts of fiber such as processed and packaged foods, milk and meat products.

• Drink a minimum of 8 glasses of water during a day. Restrict intake of alcohol and caffeine in the form of coffee and soft drinks as they tend to dehydrate the body.

• Stay active and exercise regularly

• Do not delay the urge to pass stools

• Try to manage stress

Treatment #

Dietary Changes #

• First and foremost, drinking at least 3 litres of water is a must for adults. Water hydrates the body and softens stool and aids its movement from the colon.

• Include fibre-rich vegetables like carrots, cabbage, cauliflower, broccoli, spinach, varieties of gourd etc. in your diet. Blanch the veggies and sprinkle on some seasoning and spices. Have portions equivalent to 250-300 grams daily.

• A fruit a day will keep constipation blues away. Besides containing dietary fibre, fruits like orange, apple, papaya, dates, figs etc. are packed with nutrients.

• Substitute white rice and polished wheat with whole grain products like brown rice and unpolished wheat. Oats also have similar qualities. Eat a cup full of these healthy grains daily to fight constipation.

Medicines #

• Bulking agents such as bran and psyllium are fiber supplements, which are usually recommended for normal constipation.They contain fiber which add bulk to the stools and helps the stools to quickly move through the colon. People on bulking agents should drink ample amounts of water to maintain hydration.

• Lubricants help in smooth movement of stools through the colon.eg. mineral oil.

• Stool softeners work by moistening the stools eg. docusate sodium

• Osmotic laxatives stimulate the absorption of water from the body to make stools softer. These include lactulose, lactitol or polyethylene glycol.

• Stimulant laxatives help in contracting the muscles in the intestines rhythmically. Examples include castor oil, sodium picosulfate, and bisacodyl.

• Enemas use a thin tube to inject a liquid or a gas into the rectum to expel its contents. Examples: Phosphate enema, mineral oil retention enema, and soapsuds enema.

• Suppositories such as those containing glycerin or bisacodyl are placed into the rectum.

• Chloride channel activators such as Lubiprostone are used to treat chronic constipation.