Constipation

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Constipation is an acute or chronic condition which is characterized by difficulty in passing stools or incomplete or infrequent passage of hard stools. In this condition, there is no passage of stool in 3 days or less than 3 times per week. Constipation is more common in women than in men. It is a common gastrointestinal problem.

Why Does Constipation Occur?

Constipation is one of the most common medical complaints in the United States. Constipation Causes are-

Common Causes-

• Eating foods low in fiber but rich in refined sugar or animal fat
• Not drinking enough water
• Lack of exercise and physical activity
• Not allowing sufficient time for bowel movements
• Habit of ignoring the desire to defecate
• Eating large amounts of dairy products
• Sometimes for stress, emotional and physical problems
• Overuse of laxatives
• Pregnancy

Medications that cause constipation are-

• Nacrotic containing drugs
• Antacid medicines containing calcium or aluminum
• Iron supplements
• Painkillers
• Few drugs used to control blood pressure and treat irregular heartbeat such as beta blockers, calcium channel blockers etc.
• Laxative abuse
• Diuretics
• Aluminum salts in antacids
• Antihistamines
• Antipsychotic drugs

Medical conditions that cause constipation are-

• Gastrointestinal disorders-

1. Slow-transit constipation
2. Irritable bowel syndrome
3. Chronic intestinal pseudo-obstruction
4. Colonic carcinoma
5. Diverticular disease
6. Hirschsprung's disease
7. Obstructed defecation
8. Anorectal disease (Crohn's, fissures, haemorrhoids)

• Neurological Problems-

1. Multiple sclerosis
2. Spinal cord lesions
3. Cerebrovascular accidents
4. Parkinsonism

• Metabolic/Endocrine Problems-

1. Diabetes Mellitus
2. Hypercalcaemia
3. Hypothyroidism

• Other Problems-

1. Chronic kidney failure
2. Illness requiring complete bed rest
3. Any serious illness with immobility, especially in the elderly
4. Depression
5. Eating disorders

What are the Constipation Symptoms?

• Having difficulty, feeling pain and strain during bowel movements
• Passing hard compacted (rock-like) feces
• Bloody stool
• Infrequent passage of stool
• Feeling of incompleteness after having a bowel movement
• A sense of rectal blockage
• Bloated feeling
• No bowel movement in fullness days for children and for 3 days for adults
• Abdominal pain or, swollen abdomen
• Nausea and vomiting
• Headache
• Bad taste in the mouth
• Bad breath
• Coated tongue
• Loss of appetite

A constipated baby may strain, cry, draw the legs toward the abdomen, or arch the back during bowel movement.

When to make an appointment with doctor?

Most cases patient don't need to call a doctor because, it is self-curable. But, you should go to a doctor, if you have these concerns-

• Having symptoms of constipation for 2 to 3 weeks
• Thin, pencil-like stools
• Having symptoms of other disease with constipation e. g. hypothyroidism
• If it happens for new drugs that you are using, consult with a doctor and discontinue it
• Unexplained weight loss
• Recent and significant change in bowel habits, for instance, constipation alternates with diarrhea
• Severe Constipation for 2 weeks or longer with returning abdominal pain
• Pain in the anus during a bowel movement

But, seek emergency medical care, if you have following conditions-

• Rectal bleeding
• Extreme pain in the anus during a bowel movement or Anal fissures
• Anal pain and hemorrhoids
• Constipation with fever and sharp or severe abdominal pain
• Rectal prolapse or sagging- may lead to a secretion of mucus from the anus.
• Immovable intestinal contents or fecal impaction
• Recurrent vomiting with constipation and abdominal pain

Call a doctor immediately, if an infant or a baby has following situations -

• An infant (except those exclusively breastfed) goes 3 days without a stool and is vomiting or irritable
• An infant younger than 2 months is constipated
• Non-breastfeeding infants go 3 days without having a bowel movement. It is more severe if there is vomiting or irritability.
• A child is holding back bowel movements in order to resist toilet training

How can Constipation be Diagnosed?

There is no one who never becomes constipated once in a while. In most cases extensive testing is not required for constipation diagnosis. Because, most people with constipation don’t have a more serious medical problem.

A doctor will observe the patients condition, take medical history to diagnose constipation. He will perform a physical exam and ask about any prescription or over-the-counter medications you're taking. He/ she will also notify if significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber and fluid intake. The doctor may use his fingers to see if there is a hardened mass in the abdomen. Sometimes a rectal examination is performed.

Other important Tests that the doctor may suggest are-

• Laboratory analysis of blood and stool samples- for internal bleeding or other symptoms of systemic disease
• Barium enema- to find out blockage inside the intestine
• Colonoscopy- to look for obstruction of the colon
• Thyroid function tests if hypothyroidism is suspected
• Sigmoidoscopy- to detect problems in the rectum and lower colon

If patient is old, physical and psychological assessments and a detailed history of bowel habits are important.

What are the Constipation Complications?

• Hemorrhoids or cracks (fissures) in your anus
• Rectal prolapse or sagging- may lead to a secretion of mucus from the anus.
• Immovable intestinal contents or fecal impaction
• Hernia
• Lazy bowel syndrome
• Spastic colitis
• Laxative dependency

How can Constipation be treated?

In most cases, simple changes in your diet and activity (see prevention section below) can help relieve constipation. But, if the changes fail to relieve occasional constipation or if you have other complications or if cause of constipation is a certain medical problem, you may need medical Treatment. Do not use laxative without doctor’s order. Because, most of the laxatives are harmful.

What is the way of Constipation Prevention?

• Drink plenty of water, at least 6-8 glasses a day (if fluid is not restricted for another medical condition)
• Eat well balanced diet including high-fiber foods. Good sources of fiber are fruits, vegetable, whole grain, legumes, cereal, grain etc. Aim to consume 25 to 35 grams of fiber daily.
• Drink fruit juice
• Exercise regularly.
• Avoid intake of medication causing conspirator. But, consult to your doctor before stopping it.
• Don't ignore the urge to have a bowel movement