Constipation is a condition of the digestive system where an individual has hard faeces that are difficult to expel. In most cases, this happens because the intestine has absorbed too much water from the food that is in the intestine. The slower the food moves through the intestinal tract, the more water gets absorbed by the intestines.
Constipation is considered more as a symptom and not a disease. It is the most common chronic gastrointestinal disorder in adults, affecting 2 – 20% of the population. It is more common in women than men, and in the elderly than children.
Being constipated means that your bowel movements are tough or happens less than normal. The normal length of time or frequency of bowel movements vary from person to person. Some have bowel movements 3 times a day and others just a few times in a week. When a person passes stool less than 3 times a week, it is defined as constipation. Chronic constipation is when a person has bowel movements less than 3 days in a month for more than 3 months.
What are the Associated Symptoms of Constipation?
- Fewer bowel movements
- Straining to move bowel
- Abdominal pain
- Hard stools
- Excessive time spent to pass stool
- Incomplete bowel evacuation (feeling as if everything is not yet out)
12 THINGS THAT CAN GIVE YOU CONSTIPATION
- Diet : Lack of fibre in diet.
- Physical inactivity : Lack of physical activity or exercise especially in older adults or those bedridden for a long time.
- Milk : Consumption of excessive milk and diary products may cause constipation.
- Age: Aging is a predisposing factor for constipation.
- Routine changes : Changes in routine may cause constipation. When a person travels, their normal routine changes and this can affect the digestive system which may lead to constipation for a few days.
- Missed toilet : Not going to toilet when needed can also lead to constipation. Ignoring the urge to go to the toilet can cause the urge to disappear and the longer the delay, the drier and harder the stool becomes.
- Not drinking enough water : Drinking water does not relieve constipation but can reduce the risk of the development of constipation. Sodas and drinks that contain caffeine as well as alcohol can cause dehydration which can worsen constipation and so should be avoided.
- Stress : Physical and mental has also been shown to predispose to constipation.
- Surgery : Post operative pain can make it difficult for those who have undergone surgery to pass stool for a few days.
- Pregnancy : Pregnancy can result in constipation due to hormonal changes and the compression of the intestines by the growing uterus.
- Medications : Over use of laxatives, narcotic opioids (like codeine and oxycodone), antidepressants, anticonvulsants, antihypertensives (calcium channel blockers), aluminium containing antacids, and diuretics all have side effects of constipation.
- Medical Conditions : Neurological disorders (like Parkinson’s disease, stroke and spinal cord injury), endocrine/metabolic conditions (like uraemia, diabetes, hypercalcemia, and hypothyroidism), gastrointestinal problems (like IBS, scarring of intestine, diverticulitis, and colorectal strictures and tumours), congenital abnormalities (like Hirshsprung’s disease and imperforate anus), systemic diseases (like lupus, amyloidosis and coeliac disease) and cancer chemotherapy will present with constipation.
Constipation will may need to be evaluated and reevaluated to determine the cause.
Diagnosis is based on the description of its associated symptoms including physical examination focusing on abdominal and rectal exams.
This does not require laboratory tests unless there is a suspected underlying cause. Tests may include full blood count, thyroid function test, serum calcium, serum potassium and others.
Abdominal X-rays are generally performed only if bowel obstruction is suspected. Colonoscopy may be performed if an abnormality in the colon like tumours are suspected.
How Constipation can be Treated
Constipation usually resolves on its own without any medical intervention. If the underlying cause of the constipation is known, the treatment is focused on it.
General measures and lifestyle changes that can help relieve constipation include;
- Increased intake of fibre rich diet such as fruits, vegetables and whole grains.
- Increased water intake is helpful before the onset.
- Doing more physical activities or exercise.
- Elevate knees above the hip level when passing stools.
Medical interventions may involve :
- Fibre supplementation with both soluble fibre supplements like psyllium and insoluble fibre supplements like wheat bran.
- Use of laxatives are usually last resort. There are different classes of laxatives that may be used to treat constipation. Saline laxatives which include milk of magnesia are the first line choice. Others include stimulant laxatives, lubricant laxatives, stool softeners, prokinetics and osmotic laxatives.
- Constipation that resist the above measures may require physical intervention such as manual disimpaction (using hands to physically remove impacted stools).
- Surgical interventions are also available for refractory cases To Help relieve chronic forms such as sacral nerve stimulation and colectomy.
Complications may arise if not treated promptly and accurately including
- Haemorrhoids (Pile)
- Anal fissures
- Rectal prolapse
- Fecal impaction
When to See A Doctor?
Report to the hospital if :
- Blood is present in your stool.
- You have lost weight.
- Severe pain when moving your bowel.
- Have not been able to pass stool for more than 2 weeks.
- Lifestyle changes and general measures have been unsuccessful.
- Eat well balanced diet with plenty fibre.
- Drink one and half to two litres of water and other fluids daily.
- Avoid caffeine.
- Cut back on milk intake.
- Exercise regularly.
- Go to toilet when you feel it.