Constipation is defined as having a bowel movement fewer than
three times per week. With constipation stools are usually hard, dry, small in
size, and difficult to eliminate. Some people who are constipated find it
painful to have a bowel movement and often experience straining, bloating, and
the sensation of a full bowel.
Some people think they are constipated if they do not have a
bowel movement every day. However, normal stool elimination may be three times
a day or three times a week, depending on the person.
Constipation is a symptom, not a disease. Almost everyone
experiences constipation at some point in their life, and a poor diet typically
is the cause. Most constipation is temporary and not serious. Understanding its
causes, prevention, and treatment will help most people find relief.
Lower digestive system.
Who gets constipated?
Constipation is one of the most common gastrointestinal
complaints in the United States. More than 4 million Americans have frequent
constipation, accounting for 2.5 million physician visits a year. Those
reporting constipation most often are women and adults ages 65 and older.
Pregnant women may have constipation, and it is a common problem following
childbirth or surgery.
Self-treatment of constipation with over-the-counter (OTC)
laxatives is by far the most common aid. Around $725 million is spent on
laxative products each year in America.
What causes constipation?
To understand constipation, it helps to know how the colon, or
large intestine, works. As food moves through the colon, the colon absorbs
water from the food while it forms waste products, or stool. Muscle
contractions in the colon then push the stool toward the rectum. By the time
stool reaches the rectum it is solid, because most of the water has been
absorbed.
Constipation occurs when the colon absorbs too much water or if
the colon’s muscle contractions are slow or sluggish, causing the stool to move
through the colon too slowly. As a result, stools can become hard and dry.
Common causes of constipation are
- not enough fibre in the diet
- lack of physical activity
(especially in the elderly)
- medications
- milk
- irritable bowel syndrome
- changes in life or routine such as
pregnancy, aging, and travel
- abuse of laxatives
- ignoring the urge to have a bowel
movement
- dehydration
- specific diseases or conditions,
such as stroke (most common)
- problems with the colon and rectum
- problems with intestinal function
(chronic idiopathic constipation)
Not Enough Fibre in the Diet
People who eat a high-fibre diet are less likely to become
constipated. The most common causes of constipation are a diet low in fibre or
a diet high in fats, such as cheese, eggs, and meats.
Fibre—both soluble and insoluble—is the part of fruits,
vegetables, and grains that the body cannot digest. Soluble fibre dissolves
easily in water and takes on a soft, gel-like texture in the intestines.
Insoluble fibre passes through the intestines almost unchanged. The bulk and
soft texture of fibre help prevent hard, dry stools that is difficult to pass.
A low-fibre diet also plays a key role in constipation among
older adults, who may lose interest in eating and choose foods that are quick
to make or buy, such as fast foods, or prepared foods, both of which are
usually low in fibre. Also, difficulties with chewing or swallowing may cause
older people to eat soft foods that are processed and low in fibre.
Not Enough Liquids
Research shows that although increased fluid intake does not
necessarily help relieve constipation, many people report some relief from
their constipation if they drink fluids such as water and juice and avoid
dehydration. Liquids add fluid to the colon and bulk to stools, making bowel
movements softer and easier to pass. People who have problems with constipation
should try to drink liquids every day. However, liquids that contain caffeine,
such as coffee and cola drinks will worsen one’s symptoms by causing
dehydration. Alcohol is another beverage that causes dehydration. It is
important to drink fluids that hydrate the body, especially when consuming caffeine
containing drinks or alcoholic beverages.
Lack of Physical Activity
A lack of physical activity can lead to constipation, although
doctors do not know precisely why. For example, constipation often occurs after
an accident or during an illness when one must stay in bed and cannot exercise.
Lack of physical activity is thought to be one of the reasons constipation is
common in older people.
Medications
Some medications can cause constipation, including
- pain medications (especially
narcotics)
- antacids that contain aluminium
and calcium
- blood pressure medications
(calcium channel blockers)
- antiparkinson drugs
- antispasmodics
- antidepressants
- iron supplements
- diuretics
- anticonvulsants
Changes in Life or Routine
During pregnancy, women may be constipated because of hormonal
changes or because the uterus compresses the intestine. Aging may also affect
bowel regularity, because a slower metabolism results in less intestinal
activity and muscle tone. In addition, people often become constipated when travelling,
because their normal diet and daily routine are disrupted.
Abuse of Laxatives
The common belief that people must have a daily bowel movement
has led to self-medicating with OTC laxative products. Although people may feel
relief when they use laxatives, typically they must increase the dose over time
because the body grows reliant on laxatives in order to have a bowel movement.
As a result, laxatives may become habit-forming.
Ignoring the Urge to Have a Bowel Movement
People who ignore the urge to have a bowel movement may
eventually stop feeling the need to have one, which can lead to constipation.
Some people delay having a bowel movement because they do not want to use
toilets outside the home. Others ignore the urge because of emotional stress or
because they are too busy. Children may postpone having a bowel movement
because of stressful toilet training or because they do not want to interrupt
their play.
Specific Diseases
Diseases that cause constipation include neurological disorders,
metabolic and endocrine disorders, and systemic conditions that affect organ
systems. These disorders can slow the movement of stool through the colon,
rectum, or anus.
Conditions that can cause constipation are found below.
- Neurological disorders
- multiple sclerosis
- Parkinson's disease
- chronic idiopathic intestinal
pseudo-obstruction
- stroke
- spinal cord injuries
- Metabolic and endocrine conditions
- diabetes
- uraemia
- hypercalcemia
- poor glycemic control
- hypothyroidism
- Systemic disorders
- amyloidosis
- lupus
- scleroderma
Problems with the Colon and Rectum
Intestinal obstruction, scar tissue—also called
adhesions—diverticulosis, tumours, colorectal stricture, Hirschsprung’s
disease, or cancer can compress, squeeze, or narrow the intestine and rectum
and cause constipation.
Problems with Intestinal Function
The two types of constipation are idiopathic constipation and
functional constipation. Irritable bowel syndrome (IBS) with predominant
symptoms of constipation is categorized separately.
Idiopathic—of unknown origin—constipation does not respond to
standard treatment.
Functional constipation means that the bowel is healthy but not
working properly. Functional constipation is often the result of poor dietary
habits and lifestyle. It occurs in both children and adults and is most common
in women. Colonic inertia, delayed transit, and pelvic floor dysfunction are
three types of functional constipation. Colonic inertia and delayed transit are
caused by a decrease in muscle activity in the colon. These syndromes may
affect the entire colon or may be confined to the lower, or sigmoid, colon.
Pelvic floor dysfunction is caused by a weakness of the muscles
in the pelvis surrounding the anus and rectum. However, because this group of
muscles is voluntarily controlled to some extent, biofeedback training is
somewhat successful in retraining the muscles to function normally and
improving the ability to have a bowel movement.
Functional constipation that stems from problems in the
structure of the anus and rectum is known as ano-rectal dysfunction, or
anismus. These abnormalities result in an inability to relax the rectal and
anal muscles that allow stool to exit.
People with IBS having predominantly constipation also have pain
and bloating as part of their symptoms.
How is the cause of constipation identified?
The tests the doctor performs depend on the duration and
severity of the constipation, the person’s age, and whether blood in stools,
recent changes in bowel habits or weight loss have occurred. Most people with
constipation do not need extensive testing and can be treated with changes in
diet and exercise. For example, in young people with mild symptoms, a medical
history and physical exam may be all that is needed for diagnosis and
treatment.
Medical History
The doctor may ask a patient to describe his or her
constipation, including duration of symptoms, frequency of bowel movements, and
consistency of stools, presence of blood in the stool, and toilet habits— how
often and where one has bowel movements. A record of eating habits, medication,
and level of physical activity will also help the doctor determine the cause of
constipation.
The clinical definition of constipation is having any two of the
following symptoms for at least 12 weeks—not always consecutive—in the previous
12 months:
- straining during bowel movements
- lumpy or hard stool
- sensation of incomplete evacuation
- sensation of ano-rectal
blockage/obstruction
- fewer than three bowel movements
per week
Physical Examination
A physical exam may include a rectal exam with a gloved,
lubricated finger to evaluate the tone of the muscle that closes off the
anus—also called anal sphincter—and to detect tenderness, obstruction, or
blood. In some cases, blood and thyroid tests may be necessary to look for
thyroid disease and serum calcium or to rule out inflammatory, metabolic, and
other disorders.
Extensive testing usually is reserved for people with severe
symptoms, for those with sudden changes in the number and consistency of bowel
movements or blood in the stool, and older adults. Additional tests that may be
used to evaluate constipation include
- a colorectal transit study
- ano-rectal function tests
- a defecography
Because of an increased risk of colorectal cancer in older
adults, the doctor may use tests to rule out a diagnosis of cancer, including a
- barium enema x ray
- sigmoidoscopy or colonoscopy
Colorectal transit study. This test shows how well
food moves through the colon. The patient swallows capsules containing small
markers that are visible on an x ray. The movement of the markers through the
colon is monitored by abdominal x rays taken several times 3 to 7 days after
the capsule is swallowed. The patient eats a high-fibre diet during the course
of this test.
Anorectal function tests. These tests diagnose
constipation caused by abnormal functioning of the anus or rectum—also called ano-rectal
function.
- Anorectal manometry evaluates anal sphincter muscle
function. For this test, a catheter or air-filled balloon is inserted into
the anus and slowly pulled back through the sphincter muscle to measure
muscle tone and contractions.
- Balloon expulsion tests consist of filling a balloon with
varying amounts of water after it has been rectally inserted. Then the
patient is asked to expel the balloon. The inability to expel a balloon
filled with less than 150 ml of water may indicate a decrease in bowel
function.
Defecography is an x ray of the ano-rectal area that evaluates completeness
of stool elimination, identifies ano-rectal abnormalities, and evaluates rectal
muscle contractions and relaxation. During the exam, the doctor fills the
rectum with a soft paste that is the same consistency as stool. The patient
sits on a toilet positioned inside an x-ray machine, then relaxes and squeezes
the anus to expel the paste. The doctor studies the x rays for ano-rectal
problems that occurred as the paste was expelled.
Barium enema x ray. This exam involves viewing the rectum, colon,
and lower part of the small intestine to locate problems. This part of the
digestive tract is known as the bowel. This test may show intestinal
obstruction and Hirschsprung’s disease, which is a lack of nerves within the
colon.
The night before the test, bowel cleansing, also called bowel
prep, is necessary to clear the lower digestive tract. The patient drinks a
special liquid to flush out the bowel. A clean bowel is important, because even
a small amount of stool in the colon can hide details and result in an
incomplete exam.
Because the colon does not show up well on x rays, the doctor
fills it with barium, a chalky liquid that makes the area visible. Once the
mixture coats the inside of the colon and rectum, x rays are taken that show
their shape and condition. The patient may feel some abdominal cramping when
the barium fills the colon but usually feels little discomfort after the
procedure. Stools may be white in colour for a few days after the exam.
Sigmoidoscopy or colonoscopy. An examination of the
rectum and lower, or sigmoid, colon is called a sigmoidoscopy. An examination
of the rectum and entire colon is called a colonoscopy.
The person usually has a liquid dinner the night before a
colonoscopy or sigmoidoscopy and takes an enema early the next morning. An
enema an hour before the test may also be necessary.
To perform a sigmoidoscopy, the doctor uses a long, flexible
tube with a light on the end, called a sigmoidoscope, to view the rectum and
lower colon. The patient is lightly sedated before the exam. First, the doctor
examines the rectum with a gloved, lubricated finger. Then, the sigmoidoscope
is inserted through the anus into the rectum and lower colon. The procedure may
cause abdominal pressure and a mild sensation of wanting to move the bowels.
The doctor may fill the colon with air to get a better view. The air can cause
mild cramping.
To perform a colonoscopy, the doctor uses a flexible tube with a
light on the end, called a colonoscope, to view the entire colon. This tube is
longer than a sigmoidoscope. During the exam, the patient lies on his or her
side, and the doctor inserts the tube through the anus and rectum into the
colon. If an abnormality is seen, the doctor can use the colonoscope to remove
a small piece of tissue for examination (biopsy). The patient may feel gassy
and bloated after the procedure.
How is constipation treated?
Although treatment depends on the cause, severity, and duration
of the constipation, in most cases dietary and lifestyle changes will help
relieve symptoms and help prevent them from recurring.
Diet
A diet with enough fibre (20 to 35 grams each day) helps the
body form soft, bulky stool. A doctor or dietician can help plan an appropriate
diet. High-fibre foods include beans, whole grains and bran cereals, fresh
fruits, and vegetables such as asparagus, Brussels sprouts, cabbage, and
carrots. For people prone to constipation, limiting foods that have little or
no fibre, such as ice cream, cheese, meat, and processed foods, is also
important.
Lifestyle Changes
Other changes that may help treat and prevent constipation
include drinking enough water and other liquids, such as fruit and vegetable
juices and clear soups, so as not to become dehydrated, engaging in daily
exercise, and reserving enough time to have a bowel movement. In addition, the
urge to have a bowel movement should not be ignored.
Laxatives
Most people who are mildly constipated do not need laxatives.
However, for those who have made diet and lifestyle changes and are still
constipated, a doctor may recommend laxatives or enemas for a limited time.
These treatments can help retrain a chronically sluggish bowel. For children, short-term
treatment with laxatives, along with retraining to establish regular bowel
habits, helps prevent constipation.
A doctor should determine when a patient needs a laxative and
which form is best. Laxatives taken by mouth are available in liquid, tablet,
gum powder, and granule forms. They work in various ways:
- Bulk-forming laxatives generally are considered the
safest, but they can interfere with absorption of some medicines. These
laxatives, also known as fibre supplements, are taken with water. They
absorb water in the intestine and make the stool softer. Brand names
include Metamucil, Fiberall, Citrucel, Konsyl, and Serutan. These agents
must be taken with water or they can cause obstruction. Many people also
report no relief after taking bulking agents and suffer from a worsening
in bloating and abdominal pain.
- Stimulants cause rhythmic muscle
contractions in the intestines. Brand names include Correctol, Dulcolax,
Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in
some stimulant laxatives, might increase a person’s risk for cancer. The
Food and Drug Administration has proposed a ban on all over-the-counter
products containing phenolphthalein. Most laxative makers have replaced,
or plan to replace, phenolphthalein with a safer ingredient.
- Osmotics cause fluids to flow in a special
way through the colon, resulting in bowel distension. This class of drugs
is useful for people with idiopathic constipation. Brand names include
Cephulac, Sorbitol, and Miralax. People with diabetes should be monitored
for electrolyte imbalances.
- Stool softeners moisten the stool and prevent
dehydration. These laxatives are often recommended after childbirth or
surgery. Brand names include Colace and Surfak. These products are
suggested for people who should avoid straining in order to pass a bowel
movement. The prolonged use of this class of drugs may result in an
electrolyte imbalance.
- Lubricants grease the stool, enabling it to
move through the intestine more easily. Mineral oil is the most common example.
Brand names include Fleet and Zymenol. Lubricants typically stimulate a
bowel movement within 8 hours.
- Saline laxatives act like a sponge to draw water
into the colon for easier passage of stool. Brand names include Milk of
Magnesia and Haley’s M-O. Saline laxatives are used to treat acute
constipation if there is no indication of bowel obstruction. Electrolyte
imbalances have been reported with extended use, especially in small
children and people with renal deficiency.
- Chloride channel activators increase intestinal fluid and
motility to help stool pass, thereby reducing the symptoms of
constipation. One such agent is Amitiza, which has been shown to be safely
used for up to 6 to 12 months. Thereafter a doctor should assess the need
for continued use.
People who are dependent on laxatives need to slowly stop using
them. A doctor can assist in this process. For most people, stopping laxatives
restores the colon’s natural ability to contract.
Other Treatments
Treatment for constipation may be directed at a specific cause.
For example, the doctor may recommend discontinuing medication or performing
surgery to correct an ano-rectal problem such as rectal prolapse, a condition
in which the lower portion of the colon turns inside out.
People with chronic constipation caused by ano-rectal
dysfunction can use biofeedback to retrain the muscles that control bowel
movements. Biofeedback involves using a sensor to monitor muscle activity,
which is displayed on a computer screen, allowing for an accurate assessment of
body functions. A health care professional uses this information to help the
patient learn how to retrain these muscles.
Surgical removal of the colon may be an option for people with
severe symptoms caused by colonic inertia. However, the benefits of this
surgery must be weighed against possible complications, which include abdominal
pain and diarrhoea.
Homeopathy Treatment for Constipation- Homeopathy helps for
constipation while other system fails
Can constipation be serious?
Sometimes constipation can lead to complications. These
complications include haemorrhoids, caused by straining to have a bowel
movement, or anal fissures—tears in the skin around the anus—caused when hard stool
stretches the sphincter muscle. As a result, rectal bleeding may occur,
appearing as bright red streaks on the surface of the stool. Treatment for haemorrhoids
may include warm tub baths, ice packs, and application of a special cream to
the affected area. Treatment for anal fissures may include stretching the
sphincter muscle or surgically removing the tissue or skin in the affected
area.
Sometimes straining causes a small amount of intestinal lining
to push out from the anal opening. This condition, known as rectal prolapse,
may lead to secretion of mucus from the anus. Usually eliminating the cause of
the prolapse, such as straining or coughing, is the only treatment necessary.
Severe or chronic prolapse requires surgery to strengthen and tighten the anal
sphincter muscle or to repair the prolapsed lining.
Constipation may also cause hard stool to pack the intestine and
rectum so tightly that the normal pushing action of the colon is not enough to
expel the stool. This condition, called faecal impaction, occurs most often in
children and older adults. An impaction can be softened with mineral oil taken
by mouth and by an enema. After softening the impaction, the doctor may break
up and remove part of the hardened stool by inserting one or two fingers into
the anus.
Points to Remember
- Constipation affects almost
everyone at one time or another.
- Many people think they are
constipated when, in fact, their bowel movements are regular.
- The most common causes of
constipation are poor diet and lack of exercise.
- Other causes of constipation
include medications, irritable bowel syndrome, abuse of laxatives, and
specific diseases.
- A medical history and physical
exam may be the only diagnostic tests needed before the doctor suggests
treatment.
- In most cases, following these
simple tips will help relieve symptoms and prevent recurrence of
constipation:
- Eat a well-balanced, high-fibre
diet that includes beans, bran, whole grains, fresh fruits, and
vegetables.
- Drink plenty of liquids.
- Exercise regularly.
- Set aside time after breakfast or
dinner for undisturbed visits to the toilet.
- Do not ignore the urge to have a
bowel movement.
- Understand that normal bowel
habits vary.
- Whenever a significant or
prolonged change in bowel habits occurs, check with a doctor.
- Most people with mild constipation
do not need laxatives. However, a doctor may recommend laxatives for a
limited time for people with chronic constipation.
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Constipation
in Children
Constipation
means that bowel movements are hard and dry, difficult or painful to pass, and
less frequent than usual. It is a common problem for children, but it is
usually temporary and no cause for parents to be concerned.
When a child
does not eat enough fibre, drink enough liquids, or get enough exercise,
constipation is more likely to occur. It also happens when children ignore the
urge to have a bowel movement, which they often do out of embarrassment to use
a public bathroom, fear or lack of confidence in the absence of a parent, or
unwillingness to take a break from play. Sometimes constipation is caused by
medicines or a disease.
Symptoms of
constipation include
- no
bowel movement for several days or daily bowel movements that are hard and
dry
- cramping
abdominal pain
- nausea
- vomiting
- weight
loss
- liquid
or solid, clay-like stool in the child's underwear—a sign that stool is
backed up in the rectum
Constipation
can make a bowel movement painful, so the child may try to prevent having one.
Clenching buttocks, rocking up and down on toes, and turning red in the face
are signs of trying to hold in a bowel movement.
Treatment
depends on the child's age and the severity of the problem. Often eating more fibre
(fruits, vegetables, and whole-grain cereal), drinking more liquids, and
getting more exercise will solve the problem. Sometimes a child may need an
enema to remove the stool or a laxative to soften it or prevent a future
episode. However, laxatives can be dangerous to children and should be given
only with a doctor's approval.
Although
constipation is usually harmless, it can be a sign or cause of a more serious
problem. A child should see a doctor if
- episodes
of constipation last longer than 3 weeks
- the
child is unable to participate in normal activities
- small,
painful tears appear in the skin around the anus
- a
small amount of the intestinal lining is pushed out of the anus (haemorrhoids)
- normal
pushing is not enough to expel stool
- liquid
or soft stool leaks out of the anus
Homeopathy Treatment for Constipation- Homeopathy helps for
constipation while other system fails
For More details Please contact
Whom to contact for Constipation Treatment
Dr.Senthil
Kumar Treats many cases Acute and Chronic Consitpation, In his medical
professional experience with successful results. Many patients get relief after
taking treatment from Dr.Senthil Kumar. Dr.Senthil Kumar visits Chennai
at Vivekanantha Homeopathy Clinic, Velachery, Chennai 42. To get appointment
please call 9786901830, +91 94430 54168 or mail to consult.ur.dr@gmail.com,
For
more details & Consultation Feel free to contact us.
Vivekanantha Clinic Consultation Champers
at
Chennai:- 9786901830
Panruti:- 9443054168
Pondicherry:- 9865212055 (Camp)
For appointment please Call us or Mail Us
For appointment: SMS your Name -Age – Mobile Number - Problem in Single word -
date and day - Place of appointment (Eg: Rajini – 30 - 99xxxxxxx0 – Chronic Constipation – 21st Oct, Sunday - Chennai
), You will receive Appointment details through SMS
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