What is Constipation?
BDS (Bachelor of Dental Surgery), 10 years of experience
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What is the meaning of Constipation?
When a person has less than three bowel movements in one week, the condition is known as constipation. Occasional constipation is a common occurrence, but some people experience chronic constipation, that is, infrequent bowel movements or difficulty in the passage of stools for many weeks or even longer. Chronic constipation can cause excessive straining on having a bowel movement. This can interfere with the ability of an individual to perform their daily tasks. In this article, we will be discussing causes constipation in detail –
- What are the causes of Constipation?
- What are the risk factors of Constipation?
- What are the symptoms of Constipation?
- How to diagnose Constipation?
- What is the treatment for Constipation?
- What are the complications of Constipation?
- How to prevent Constipation?
What are the causes of Constipation?
Constipation occurs when the stool or waste moves very slowly through the digestive tract, or the stools cannot be eliminated properly from the rectum (the last several inches of the large intestine), causing the stools to become dry and hard. The possible causes of constipation are:
- Blockages in the rectum or colon: This may lead to stopping or slowing of the stool movement. The causes may include:
- Colon (the longest part of the large intestine) cancer
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- Anal fissure (tiny tears caused in the skin around the anus)
- Bowel obstruction (blockage in the intestines)
- Bowel stricture (narrowing of the colon)
- Rectal cancer
- Rectocele (bulging of the rectum through the vaginal back wall)
- Stomach (abdominal) cancer pressing on the colon
Problems associated with the nerves around the rectum and colon: Neurological or nerve-related disorders can cause the contraction in the muscles present in the rectum and colon, and move the stools through the intestines. The causes may include:
- Autonomic neuropathy (damage to the nerves controlling the body functions)
- Stroke (blockage of the blood flow to the brain)
- Spinal cord (backbone) injury
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- Multiple sclerosis (a disease in which the protective covering of the nerves is eaten away by the immune or disease-fighting system of the body)
- Parkinson’s disease (a central nervous system disorder that may affect movements and cause tremors)
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Problems with the muscles involved in bowel movement: The pelvic muscles that are involved in having a bowel movement may lead to chronic constipation. The causes may include:
- Weakened pelvic muscles
- Dyssynergia (when the pelvic muscles cannot coordinate contraction and relaxation correctly)
- Anismus (the inability in relaxing the pelvic muscles allowing a bowel movement)
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Disorders affecting the hormones in the body: The body fluids are balanced by the hormones. The diseases that upset the hormonal balance may cause constipation, and include:
- Pregnancy
- Diabetes
- Hypothyroidism (an underactive thyroid)
- Hyperparathyroidism (an overactive parathyroid gland)
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What are the risk factors of Constipation?
Certain factors may increase the risk of developing constipation. These factors include:
- Old age
- More common in women
- Dehydration
- A low-fiber diet
- Little or no physical activity
- Depression
- Eating disorders
- Certain medications like high blood pressure medications, sedatives, opioid pain medications
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What are the symptoms of Constipation?
The symptoms of constipation include:
- Difficulty in passing stools
- Straining when passing stools
- Dry, lumpy, or hard stools
- Passing fewer stools than normal
- Nausea
- Loss of appetite
- Feeling bloated
- Pain in the abdomen
- Cramping in the abdomen
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How to diagnose Constipation?
- Physical examination: The doctor will physically examine the patient and ask about any medical history.
- Digital rectal exam: The doctor inserts a gloved, lubricated finger into the rectum to feel for the abnormalities.
- Blood tests: It helps in checking for any pre-existing medical conditions like hypothyroidism (low thyroid) or high calcium levels that may be causing constipation.
- X-ray: An x-ray helps the doctor to check for blockages in the intestine and if any stool is present throughout the colon.
- Sigmoidoscopy: The doctor inserts a flexible, lighted tube into the anus for the examination of the rectum and sigmoid colon (lower portion of the colon).
- Colonoscopy: This procedure helps the doctor in the examination of the rectum and entire colon using a flexible tube with a camera on one end.
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- Anorectal manometry: The procedure is done by inserting a flexible, narrow tube into the rectum and anus, and then inflating a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows the doctor to measure the coordination of the muscles used during the movement of the bowels.
- Balloon expulsion test: This procedure is often done along with anorectal manometry. It helps in measuring the time taken to push out a balloon filled with water and place it in the rectum.
- Colonic transit study: This procedure involves the swallowing of a capsule containing a wireless recording device or a radiopaque marker. The progression of the capsule through the capsule is recorded over 24 to 48 hours and can be seen in the x-rays.
- Scintigraphy: A radioactive-activated food is eaten and a special camera is used for recording its progress. This helps the doctor in diagnosing intestinal muscle dysfunction and how well the food moves through the colon.
- Defecography: The doctor inserts a soft paste made of barium into the rectum. The barium paste is removed from the stools. The barium is visible on the x-rays and may reveal a prolapse or problems associated with muscle coordination and muscle function.
- MRI defecography: The doctor inserts a contrasting gel into the rectum. This gel is passed through the stools. The MRI scanner helps in visualizing and assessing the function of the defecation muscles. It can also help in diagnosing disorders like rectal prolapse or rectocele, which may be causing constipation.
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What is the treatment for Constipation?
The various treatment options for constipation include:
Lifestyle and diet changes:
- Increase the fiber intake in your diet.
- Exercise regularly.
- Immediately use the washroom if you have the urge to have a bowel movement.
Laxatives:
- Fiber supplements: They help in adding bulk to the stools. Bulky stools are softer and can be passed easily. Examples include psyllium and methylcellulose.
- Stimulants: Stimulants like bisacodyl and sennosides cause the contraction of the intestines.
- Osmotics: The osmotic laxatives help the stools in moving through the colon by increasing the fluid secretion from the intestines and helping in the stimulation of the bowel movements. Examples include polyethylene glycol and oral magnesium hydroxide.
- Lubricants: Lubricants like mineral oil help the stool to move through the colon easily.
- Stool softeners: Stool softeners like docusate calcium and docusate sodium draw water from the intestines to moisten the stool.
- Enemas and suppositories: Enema help in softening the stools and producing a bowel movement. Bisacodyl or glycerine suppositories also help in the movement of the stools out of the body by providing stimulation and lubrication.
Other medications:
- Medications for drawing water into the intestines: Examples include linaclotide, plecanatide, and lubiprostone.
- Serotonin 5-hydroxytryptamine 4 receptors: Prucalopride helps in moving the stool through the colon.
- Peripherally acting mu-opioid receptor (PAMORAs): If the cause of constipation is opioid pain medications, PAMORAs like naloxegol and methylnaltrexone can reverse the effect of opioids on the intestine and allow the bowel to keep moving.
Biofeedback:
- In biofeedback training, a therapist helps you in learning how to relax and tighten the muscles in the pelvis (region below the stomach).
- Relaxing the pelvic floor muscles at the correct time during the passage of stools can make the process easier.
- During a biofeedback session, a special tube known as a catheter is inserted into the rectum to measure the muscle tension.
- The therapist will guide you through some exercises to alternately relax and tighten the pelvic muscles.
- A machine helps in gauging the muscle tension and uses lights or sounds to help in understanding whether the muscles have been relaxed.
Surgery:
- If all other treatment methods have failed and the cause of chronic constipation is a rectocele, stricture, or blockage, surgery may be a treatment option.
- In people with an abnormally slow movement of the stools through the colon, the surgical removal of a part of the colon may be considered. Entire removal of the colon is rarely needed.
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What are the complications of Constipation?
The complications of constipation may include:
- Anal fissure (the skin is torn in the anus)
- Fecal impaction (stools that cannot be expelled)
- Hemorrhoids (swelling of the veins in the anus)
- Rectal prolapse (intestine protruding from the anus)
Contact your doctor if you notice any of the above complications.
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How to prevent Constipation?
Constipation can be prevented by the following means:
- Drink lots of fluids
- Eat a fiber-rich diet including fruits, vegetables, whole grain cereals, bran, and beans
- Avoid low-fiber food, processed food, dairy, and meat products
- Exercise regularly
- Manage your stress
- Make a regular schedule for bowel movements
- Include plenty of fiber in the diet of children who have just begun eating solid foods
- Do not ignore the urge of passing stools
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We hope that we were able to answer all your questions regarding constipation through this article.
If you want more information and treatment for constipation, you can contact a Gastroenterologist.
We only aim to give you information through the article and do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan.
