Overview and Facts
Constipation is a condition in which a person faces difficulty to empty his bowels. The stool is usually hard and dry, and bowel movements are hard to pass. Most people experience constipation at some point in their lives. How common is constipation can be estimated by the fact that around 400 million USD are spent on laxatives in a year by affected people in the U.S., who contribute to around 15-20% of the total U.S. population. [1]
The amount of bowel movement necessary to be considered as normal is flexible. For some people, two or three bowel movements in a week is normal, whereas for others, two to three bowel movements in a day might be normal. In fact, even less than 50% of people have at least one bowel movement a day.
Therefore, unless there are less than three bowel movements in a week accompanied by hard, dry and painful eliminations, the condition is not considered as constipation.
One of the prevailing myth in the society is that constipation can lead to accumulation of toxins or can cause diseases like colon cancer.
Constipation can be caused by various factors like underlying severe medical condition, psychological disturbances, lifestyle and inactiveness, but is rarely life-threatening.
Types and Symptoms of Constipation
Types of Constipation:
Based on the underlying cause, constipation can be broadly divided into two types:
1. Primary Constipation: It is also known as functional constipation and caused by functional problems in the intestinal tract. It can be further divided into three types:
- Slow-Transit Constipation: This is caused when there is a decrease in motility (gut movement) and transit time – total time taken by the food to pass through all the organs of the digestive system. It may also include bloating, infrequent bowel movements and abdominal discomfort.
- Pelvic-Floor Dysfunction: It is also known as Outlet constipation. In this, dissonant of musculature of pelvic floor causes anal relaxation failure, anal contraction and inappropriate propulsion of stool. This type of constipation rarely responds to medications.
- Normal-Transit Constipation: There are people that have normal rate of food transit and daily bowel movements, yet they have constipation. This is known as normal-transit constipation. In this, people have difficulty in passing out stools and have abdominal bloating. This condition is often associated with high level of psychological distress.
2. Secondary Constipation: When the underlying cause of constipation is other conditions like Parkinson’s disease, hypothyroidism, celiac disease and multiple sclerosis or consumption of certain medications, then it is said to be secondary constipation.
Symptoms of Constipation:
Major symptoms of constipation are as follows:
- Abdominal pain
- Abdominal cramps
- Vomiting and nausea
- Loss of appetite
Risk Factors of Constipation
Factors that may increase the risk of constipation are discussed below:
- Age: Constipation is more common in the elderly.
- Gender: Women are more likely to have constipation.
- Fluids Level: Being dehydrated increases the chances of constipation.
- Diet: Reduced intake of fibers and high consumption of dairy products can cause constipation.
- Physical Activity: People abstaining from physical activities are more likely to have constipation.
- Medications: Certain medications like antidepressants and iron pills can cause constipation.
- Medical Conditions: People with medical conditions like eating disorders, irritable bowel syndrome, colon cancer are at a higher risk of constipation.
- Pregnancy: Pregnant women are at a higher risk of constipation.
Do I have Constipation?
Difficulty in excreting is called constipation. But, this might occur due to some underlying medical condition, such as
- Appendicitis
- Cystic fibrosis
- Edema
- Irritable bowel syndrome
- Diverticulosis.
If you are having constipation with fever, chills or pain, then it should not be ignored and proper medical attention should be sought immediately.
Causes and Prevention of Constipation
Causes of Constipation:
Constipation can occur due to following reasons:
1. Decreased Fiber Intake: Reduced intake of fibers increases the likelihood of having constipation. Generally, foods that are low in fiber have high fat content, such as cheese and meat. These should be avoided.
2. Idleness: Physical inactivity or idleness can also cause constipation. People who have been at bed rest for several days or weeks can experience constipation. Elderly people, who tend to have more inactive lifestyle than younger people are at a higher risk of constipation.
3. Medication: Certain medications can cause constipation. Some of which are:
- Narcotic drugs like oxycodone, codeine and hydromorphone.
- Antidepressants like imipramine and amitriptyline.
- Anticonvulsants like carbamazepine and phenytoin iron supplements
- Aluminum containing antacids
4. Milk: Milk and other dairy products can cause constipation.
5. Irritable Bowel Syndrome: People with irritable bowel syndrome(IBS) are much more susceptible to constipation.
6. Pregnancy: Pregnant women can suffer from constipation due to various hormonal changes.
7. Aging: Elderly people switch to sedentary lifestyle and their metabolism slows down. This makes them more vulnerable to constipation.
8. Circadian Cycle: Changes in routine disturbs the circadian cycle of a person, which makes him/her more vulnerable to constipation.
9. Laxative Dependence: Laxatives help in improving bowel movement, but overuse of laxatives can make one dependent on it. This might giving rise to constipation.
10. Avoiding the Natural Call: Ignoring the urge to go toilet when needed can lead to constipation as the stool becomes drier and harder with time.
11. Dehydration: Dehydration can cause constipation by making the stool harder and drier. Carbonated drinks and caffeine promote dehydration and may worsen the situation.
12. Colon or Rectum Malfunctioning: Colorectal stricture, a condition which causes erratic narrowing of colon or rectum, can make it difficult to excrete and hence, may lead to constipation.
13. Diseases: There are various diseases that can slow down the bowel movement or the movement of feces through colon, rectum or anus, which may result in constipation. Some of the diseases that can cause constipation are:
- Neurological Disorders: These include Parkinson’s disease, multiple sclerosis, spinal cord injuries, stroke and chronic idiopathic intestinal pseudo-obstruction may cause constipation.
- Metabolic Conditions: These may include diabetes, Uremia, hypercalcemia and hypothyroidism can promote constipation.
- Systemic Diseases: Diseases like lupus, amyloidosis and scleroderma that adversely affect the body, any specific organ or tissue are called systemic diseases. These diseases increase the risk of constipation.
- Cancer: People with cancer generally suffer from constipation. This is due to pain relief medications and chemotherapy. Constipation can also happen if a tumor squeezes or blocks the digestive tract.
Prevention of Constipation:
Some of the preventive measures that can be taken to avoid constipation are:
- Don’t Skip the Meal: People often become constipated when they skip their meals. This is because eating food stimulates the gut muscles. When you eat nothing, no gut movement ocurrs. In this context, breakfast is particularly very important.
- Have More Fibers: Increase the intake of fibers by having more fruits. Fibers helps improve the gut movement while adding bulk to the bowel.
- Drink a Lot of Water: Drinking a lot of water makes sure that you do have extra dry and hard bowel. Water makes your bowel soft and improve the movement.
- Exercise Daily: Living a sedentary lifestyle is a major cause of constipation. Exercising daily improves your metabolism and ease your bowel movement.
Diagnosis and Tests for Constipation
There are various tests that can be done to diagnose constipation and the underlying reason behind it. Some of the tests are discussed below:
- Physical Examination: In this, the abdomen is carefully examined to check for the presence of stools. It helps recognize any systemic disease that might be a cause of constipation.
- Digital Rectal Examination: Digital rectal examination (DRE) is one of the crucial tests for constipation diagnosis. Abnormalities like skin tags, external hemorrhoids, anal fissure and rectal prolapse can be easily identified through this. If the patient experience intense pain at the starting of the test, then it is an indicator of anal fissure. Keeping a watch on the perineum while the patient is straining could show stool’s leakage, prolapse of internal hemorrhoids or a gaping anus.
- Blood Test: A blood test may reveal the presence of any systemic condition like hypothyroidism that can cause constipation.
- Sigmoidoscopy: It is the examination of sigmoid colon – the S-shaped last section of large intestine, which ends at rectum. In this test, a sigmoid (flexible tube) is inserted into the rectum to examine the lower portion of colon and rectum.
- Colonoscopy: It is the examination of rectum and the entire colon. In this, a colonoscope (flexible tube with a camera at the top) is inserted into the rectum.
- Anorectal Manometry: In this, functioning of sphincter muscles are analyzed. To perform this procedure, a flexible tube is inserted into the rectum and then, the tip of the tube is inflated like a small balloon. Pulling back of inflated tube allows the examination of muscles responsible for bowel movement.
- Balloon Expulsion Test: In this, the time taken by the patient to push the water-filled balloon out of his rectum is measured.
- Colonic Transit Study: In this, the movement of food through the colon is analyzed. The patient need to swallow a capsule having radiopaque marker or wireless recording device. The movement of the capsule is then recorded over several days.
- Scintigraphy: This is similar to colonic transit study with only difference that instead of a capsule, patient is made to eat a radioactive meal.
- X-Ray Defecography: In this, an X-ray of rectum is taken while defecation. A soft paste of barium is inserted into the rectum and the patient is then asked to pass it out like stool. An X-ray could reveal a prolapse or other problems in the muscles.
- MRI Defecography: This test is similar to X-ray defecography with only difference that instead of barium paste a contrast gel is inserted into the rectum. The test can also diagnose the problems like rectocele and rectal prolapse.
Treatment and Care for Constipation
Treatment of Constipation:
Most of the time, constipation is not life threatening and can be cured by medicines and simple changes in one’s lifestyle. In case of secondary constipation, specific treatment for the underlying cause may be required.
Laxatives: These act in many ways, usually by softening the stool and easing its movement across the colon. Fiber supplements, stool softeners, lubricants and osmotics are common examples of laxatives. Most of these are available over the counter (OTC).
Medications: There are basically two types of medications that can be prescribed to treat constipation.
- Water Drawing Medications: These include linaclotide and lubiprostone. They help in constipation by drawing water into the intestines.
- Other Medications: Colchicine/probenecid, misoprostol and OnabotulinumtoxinA. All of these medicines work in different ways to cure constipation.
Pelvic Muscle Training: In this biofeedback training, patients work with therapists to learn how to tighten and relax pelvic floor muscles. During the training session, a flexible tube is inserted into the rectum, then the therapist guides the patient through the ways to relax and tighten pelvic muscles.
Treating Specific Complications: In case of complications, specific treatment may be required.
Hemorrhoids:
This can be treated at home by:
- Making dietary changes.
- Taking warm tub baths
- Applying hemorrhoid cream or suppositories.
Anal Fissures:
This can be treated by:
- Making dietary changes
- Using stool softeners
- Surgery
Rectal Prolapse: In this, the doctor tries to push the rectum back through anus. In severe cases, a surgery may be required to strengthen and tighten sphincter muscles.
Fecal Impaction: Fecal impactions are softened by mineral oil that can be taken orally or through enema. Doctor may remove the part of hardened stool by inserting one or two fingers inside the anus.[Source]
Care for People with Constipation:
A person suffering from constipation can be taken care of in the following ways:
- Encourage him to engage in physical activities and exercises.
- Make him drink a lot of water throughout the day.
- Provide him with high-fiber diet.
- After surgery, proper rest should be given.
- Talk to him about the condition and contact the doctor in case of severe pain.
OTC Medications and Self-Management Methods for Constipation
Some over-the-counter (OTC) laxatives that can be used in constipation are as follows:
- Fiber Supplements: They add bulk to the stools. Psyllium, methylcellulose fiber and polycarbophil calcium are some of the examples.
- Stimulants: They helps in the contraction of the intestine. E.g. Bisacodyl.
- Osmotics: They increase the amount of fluids flowing through colon. Examples include oral magnesium hydroxide, magnesium citrate and polyethylene glycol.
- Lubricants: These coat the surface of the stool, allowing it to easily move through the colon. They include various mineral oils.
- Stool Softeners: They make the stool soft by drawing water from the intestine. Docusate calcium and docusate sodium are common stool softeners.
- Enemas: They help in stool softening and facilitating bowel movement. Common examples are soapsuds, sodium phosphate and tab water enemas.
Self-Management Methods for Constipation:
Constipation can be self-managed by following ways:
- Taking care of your diet. Having high-fiber, low-fat diet is advised.
- Drinking a lot of water.
- Exercising daily
- Avoiding caffeine and carbonated drinks
- Not avoiding natural calls
Natural Ways to Cure Constipation
In most cases, constipation is treated without the use of medications. Some natural ways to cure constipation are:
Being Hydrated: Consumption of water increases the fluid levels inside the digestive system. A glass of lukewarm water, first in the morning is recommended to the people suffering from constipation.
Increasing Fiber Intake: One should take a proper amount of fibers in the diet if he/she wants to treat or prevent constipation. People are advised to take 18-30 grams of fibers per day.
Bulking Agents: Bulking agents like wheat bran can help soften the stools and hence, are very effective in constipation.
Exercising Regularly: Sedentary lifestyle or lack of activity can often lead to constipation as it slows down the metabolic functions. People suffering from constipation should exercise regularly.
Avoid Holding Stools: One should not avoid visiting toilet if he/she feels so. Avoiding going to toilet makes the stool drier and harder, which may result in constipation.
Homeopathic Remedies: This involves a range of drugs like carbonica, silica, Nux Vomica and Lycopodium.
Diet: Some of the things that you can include in your diet are:
- Prune juice
- Castor oil
- Herbal tea
- Coconut and olive oil
- Wheat bran
Yoga: Yoga can help you get rid of constipation. Some of the asanas that you should perform to treat or prevent constipation are:
- Ardha Matsyendrasana
- Pawanmuktasana
- Shishuasana
- Malasana
Health Tip by Expert
Constipation is not a serious condition in most of the cases. Changes in lifestyle and certain home remedies can help one get rid of constipation. However, if constipation is accompanied by fever and some other symptoms, or if the condition is not improving for a long time, then one must consult a doctor.
