Constipation

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
The 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-

Narcotic 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-

Slow-transit constipation

Irritable bowel syndrome

Chronic intestinal pseudo-obstruction

Colonic carcinoma

Diverticular disease

Hirschsprung's disease

Obstructed defecation

Anorectal disease (Crohn's, fissures, haemorrhoids)

Neurological Problems-

Multiple sclerosis

Spinal cord lesions

Cerebrovascular accidents

Parkinsonism

Metabolic/Endocrine Problems-

Diabetes Mellitus

Hypercalcaemia

Hypothyroidism

Other Problems-

Chronic kidney failure

Illness requiring complete bed rest

Any serious illness with immobility, especially in the elderly

Depression

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
A 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 the bowel movement.

When to make an appointment with a 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 diseases 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
A 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 the 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 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 a 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 the 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