Constipation is a condition where a person is required to pass hard stools, have irregular bowel movements and it requires significant efforts for motion.
It is a gastrointestinal problem and is very common. Most of the times, it is a temporary condition.
Alternative names
Lack of bowel movements, Irregularities of bowels, Costiveness.
If the muscles of the colon contract slowly or if there is excessive absorption of water in the colon then the stool becomes dry and hard and passes through the colon very slowly. This leads to constipation.
If the coordination of the muscles required for bowel movements is not proper then also constipation may occur, this can cause strain while bowel movements. This is called pelvic floor dysfunction.
Constipation may have several other reasons. Medications like diuretics, pain killers, medications for high blood pressure, depression or medications for Parkinson’s disease can cause constipation.
Due to vomiting or diarrhea, body salts are lost which can cause constipation. Anal fissures can cause spasm of rectal muscles causing constipation. Hormonal disturbances, nerve problems due to spinal cord injury, intestinal obstruction or diverticulitis, thyroid, stroke, diabetes, laxative abuse, travel, ageing, illness, pregnancy, lifestyle changes, routine changes, no physical activity, low fiber diet, less fluid intake, ignoring urge for bowel movements, irritable bowel syndrome, smoking cessation and psychosomatic reasons are some more causes of constipation.
Sometimes constipation is due to more serious causes like hormonal disturbances, auto immune diseases or colon cancer. In children it may be due to lack of nerve cells necessary for bowel movements in a condition called as Hirschsprung Disease. Women, elderly people and children are more prone to constipation.
Chemotherapy, less fluid intake, low fiber diet, certain medications, sedentary, older adult and bed ridden condition are the risk factors for constipation. In children constipation may be due to threat or reluctance for toilet.
If the frequency of stool is less than three per week then it is considered as constipation. The stools are dry and hard. Feeling of rectal blockage is there. Bowel movements are extremely strainful. There may be a feeling of incomplete evacuation after a bowel movement. Manual efforts may be required for complete evacuation like finger evacuation or manipulation of lower abdomen for bowel movement.
Constipation is diagnosed based on medical history including medications, physical examination and some tests. The tests include blood tests, anorectal manometry, defecography, sigmoidoscopy, colonoscopy, barium enema X-ray and marker studies or cororectal transit studies.
Intake of high fiber diet and control over low fiber diet are the most effective treatments for constipation. High fiber diet contains beans, fruits, vegetables and whole grains.
Low fiber diet foods are meat, cheese and processed foods.
Sufficient fluid intake, regular physical activity, sufficient time for motions and attention towards urge to motion are some more considerations for constipation management.
Medications for constipation include laxatives, 5-HT-4 agonists and chloride channel activators. Laxatives should be tried if high fiber diet, increased fluid intake and regular physical exercise do not work and they are not recommended for children.
Surgery can also be done but that is the last option.
Chronic constipation may lead to fissures, hemorrhoids, fecal impaction or rectal prolapse (small rectal tissue is pushed outside). Due to frequent use of laxatives to relieve constipation, there may be dependence on laxatives and may interfere with the absorption of nutrients and vitamins also.
Acute constipation is not a serious issue but chronic constipation may be indication of serious disease or it may lead to complication. If there is constipation for more than three weeks, bowel movements take place twice a week, presence of blood in stool, rectal or abdominal pain or both, thin stool, undue weight loss and constipation and diarrhea are alternating then consult your doctor.
Constipation can rather be prevented than treated. Eating high fiber diet, physical exercise, high fluid intake, limited low fiber diet, attending motion call and over the counter laxatives prevent constipation.
