CONSTIPATION

What is Constipation?

Constipation is a symptom which has different meaning to different individuals. Most commonly, it is infrequent or inadequate, painful or difficult passage of small volume hard stool.

For most people, it is normal for bowel movement to occur from three times a day to three times a week; other people may go a week or more without experiencing discomfort or harmful effects. Normal bowel habits are affected by diet. The average UK diet includes 12-15 gms of fibre per day, although 25-30 gms of fibre and about 60-80 ounces of fluid daily are recommended for proper bowel function. Exercise is also beneficial to proper function of the colon.             

                                                       Eating food high in fibre, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fibre per day recommended for proper bowel function.

About 80% of people suffer from constipation at some time during their lives, and brief periods of constipation are normal. Constipation may be diagnosed if bowel movements occur fewer than three times weekly on an ongoing basis. Widespread beliefs, such as the assumption that everyone should have a movement at least once per day, have led to overuse and abuse of laxatives.
 

What causes constipation?

There may be several, possibly simultaneous, causes for constipation, including inadequate fibre and fluid intake, a sedentary lifestyle, and environmental changes. Constipation may be aggravated by travel, pregnancy or change in diet. In some people, it may result from repeatedly ignoring the urge to have a bowel movement.

More serious causes of constipation include growths or areas of narrowing in the colon. So, it is wise to seek the advice of a Colorectal surgeon when constipation persists. Constipation may rarely be a symptom of scleroderma, lupus or disorders of the nervous or endocrine systems, including thyroid disease, multiple sclerosis, Parkinson’s disease, stroke and spinal cord injuries.

 

Can medication cause constipation?

Yes, many medications including pain-killers, antidepressants, tranquillisers and other psychiatric medications, blood pressure medications, diuretics, iron supplements, calcium supplements and aluminium containing antacids can cause or worsen constipation.

Furthermore, some people who are not actually constipated may become dependent on laxatives in an ill-advised attempt to have daily bowel movements, and many cause themselves harm through laxative abuse.

When should I see a doctor about constipation?

Any persistent change in bowel habit – increase or decrease in frequency or size of stool or an increased difficulty in evacuating – warrants medical advice. Whenever constipation symptoms persist for more than three weeks, you should consult your doctor. If blood appears in stool, consult your GP.

How can the cause of constipation be determined?

Constipation may have many causes, and it is important to identify them so that treatment can be simple and specific as possible. Your doctor will want to check for any anatomic causes, such as growths or areas of narrowing of the colon.

Digital examination of the anorectal area is usually the first step, since it is relatively simple and may provide clues to the underlying causes of the problem. Examination of the intestine with either a flexible lighted instrument or barium x-ray study may help pinpoint the problem and exclude serious conditions known to cause constipation, such as polyps, tumours or diverticular disease. If an anatomic problem is identified, treatment can be directed toward correcting the abnormality.

Other tests may identify specific functional causes to help direct treatment. For example, “marker studies” in which the patient swallows a capsule containing markers that show up on x-rays taken repeatedly over several days, may provide clues to disorders in muscle function within the intestine. Other physiologic tests evaluate the function of the anus and rectum. These tests may involve evaluating the reflexes of anal muscles that control bowel movements using a small plastic catheter, or x-ray testing to evaluate function of the anus and rectum during defaecation.

In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be non-specific.

 

How is Constipation treated?

The vast majority of patients with constipation are successfully treated by adding high fibre foods like bran, shredded wheat, whole grain breads and certain fruits and vegetables to the diet, along with increased fluids. Your doctor may also recommend lifestyle changes. Fibre supplements containing undigestible vegetable fibre, such as bran are often recommended and may provide many additional benefits in addition to relief of constipation. They may help to lower cholesterol levels, reduce the risk of developing colon polyps and cancer, and help prevent symptomatic haemorrhoids.

Fibre supplements may take several weeks, possibly months, to reach full effectiveness, but they are neither harmful nor habit forming, as some stimulant laxatives may become with overuse or abuse. Other types of laxatives, enemas or suppositories should be used only when recommended and monitored by your own doctor.

Designating a specific time each day to have a bowel movement also may be very helpful to some patients. In some cases, bio-feedback may help to retrain poorly functioning anal sphincter muscles. Only in rare circumstances are surgical procedures necessary to treat constipation. Your own doctor can discuss these options with you in greater detail to determine the best treatment for you.