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Gastroenterology
Diseases Definitions

  • Constipation

    It's happened to most of us at one time or another. That tight, bloated feeling, signaling a bout of constipation. Although constipation may not seriously affect your daily routine, it can make you feel uncomfortable.

    Constipation

    Constipation can be defined as infrequent, fewer bowel movements than normal, hard pellet like stools that are painful to pass, or difficulty in evacuating stool.

    Passing one or more soft, bulky stools every day is a desirable goal. Though the frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than 3 days pass without a bowel movement, the intestinal contents may harden, and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass, however, even after shorter intervals between bowel movements.

    While troublesome, constipation is not usually a serious disorder. However, there may be other underlying problems causing constipation and, therefore, testing is often recommended. Fortunately, in most cases constipation can be easily treated by making a few lifestyle changes. The most important of these are eating a diet high in fiber; drinking plenty of fluids and exercising.

    What are some common misconceptions about Constipation?

    Many false beliefs exist concerning proper bowel habits. One of these is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the life span. These misconceptions have led to a marked overuse and abuse of laxatives. Every year, Americans spend $725 million on laxatives. Many are not needed and some are harmful.

    What is Constipation?

    The stomach churns and mixes food so it can be digested. The near-liquid food then enters the small intestine, which extracts calories, minerals and vitamins. The small intestine ends in the right-lower abdomen where it enters the colon. The colon, or large bowel, is 5 to 6 feet long. Its function is to withdraw water from the liquid stool, so that by the time it reaches the rectum there is a soft-formed stool.

    As water and waste materials enter your colon, or large intestine, the colon absorbs excess water while forming the waste products. Muscle contractions move the waste to the rectum. When the colon’s natural contractions are disturbed, waste materials move slowly. A lazy colon that does not contract properly and fails to move the stool to the rectum often causes constipation. The colon also can become spastic and remain contracted for a prolonged time. In this case, stool cannot move along. Too much water is absorbed and hard pellet-like stool. If an excessive amount of water is extracted, the stool can become hard and difficult to expel.

    Constipation also can result from a mechanical obstruction, such as tumors or advanced Diverticulosis, a disorder, which can distort and narrow the lower-left colon. Other conditions that can produce a sluggish, poorly contracting bowel include: pregnancy, anal fissures and hemorrhoids, certain drugs, thyroid hormone deficiency, the abuse of laxatives, travel, and stress.

    What are some of the causes of Constipation?

    Constipation is a symptom, not a disease. Like a fever, constipation can be caused by many different conditions. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:

    What causes Constipation in children?

    Constipation is common in children and may be related to any of the causes noted in the previous section. In a small number of children, constipation may be the result of physical problems. Children with such defects as the absence of normal nerve endings in portions of the bowel, abnormalities of the spinal cord, thyroid deficiency, mental retardation, and certain other inherited metabolic disorders often suffer symptoms of constipation.

    Constipation in children, however, usually is due to poor bowel habits.
    Studies show that many children who suffer from constipation when they are older have a history of passing stools that are firmer than average in their early weeks of life. Because this occurs before there are significant variations in diet, habits, or attitudes, it suggests that many children who develop constipation have a normal tendency to have firmer stools. Such children suffer little from the tendency unless it is aggravated by poor bowel habits or poor diet.

    Constipation may result in pain when the child has bowel movements. Cracks in the skin, called fissures, may develop in the anus. These fissures can bleed or increase pain, causing a child to withhold his or her stool.
    Children may withhold their stools for other reasons as well. Some find it inconvenient to use toilets outside the home. Also, severe emotional stress caused by family crises or difficulties at school may cause children to withhold their stools. In these instances, the periods between bowel movements may become quite long, in some cases lasting longer than 1 or 2 weeks. These children may develop fecal impactions, a situation where the stool is packed so tightly in the bowel that the normal pushing action of the bowel is not enough to expel the stool spontaneously.

    What causes Constipation in older adults?

    Older adults are five times more likely than younger adults to report problems with constipation. Poor diet, insufficient intake of fluids, lack of exercise, the use of certain drugs to treat other conditions, and poor bowel habits can result in constipation. Experts agree, however, that too often older people become overly concerned with having a bowel movement and that constipation is frequently an imaginary ailment.

    Diet and dietary habits can play a role in developing constipation. Lack of interest in eating - a problem common to many single or widowed older people may lead to heavy use of convenience foods, which tend to be low in fiber. In addition, loss of teeth may force older people to choose soft, processed foods, which also tend to be low in fiber.

    Older people sometimes cut back on fluids, especially if they are not eating regular or balanced meals. Water and other fluids add bulk to stools, making bowel movements softer and easier to pass.

    Prolonged bed rest, for example, after an accident or during an illness, and lack of exercise may contribute to constipation. Also, drugs prescribed for other conditions, such as antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and anti-Parkinson drugs, can produce constipation in some people.

    The preoccupation with bowel movements sometimes leads older people to depend heavily on laxatives, which can be habit-forming. The bowel begins to rely on laxatives to bring on bowel movements, and over time, the natural mechanisms fail to work without the help of drugs. Habitual use of enemas also can lead to a loss of normal function.

    Is Constipation serious?

    Although it may be extremely bothersome, constipation itself usually is not serious. However, it may signal and be the only noticeable symptom of a serious underlying disorder such as cancer. Constipation can lead to complications, such as hemorrhoids caused by extreme straining or fissures caused by the hard stool stretching the sphincters. Bleeding can occur for either of these reasons and appears as bright red streaks on the surface of the stool. Fissures may be quite painful and can aggravate the constipation that originally caused them. Fecal impactions tend to occur in very young children and in older adults and may be accompanied by a loss of control of stool, with liquid stool flowing around the hard impaction.

    Occasionally, straining causes a small amount of intestinal lining to push out from the rectal opening. This condition is known as rectal prolapse and may lead to secretion of mucus that may stain underpants. In children, mucus may be a feature of cystic fibrosis.

    Are You Regular?

    Many people think they are constipated or irregular If they don't have at least one bowel movement a day. But this is not necessarily true. Normal can range from three bowel movements a day to three a week depending on the person. So how can you tell if you're constipated? Look for the following symptoms:

    When is medical attention needed?

    Generally, constipation is a temporary condition that can be easily corrected. However, there could be times when it may point to a more serious problem. See your doctor if any of the following occurs:

    What diagnostic tests can help determine the causes of Constipation?

    The patient's medical history is the most important factor in diagnosing constipation. Constipation may be caused by abnormalities or obstructions of the digestive system in some people. A doctor can perform tests to determine if constipation is the symptom of an underlying disorder. The physician will perform a physical exam and obtain routine blood, urine, and stool tests. In addition to this -

    Prevention

    The good news is that there are some simple things you can do to relieve symptoms and prevent constipation in the future. Consider the following tips to help keep you regular:

    Diet-Foods that are high in roughage, bran and fiber are essential in correcting and preventing constipation. In parts of the world where unprocessed grain is used and where large amounts of fiber are consumed, there is little constipation, and passing one or two large, soft stools a day is normal. The following foods should be eaten daily in adequate amounts:

    Bulking Agents-Fiber is the undigested part of plant food that passes into the colon. Certain types of fiber can absorb and hold large amounts of water. This, in turn, results in a larger, bulkier stool, which is soft and easier to pass. Adequate fiber in food or from supplements is recommended daily. This type of water-retaining fiber generally is easily obtained each day by one of the following:

    Fiber: What you should know

    One of the best ways to treat occasional constipation is to eat a diet high in fiber. Fiber is the part of a plant that can't be digested. It adds bulk to keep other foods moving through the digestive system and it holds water, which softens the stool for easy elimination.
    Fiber comes in two different types, both of which are needed for proper bowel function:

    1. Soluble fiber forms a gel-like material in water. It helps restore regularity and soften stools. Good sources include oats, beans, peas, many types of fruit and products containing psyllium.
    2. Insoluble fiber does not dissolve in water and moves through your digestive system quickly and largely intact. It helps keep you regular by bulking up the stool. Good sources include wheat bran, wholegrain cereals and many vegetables.

    Easy ways to increase fiber

    Adding fiber to your diet may be easier than you think. Here are some tips that can help you get started:
    Substitute high-fiber foods (wholegrain bread, brown rice, fruits and vegetables) for low-fiber foods (white bread, white rice, candy and chips).
    Try to eat more raw vegetables and fresh fruit, including the skins, when appropriate. Cooking vegetables can reduce their fiber content, and skins are a good source of fiber.
    Eat high-fiber foods at every meal. Bran cereal for breakfast is a good start, but try to include some fruits, vegetables, whole grains and beans in your diet as well.
    Two notes of caution: be sure to increase your fiber intake gradually, giving your body time to adjust; and drink at least six to 8 ounce glasses of fluids a day.

    Questions about Fiber

    Q: HOW MUCH FIBER DO I NEED EACH DAY?
    A: Nutrition experts suggest 20 to 35 grams. The average American consumes only 10 to 15 grams.

    Q: WHAT ARE THE BEST WAYS TO INCREASE MY FIBER INTAKE?
    A: Eat a variety of high-fiber foods throughout the day, replace foods low in fiber content with foods containing higher amounts of fiber and eat plenty of fruits and vegetables.

    Q: AT WHAT RATE SHOULD I ADD FIBER TO MY DIET?
    A: Gradually. Too much too soon can cause a bloated feeling and abdominal cramps. It may take several weeks to add the recommended amount of dietary fiber to your diet. While you're working on it, be sure to drink plenty of fluids.

    Bowel Retraining Program

    1. Do not use laxatives.
    2. Eat a diet high in roughage, such as bran cereals and leafy vegetables.
    3. Drink six (6) ounces of prune or apricot juice each morning.
    4. Eat two (2) large servings of stewed fruit each day.
    5. Take one (1) heaping tablespoon of a psyllium-based bulking agent twice a day. Use the NutraSweet® product to avoid excessive calories.
    6. Eat a normal breakfast.
    7. Set aside 15 minutes after breakfast to sit on the toilet, but do not strain to have a bowel movement.
    8. If you do not have a bowel movement by the third day, use an enema and repeat the above steps.

    What is the treatment for Constipation?

    The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives.

    Because there are many causes of constipation, treatment depends on the physician's findings and diagnosis. Your doctor will want to know if you have a history of constipation or any other digestive problem. He or she will ask about your bowel habits, diet, stress and any medications you take. Keeping track of this information can help your doctor pinpoint the problem. Your doctor may then perform a physical exam. In some cases other tests may be necessary.

    After serious problems are excluded, chronic constipation usually responds to simple measures. For most people, dietary and lifestyle improvements can lessen the chances of constipation. General guidelines for treating constipation include: eating a well-balanced diet that includes fiber-rich foods regularly such as unprocessed bran, whole-grain breads, and fresh fruits and vegetables, is recommended, drinking plenty of liquids each day, regular walking and performing aerobic exercise will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax. In particular, patients should respond to the urge to defecate. Retaining stool at this point will aggravate the condition

    Bowel habits also are important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored.

    If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an under-active thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy.
    If lifestyle changes do not help, your doctor may suggest one of the following types of treatments:

    Fiber laxatives and stool softeners should be used only as directed. Different treatments work in various ways; let your doctor choose the best one for you. In most cases, laxatives should be the last resort and taken only under a doctor's supervision. A doctor is best qualified to determine when a laxative is needed and which type is best. There are various types of oral laxatives, and they work in different ways. Above all, it is necessary to recognize that a successful treatment program requires persistent effort and time.

    Constipation does not occur overnight, and it is not reasonable to expect that constipation can be relieved overnight.

    Do Laxatives Help?

    There are two main types of laxatives: Stimulants (chemical) and saline (liquid or salt). They occasionally help temporary constipation problems.


    However, chronic use of laxatives is discouraged because the bowel becomes dependent upon them. Bowel regularity should occur without laxatives. An occasional enema is preferable over the chronic use of laxatives.

    Surgery

    With certain medical conditions, such as severe Diverticulosis, and with extreme constipation in some younger patients, surgery may provide relief.

    Summary

    Constipation usually is a short-term disorder which is easily treated by simple measures. However, the condition may reflect a serious underlying disorder that can only be detected and treated by the physician. For chronic constipation, it is important that the patient understands how this occurs. By the intake of proper foods and fiber supplements, it is usually possible to retrain the colon so that normal regularity occurs.

    Doctors agree that prevention is the best approach to constipation. While there is no way to ensure never experiencing constipation, the following guidelines should help: