Constipation

Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.
Some people think they are constipated if they do not have a bowel movement every day. However, normal stool elimination may be three times a day or three times a week, depending on the person.
Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

What causes constipation?

To understand constipation, it helps to know how the colon, or large intestine, works. As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed

Constipation occurs when the colon absorbs too much water or if the colon’s muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. Common causes of constipation are
The main causes of constipation include:

• Hardening of the feces

1. Insufficient intake of dietary fiber
2. Dehydration from any cause or inadequate fluid intake
3. Medication, e.g. diuretics and those containing iron, calcium, aluminum

• Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along

1. Hypothyroidism (underactive thyroid gland)
2. Hypokalemia
3. Injured anal sphincter (patulous anus)
4. Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants
5. Severe illness due to other causes
6. Acute porphyria (a rare inherited condition)
7. Lead poisoning
8. Lactose Intolerance
9. Dyschezia (usually the result of suppressing defecation)

• Diverticula

1. Tumors, either of the bowel or surrounding tissues

• Obstructed defecation, due to:

1. Mechanical causes from morphological abnormalities of the anorectum including megarectum, rectal prolapse, rectocele, and enterocele
2. Functional causes from neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles, including anismus, descending perineum syndrome, andHirschsprung's disease
3. Retained foreign body or a bezoar

• Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.

1. Functional constipation
2. Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain[8]

• Smoking cessation (nicotine has a laxative effect)[9]
• Abdominal surgery, other types of surgery, childbirth
• Severe dehydration
• Some causes are with particular respect to infants:[10]

• Switching from breast milk to bottle feeds, or to solid meals
• Potty training anxiety
• Hirschsprung’s disease - a condition from birth where the child has a nerve cell defect that affects communication between the brain and bowels

What tests are done to find the causes of constipation?

To find out why you have constipation, your doctor will perform a complete physical examination. The doctor may also order one or more tests if a serious problem is suspected as the cause of constipation.

• Sigmoidoscopy. The doctor puts a thin, flexible tube called a sigmoidoscope into the rectum. This scope can show the last third of your large intestine.
• Colonoscopy. The doctor looks at the entire large intestine with a long, flexible tube with a camera that shows images on a TV screen. The tube is like a sigmoidoscope but longer. You receive medicine to help you sleep during a colonoscopy.
• Colorectal transit study. For this test, you swallow small capsules that can be seen on an x ray as they move through the large intestine and anus.
• Anorectal function test. The doctor inserts a small balloon into the anus to see if you are able to push it out.
• Defecography test. The doctor inserts a soft paste into the rectum. The doctor asks you to push out the paste while an x-ray machine takes pictures of the rectum and anus.

Not Enough Fiber in the Diet

People who eat a high-fiber diet are less likely to become constipated. The most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats.
Fiber—both soluble and insoluble—is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.
Americans eat an average of 5 to 14 grams of fiber daily,* which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed.
A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy, such as fast foods, or prepared foods, both of which are usually low in fiber. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and low in fiber.

Eat more fiber.

Fiber helps form soft, bulky stools and is found in many vegetables, fruits, and grains. Be sure to add fiber to your diet a little at a time so your body gets used to it. Limit foods that have little or no fiber such as pizza, ice cream, cheese, meat, snacks like chips, and processed foods such as instant mashed potatoes or frozen dinners

High-fiber Foods

Not Enough Liquids

Research shows that although increased fluid intake does not necessarily help relieve constipation, many people report some relief from their constipation if they drink fluids such as water and juice and avoid dehydration. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day. However, liquids that contain caffeine, such as coffee and cola drinks will worsen one’s symptoms by causing dehydration. Alcohol is another beverage that causes dehydration. It is important to drink fluids that hydrate the body, especially when consuming caffeine containing drinks or alcoholic beverages.

Lack of Physical Activity

A lack of physical activity can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise. Lack of physical activity is thought to be one of the reasons constipation is common in older people.

Get enough exercise.

Regular exercise helps your digestive system stay active and healthy. Exercising 20 to 30 minutes every day may help.

Check with your doctor about any medicines you take.

Some medicines can cause constipation. Be sure to ask your doctor if any medicines you are taking could cause constipation.

Medications

Some medications can cause constipation, including

• pain medications (especially narcotics)
• antacids that contain aluminum and calcium
• blood pressure medications (calcium channel blockers)
• antiparkinson drugs
• antispasmodics
• antidepressants
• iron supplements
• diuretics
• anticonvulsants

Changes in Life or Routine

During pregnancy, women may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling, because their normal diet and daily routine are disrupted.

TREATMENT:
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