Constipation
- Epidemiological studies have clearly established a link between coffee consumption and worsening constipation.
- Less than 50% of people have one bowel movement a day.
- Contrary to popular belief, there is no evidence that "toxins" accumulate in the intestine when bowel movements are infrequent.
- The prevalence of constipation increases exponentially in adults older than 65 years.
- Some researchers have suggested that cumulative exposure to environmental neurotoxins may play a role in the age-related increase in the prevalence of constipation.
Constipation is a symptom, not a disease. Constipation is defined as having a bowel movement fewer than three times per week. Severe constipation is defined as less than one bowel movement 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.
- Low-fiber 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.
- Lack of physical activity. 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.
- 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 - Irritable bowel syndrome (IBS). IBS commonly produces chronic constipation, although some people have intermittent, watery diarrhea and others complain of alternating constipation and diarrhea.
- Changes in life or routine such as pregnancy, aging, and travel
- Abuse of laxatives. Because of the possibility that stimulant laxatives can damage the colon, most experts recommend that stimulant laxatives should be used as a last resort after non-stimulant treatments have failed.
- Ignoring the urge to have a bowel movement. Bowel movements are under voluntary control. This means that the normal urge people feel when they need to have a bowel movement can be suppressed. People who ignore the urge to have a bowel movement may eventually stop feeling the need to have one, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy.
- Dehydration. 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.
- Specific diseases or conditions. Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems.
- Problems with the colon and rectum.
- Problems with intestinal function. Functional constipation means that the bowel is healthy but not working properly. Functional constipation is often the result of poor dietary habits and lifestyle. It occurs in both children and adults and is most common in women. Colonic inertia, delayed transit, and pelvic floor dysfunction are three types of functional constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower, or sigmoid, colon.
Sometimes constipation can lead to complications. These complications include hemorrhoids, caused by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) caused by hard stool stretching the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool.
Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition, known as rectal prolapse, may lead to secretion of mucus from the anus. Usually eliminating the cause of the prolapse, such as straining or coughing, is the only treatment necessary.
Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and by an enema.
Frequent use of laxatives may lead to development of lazy bowel syndrome, a condition in which your bowels become dependent on laxatives to function properly. In fact, laxative use can cause a number of problems, including poor absorption of vitamins and other nutrients, damage to your intestinal tract and worsening constipation.
Although treatment depends on the cause, severity, and duration of the constipation, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent them from recurring.
Diet
A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.
Lifestyle Changes
Other changes that may help treat and prevent constipation include drinking enough water and other liquids, such as fruit and vegetable juices and clear soups, so as not to become dehydrated, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.
Laxatives
Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, a doctor may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, helps prevent constipation.
Enemas
There are many different types of enemas. By distending the rectum, all enemas (even the simplest type, the tap water enema) stimulate the colon to contract and eliminate stool. Other types of enemas have additional mechanisms of action. For example, saline enemas cause water to be drawn into the colon. Phosphate enemas (e.g., Fleet phosphosoda) stimulate the muscles of the colon. Mineral oil enemas lubricate and soften hard stool. Emollient enemas (e.g., Colace Microenema) contain agents that soften the stool.
Biofeedback
Most of the muscles of the pelvis surrounding the anus and rectum are under some degree of voluntary control. Thus, biofeedback training can teach patients with pelvic floor dysfunction how to make their muscles work more normally and improve their ability to defecate. During ano-rectal biofeedback training, a pressure-sensing catheter is placed through the anus and into the rectum. Each time a patient contracts the muscles, the muscles generate a pressure that is sensed by the catheter and recorded on a screen. By watching the pressures on the screen and attempting to modify them, patients learn how to relax and contract the muscles more normally.
References and Sources:
- 1. Constipation National Digestive Diseases Information Clearinghouse
- 2. Constipation eMedicine
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