Constipation

Constipation is a condition where stools or bowel movements are hard and difficult to expel from the body. This can result in fewer, strained bowel movements. It usually occurs because too much water is absorbed from the food/stool while in the colon. Constipation is a common condition that affects almost everyone at some time.

Causes of Constipation

Constipation occurs when there is a slow movement of food through the digestive system. This could be due to improper functioning of the colon muscles. As food remains longer in the colon more water is absorbed from it. The time between bowel movements can vary from person to person, but if you have not passed a stool for 3 days, it can be hard and difficult to pass. Factors that can increase your risk of constipation include physical inactivity, a diet that’s low in fibre and certain medications such as narcotic pain medication, antidepressants and anticonvulsants. Consumption of milk and other dairy products can cause constipation in some people. Other causes/factors include aging, pregnancy, a change in routine, delaying a bowel movement, poor water consumption, overuse of laxatives leading to dependency, abnormalities of the digestive tract such as Hirschsprung disease, irritable bowel syndrome or a stricture, compression of the colon due to a tumour or scar tissue, certain neurological disorders such as multiple sclerosis and Parkinson’s disease, and endocrine disorders such as diabetes or hypothyroidism.

Impact

Constipation may cause some discomfort but is not life-threatening and usually resolves on its own. Chronic constipation may lead to complications. It should be investigated for any underlying condition.

Anatomy

Food from the stomach enters the small intestine and then passes into the large intestine or colon. Here, water and ions are absorbed to form faeces or stools. The colon forms an arch which encircles the small intestine and can be divided into 4 parts, the ascending, transverse, descending and sigmoid colon. The sigmoid or terminal portion of the colon connects to the rectum which leads to the anus. Circular and longitudinal muscle bands along the length of the colon help with absorption and movement of faeces towards the rectum. This movement occurs more prominently when one is active.

Symptoms of Constipation

Those with constipation have fewer bowel movements and find it difficult to pass stools. It may seem incomplete even after passing stools. The stools are harder and smaller. You may experience bloating of the abdomen or a stomach ache. Loss of appetite may also be experienced. You should contact your doctor if you are not able to pass stools or gas, if blood is present in your stools or if constipation has lasted more than 2 weeks or if there is a dramatic change in stool consistency.

Diagnosis of Constipation

Your doctor will review your symptoms and perform a physical examination to identify any underlying cause. Blood tests may be performed to check hormone levels. Tests may be performed to see how food moves through the colon. The anal muscles are evaluated. A colonoscopy may be performed to identify any blockage within the colon.

Untreated Constipation

Constipation usually resolves on its own or with conservative treatments. If an underlying cause is present, it may require treatment. Chronic constipation that is untreated may lead to complications such as haemorrhoids, bleeding, obstruction, or a prolapse, where part of the rectum or colon protrudes through the anus.

Treatment of Constipation

Constipation can be prevented by eating a well-balanced diet with an increased amount of fibre and water and reducing caffeine as it can dehydrate stools. Those who find dairy products constipating should reduce such consumption. Engaging in more physical activity and regular exercise is recommended. Do not resist the urge to go to the bathroom and give yourself enough time.

Those with constipation are advised to increase water intake and try warm liquids. High-fibre cereal, prunes and other fruits and vegetables are recommended. Exercise is recommended as it also stimulates the muscles of the colon. Your doctor may prescribe a laxative to ease constipation. There are various kinds of laxatives that work in different ways. Stimulants help the muscles of the intestine to contract more effectively. Stool softeners moisten the stools. Lubricants help the stools move through the colon more easily. Osmotics draw water into the colon. Other laxatives include fibre supplements, saline laxatives and chloride channel activators. If conservative treatments fail and you are unable to pass stools, surgery may be necessary. This involves removal of a segment of the rectum or anal canal to clear the blockage. Newer less invasive procedures such as antegrade colonic enema surgery may also be recommended.