Constipation

Constipation refers to an uncomfortable condition in which a person may experience fewer bowel movements with difficulty in passing stools or a feeling of incomplete bowel movement. Constipation tends to be common in all age groups regardless of the gender since it depends on many factors common to all. Constipation is not a disease in itself but can be an indicator of some underlying digestive or nutritional problem. Mostly, this condition resolves by itself very quickly, but if not, it can be very uncomfortable and cause considerable discomfort. 

In most people, it is not a reason for concern and can be managed easily by monitoring the eating habits. As per experts, it is not essential to have a bowel movement every day. The frequency of bowel movements depends on many factors such as a person’s health and his/her eating habits. Different people can have different patterns of bowel movement. In a more precise medical definition, if a person is struggling with constipation, it indicates that he/she has had three or fewer bowel movements in a week. However, if a person notices a sudden change in the pattern of his/her bowel movement, he/she should seek medical advice.

What is Constipation?

Constipation is a common condition where a person has fewer bowel movements and/or has difficulty in passing stools. The person may experience a change in the number of times a person passes stools or a change in the quantity or quality of stool passed. This can be due to functional causes like stress, or due to serious conditions like piles, fissures, and rarely, cancer. Most often it is due to poor dietary patterns.

Based on the duration of symptoms, a person may experience two types of constipation.

• Chronic Constipation
  The symptoms of chronic constipation appear gradually. One may experience mild symptoms at first, but their intensity will gradually increase. Chronic constipation develops over time due to various factors, such as dehydration, poor diet, or continued medication intake. Hence, chronic constipation could be present for a few weeks or even for several months. Chronic constipation is much more likely to lead to complications.
• Acute Constipation
  Acute constipation occurs suddenly and may last for a few days. This could again be due to several factors, but the symptoms are usually quite intense and harder to ignore. Acute constipation may be relieved easily by using medications. However, acute constipation could be the result of a serious health condition and hence must not be ignored.

The symptoms of constipation are easy to identify and include:

• Fewer bowel movements than usual.
• A feeling of incomplete bowel movements.
• Difficulty or pain in passing stools.
• Hard stools.

These symptoms may be relieved within a few hours or may persist longer. However, if a person experiences the following symptoms, he/she must visit their doctor immediately:

• Bleeding while passing stools. (Read more - Blood in stools)
• Constipation accompanied by abdominal pain.
• Inability to pass gas.
• Nausea and Vomiting.
• Fever.
• Back pain.
• Pain in the pelvic area.
• Loss of weight.

A person may experience constipation due to several reasons. The main cause of constipation is the slow movement of the stool in the digestive tract, which prevents its effective elimination by the rectum. This may also lead to the formation of hard stools that become more difficult to pass as constipation progresses. The common causes of chronic constipation include:

• Blockages
  There could be a presence of some blockage, which is making it difficult for the stool to be passed effectively. Some of these blockages could be anal fissures, bowel obstruction, or cancerous growth in the rectal or colon area (colorectal cancer).
• Problems with muscle movements
  Difficulty in the movement of the pelvic muscles involved in the bowel movements can also lead to chronic constipation. The muscle problems could include an inability to relax the pelvic muscles, an inability of the muscles to relax and contract properly, or weakening of the pelvic muscles.
• Hormonal imbalances
  Hormones play a role in regulating the balance of fluids in one’s body. Hormonal imbalances due to certain health conditions, such as diabetes, thyroid problems, and pregnancy, can result in constipation. (Read more - Hyperthyroidism)
• Neurological problems
  Presence of neurological diseases, such as multiple sclerosis, Parkinson’s disease, spinal cord injuries, or learning disabilities, can influence the nerves that regulate bowel movements. (Read more - Spinal fracture treatment)
• Medications
  Certain medications, such as antacids and diuretics, can increase the risk of having constipation. In some cases, it has been reported that people who take iron supplements or biotin supplements may also experience temporary constipation.

Risk factors

There are various risk factors that can trigger constipation. These include:

• Progressive age.
• Staying dehydrated for a long time.
• Eating a low fibre diet.
• Limited physical activity.
• Intake of certain medications.
• Disturbed sleep cycle. (Read more - Insomnia causes)
• Having an eating disorder.

Constipation can be prevented in several ways. The most important step suggested by doctors is to find the underlying cause of constipation.

For example, some people report feeling terribly constipated after consuming milk. This must not be ignored, as it could indicate lactose intolerance, and once the person is aware of this condition, future episodes of constipation can be avoided.

There can be many lifestyle changes as well, which may be very helpful. These changes include

• Getting regular physical exercise.
• Avoiding processed foods.
• Avoiding deep fried foods.
• Drinking plenty of fluids throughout the day.
• Eating a fibre-rich diet.
• Avoiding dehydrating fluids.
• Being aware of the side effects of the medications one takes.
• Identifying foods that lead to constipation.
• Preventing stress.

These factors are not only essential for preventing constipation but help in having good overall health as well.

Doctors may use various tools and ways to determine the cause of constipation. These include:

Medical History

Providing the doctor with a medical history can prove to be very helpful in determining the underlying causes and pattern to constipation. The doctor will inquire about:

• Any previous surgery.
• Patterns of weight gain or weight loss.
• A family history of anaemia or other diseases related to the digestive tract.
• The pattern of bowel movement.
• Duration of the symptoms.
• Eating habits.
• Nature of diet.
• Level of daily physical activity.
• Stress level.
• Use of any supplements.
• Use of Medications.

Hence, it is recommended that before going to the doctor, you should keep track of the bowel movements and be aware of the food habits as well. All the important details must be provided to the doctor for an accurate diagnosis.

Physical Examination

A physical examination will include

• Checking the blood pressure.
• Checking for any swellings, outgrowths, tenderness, and pain in the abdominal area.
• Rectal examination.
• Physical examinations can help the doctor determine the severity of the symptoms.

Laboratory Tests

Blood tests may be done to check for any hormonal abnormalities. Stool tests help in revealing the presence of blood or other signs of infection or disease. In contrast, a urine test may be performed to check for diabetes.

• Endoscopy
  An endoscopy may be done for the doctor to locate any outward signs of digestive problems. A colonoscopy is done specifically to help determine the cause of constipation. A biopsy can also be performed to check for signs and symptoms of cancer.
• Imaging Tests
  Imaging tests, which may be recommended by the doctor, include the lower gastrointestinal series, magnetic resonance imaging (MRI), or computed tomography (CT) scan.
• Bowel Function Tests
  Bowel function tests help the doctor assess whether or not the bowel muscles are working efficiently.
• Colorectal Transit Studies
  Colorectal transit studies help the doctor to visualize how well the stool is moving through the colon.

To provide immediate relief, your doctor may recommend laxatives. These laxatives help in treating constipation occasionally but do not cure the underlying cause. Overuse of laxatives can lead to several side effects and can prove to be harmful in the long run.

It is quite common for people with constipation to overuse laxatives, which can lead to various health problems. In people with eating disorders, the uninterrupted use of laxatives can prove to be very harmful and may damage the lining of the digestive tract. So, over-the-counter laxatives must be used cautiously to get relief.

A doctor must be contacted immediately if a person experiences the following symptoms after taking laxatives:

• Bleeding while passing stools.
• Bleeding from the nose.
• Abdominal pain.
• Nausea.
• Change in the bowel movements.
• Weakness.

There are several laxatives available in the pharmacies for treating constipation. Oral osmotic agents draw water into the colon to enable an easier passage of stools. Oral bulk formers act the opposite way by absorbing water to form stools, which can be passed easily. Other laxatives include oral stool softeners and oral stimulants.

Oral laxatives can interfere with the body’s ability to absorb certain nutrients and medications. Some laxatives may also cause electrolyte imbalance. Before taking the laxative, it is important to read the label to check the following things:

• Side effects involved.
• Drug interaction.
• Presence of health conditions, such as diabetes, kidney issues, or pregnancy.
• Children under the age of 6 years must not be given laxatives without prior doctor’s consultation.
• Doctors recommend taking care of eating habits and diet as well to keep the problem of constipation at bay. If constipation is serious and worsens over time, the doctor may suggest some other medicines. In case of any blockage, the doctor may recommend surgical correction to fix it.

Home Remedies

Home remedies can also be very helpful in providing relief from constipation. Some easy home remedies are as follows:

• Asafoetida
  Simply add two pinches of asafoetida to a glass of warm water and consume twice a day.
• Carom Seeds
  Dry roast a teaspoon of carom seeds on a pan and then crush them into a powder. Swallow it with some lukewarm water.
• Water
  If you experience mild constipation every now and then, begin your day with a glass of lukewarm water, which will enable bowel movements. Drink the water on an empty stomach every morning. Keep drinking water at regular intervals throughout the day to prevent dehydration.
• Coffee
  Caffeine is a natural laxative and is quite mild in nature. Brew a cup of black coffee and have it in the morning. It is recommended that one does not grow dependent on this remedy as caffeine can lead to dehydration and may cause sleep difficulties when taken during bedtime.

Lifestyle management

Diet

• The first and foremost step to achieve long-term relief from constipation should be taking care of one's diet. Diet can play a crucial role in this. To prevent constipation, it is important to include more fibre in the diet. Fibre-rich foods along with plenty of water greatly help in providing relief.
• An average adult needs up to 25 grams of fibre each day. Good sources of fibre include whole grains, such as whole wheat bread, oatmeal, and cereals. Legumes, such as kidney beans and soybeans, are also rich in fibre. Green leafy vegetables not only provide fibre but also supply essential nutrients. Nuts, such as almonds and peanuts, can be consumed as healthy fats for added fibre.
• It is very important to drink enough water every day to keep the digestive functions running smoothly. Water also helps in softening the stools and makes them easier to pass. One can also consume other fluids, such as fruit juices.
• Consuming probiotic-rich foods also improves the digestive health and provides long-term benefits.
• To prevent food-related constipation, refrain from eating processed foods, aerated drinks, and frozen food.

Exercise

Regular physical exercise helps in promoting digestive health and stimulates the bowel muscles. The doctor may also suggest bowel training to form a regular pattern and hence attain relief from constipation.

Medications

If you are taking any medications or supplements, consult your doctor to find out if these could be the cause of constipation. If so, you can request for an alternative medication.

Prognosis

Constipation tends to be diet-related in most cases and can be easily managed and prevented by maintaining a healthy diet as well as having a good intake of fluids. However, chronic constipation must not be ignored, as it could be indicative of some other digestive issue.

Complications

If chronic constipation is left untreated, it may result in the following complications such as:

• Haemorrhoids
• Anal fissures
• Stool that cannot be expelled
• Rectal prolapse