Constipation - a Common Health Disorder: How to Relieve
Part-I

Prof JC Sanasam *

Bristol Stool Chart :: Pix - Wikipedia / originally by Kyle Thompson. Redone from scratch by JP Brettle

Drink lots of water, eat more fibre, exercise regularly, lose the stress, stick with a regular routine, don’t overdo with the laxatives (medicaments to move bowel)

At some point in their lives most people get constipated. It can be acute, which means sudden and lasting a short time, or chronic, which means lasting a long time, even years. Most constipation is acute and not dangerous. Normal bowel habits differ from person to person. Some people think they are constipated if they do not have a bowel movement every day.

In some people bowel movements may occur three times a day and in some others it may be three times only in a week. In short, constipation is a condition in which a person has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass.

The majority feel their abdomen bloated or painful in the area between the chest and hips, very often shaming a low back-pain, which many a time is the presenting symptom when they go to consult a physician.

15 percent of the population irrespective of age, race, or gender in the US are said to have constipation. However it appears that the incidence is commoner in women, among those in old age at 65 and above, and among people in lower socioeconomic classes. Constipation is also a common problem during pregnancy, also during days following childbirth or surgery, or after taking medications to relieve pain from situations such as a broken bone, tooth extraction or back pain.

Common Causes of Constipation

Diets low in fibre: A diet with too little fibre seems to be the commonest cause of constipation. Fibre is a substance in foods that come from plants. Fibre helps stool stay soft so it moves smoothly through the colon, the terminal segment of the intestine. Older adults in US do not get enough fibre in their diet, maybe they lose interest in eating, or they do not feel hungry as often, or they do not want to cook or are in the habit of fast foods (maybe for US only), which are often low in fibre.

Lack of water and liquid: Water and liquid lubricates the intestines and also moistens and make the food-fibre we eat more effective along its flow in our body.

Lack of physical activity: Constipation often occurs after an accident or during an illness when a person must stay in bed unable to exercise; maybe it is also one of the causes for constipation among the old people as well.

Medications: Medications that commonly can cause constipation are
pain killers, especially narcotics (pain killer with sleeping effect);
antacids that contain aluminum and calcium;
calcium channel blockers, which are used to treat high blood pressure and heart disease;
antispasmodics – medications that prevent painful muscle contractions;
certain antidepressants (medicines used against depression states in psychiatry),
iron supplements (a common ingredient in the treatment for anaemia - lack of haemoglobin in blood);
diuretics – medications that help the kidneys remove fluid from the body i.e., that make kidneys excrete more urine;
anticonvulsants – medications that decrease the abnormal electrical activity in the brain to prevent seizures;
medications that treat Parkinson’s disease – a disorder with uncontrolled movement of the body and limbs etc.

Constipation can also be caused by overuse of laxatives (medications to treat constipation) itself. Laxatives relieve constipation in the beginning; people must increase the dose over time because the body grows reliant on laxatives to have a bowel movement. Continued overuse of laxatives can damage nerves, muscles, and tissues in the large intestine and thus decrease the colon’s natural ability to contract and make constipation worse.

Life Changes or Daily Routine Changes: People can become constipated while travelling because their normal diet and daily routine changes. During pregnancy women may be constipated because the uterus compresses the intestine. Aging can affect bowel regularity, because of a gradual loss of nerves stimulating the muscles in the colon.

Ignoring the Urge to Have a Bowel Movement: Some people delay having a bowel movement because they do not want to use toilets outside their home, particularly public restrooms, or there are no public restrooms like in Manipur and elsewhere in India, or they feel they are too busy.

Neurological and Metabolic Disorders: Neurological disorders, such as spinal cord injury and Parkinsonism, and metabolic disorders such Diabetes and Hypothyroidism can also be causes of constipation.

Uncommon Causes of Constipation

Gastro-intestinal Tract Problems: Adhesions – bands of tissue that can connect the loops of intestine to each other, which may block food or stool;
diverticulosis – a condition that occurs when small pouches or sacs form, and push outward through weak spots weak spots in the colon wall;
colon polyps – growths on the inside surface of the colon; tumours;
coeliac disease – an immune reaction to the protein called gluten, found in wheat, rye, and barley, that causes damage to the lining of small intestine prevents absorption of nutrients.

Functional Gastro-intestinal Disorders: Functional constipation due to Functional Gastro-intestinal Disorders is diagnosed in people who have had two or more of these symptoms for at least 6 months;

They are:
straining to have a bowel movement at least 25% of the time;
having lumpy or hard stools at least 25% of the time;
feeling as though stool is in the rectum after a bowel movement at least 25% of the time;
feeling as though something is blocking stool from passing at least 25% of the time;
using fingers to help with stool passage at least 25% of the time;
and having fewer than three bowel movements in a week.

Irritable Bowel Syndrome is also a functional Gastro-intestinal disorder; but the symptoms include abdominal pain or discomfort, often reported as cramping along with diarrhoea and constipation both. It should not be confused with plain constipation.

(Diagnosis and treatment of constipation, next week )