Constipation
Constipation is an issue of passing stool. Constipation normally refers to having fewer than three stools per week or trouble passing stool. Constipation is reasonably common and can be brought on by too little dietary fiber, fluids and exercise. But other diseases or some drugs might be responsible. Constipation is most commonly treated with dietary and exercise changes or with nonprescription drugs. Constipation can need medications, medication changes or other treatments ordered by a health care provider. Chronic constipation also known as long term constipation can need treatment of another disease or condition that can cause or make constipation worse.
It is a bowel disorder that causes infrequent or difficult bowel movements. The stool tends to be hard and dry. The symptoms may further be abdominal pain, bloating and having the feeling that one has not passed the bowel movement completely. Complications arising from constipation include hemorrhoids, anal fissure or fecal impaction. In adults, three per week and three per day is normal bowel frequency. Babies have three or four bowel movements per day whereas children usually have two to three per day.
Symptoms of constipation
Constipation is a symptom not a disease. The most frequent perception of constipation is infrequent bowel movements typically less than 3 stools per week. Individuals may have other associated complaints such as
Straining during bowel movements
Taking too long to pass a bowel movement
Hardness of stool
Pain with bowel movements secondary to straining
Abdominal pain
Abdominal bloating.
the feeling of incomplete evacuation of the bowel.
The Rome III Criteria are a group of symptoms that assist in standardizing the diagnosis of constipation across different age groups. The criteria assist doctors in defining constipation more clearly in a standardized way.
It is numerous causes, Some of the common causes include slow colonic transit of stool, irritable bowel syndrome and pelvic floor dysfunction. Underlying associated conditions are hypothyroidism, diabetes, Parkinsons disease, celiac disease, non-celiac gluten sensitivity, vitamin B12 deficiency, colon cancer, diverticulitis and inflammatory bowel disease
. Medications causing constipation are opioids some antacids, calcium channel blockers and anticholinergics of patients taking opioids approximately 90% develop constipation. Constipation is more significant when there is weight loss or anemia. there is blood in the stool, there is a family history of inflammatory bowel disease or colon cancer or it is new onset in an older person.
Causes of constipation
The causes of constipation are categorized into congenital, primary and secondary. The most prevalent type is primary and non life threatening. It can also be categorized by the age group affected like children and adults.
Primary or functional constipation is characterized by persistent symptoms for more than six months not attributed to an underlying cause like medication side effects or an underlying medical condition. It is not accompanied by abdominal pain thereby differentiating it from irritable bowel syndrome. It is the most prevalent type of constipation and is usually multifactorial. In adults, primary causes include dietary factors such as inadequate dietary fiber or fluid intake, or behavioral factors such as reduced physical activity.
In children, etiologies may be diet poor in fiber and fluids, medical conditions and aversion to bathroom use. In older persons, typical etiologies have been linked to inadequate dietary fiber, poor fluid intake, reduced physical activity, drug side effects, hypothyroidism and colorectal cancer obstruction. Evidence for these factors however is weak.
Secondary causes are side effects of drugs like opiates, endocrine and metabolic disorders like hypothyroidism and obstruction due to colorectal cancer or ovarian cancer. Celiac disease and non-celiac gluten intolerance can also present with constipation. Cystocele can occur due to chronic constipation.
Diet
Constipation may be caused or worsened by a low-fiber diet, low fluid intake or dieting. Dietary fiber reduces colonic transport time, enhances stool bulk and at the same time softens stool. Diets with low fiber thus cause primary constipation.
Treatments of constipation
Only a few cases need immediate medical treatment or will have serious repercussions.
The management of constipation should be aimed at the underlying cause if identifiable. The National Institute of Health and Care Excellence divides constipation in adults into two groups chronic constipation of unknown cause and opiate-induced constipation.
In chronic constipation of indeterminate causes, the primary treatment is increased water and fiber intake. Laxatives or enemas are not to be used routinely because bowel movements can become dependent on their use.
Supplements
Supplements of soluble fiber like psyllium are overall regarded as first-line treatment of chronic constipation over insoluble fibers like wheat bran. Adverse effects of fiber supplements include flatulence, bloating, diarrhea, potential malabsorption of calcium, iron and certain drugs. Opiate-induced constipated patients, though are not expected to derive any benefit from fiber supplements.
Physical way
Constipation that is resistant to the above interventions can need physical intervention like manual disimpaction the physical removal of impacted stool with the hands see fecal impaction. Exercise
Regular exercise can correct chronic constipation.
Surgical way
In refractory cases, interventions can be done to assist with constipation. Sacral nerve stimulation is beneficial in a minority of cases. Colectomy with ileorectal anastomosis is another procedure that is only done in patients who are known to have a slow colonic transit time and in whom a disorder of defecation has either been cured or is not present. Because this is a major surgery side effects can be significant abdominal pain, small bowel obstruction and postoperative infections. Additionally, it has a highly variable success rate and is highly case-dependent.