What is constipation?
Bowel movements may vary for each individual and across cultures
depending on the intake of fibre in the diet. Normal bowel
movements may vary from 3 per day to 3 per week. When a person has
infrequent or hard stools or has to exert considerable effort
while passing stool, he may be said to have constipation.
What are the causes? Constipation may be due to various physiological and
psychological conditions. Most people experience constipation that
may be due to dietary changes, but this is temporary and corrects
by itself. If it continues over a long period of time and recurs
often, permanent dietary modification might be needed. Some of the
common causes of constipation are:
1. Poor diet – diets rich in animal meats but low in fibre are the
most common cause of constipation. Fibre helps bowel movements to
be easy and regular.
2. Poor bowel habits - this is a common cause especially in
children. Once children are toilet trained, they must be
encouraged to go to the toilet regularly everyday. Adults usually
suffer from the problem when they ignore the urge to evacuate over
a long period of time. This may be because of lack of time or some
other reason. After some time they stop getting the urge to use
the toilet leading to progressive constipation.
3. Fissures or haemorrhoids – certain painful conditions like anal
fissures or haemorrhoids may prevent a person from wanting to
evacuate. Such people have chronic constipation.
4. Inadequate physical activity.
5. Hormonal changes as during pregnancy.
6. Anxiety, depression and other emotional conditions may
sometimes cause constipation.
7. Medications – certain medications such as those given for pain
relief, depression and some narcotics cause constipation.
8. Laxatives – many people who become used to taking laxatives for
inducing bowel may become dependent on it and may have difficulty
in evacuation without a laxative.
What are the symptoms?
The most common symptoms a person with constipation may experience
are:
* Infrequent passage of stool
* Difficulty in bowel movement
* Bloated feeling in the stomach after a meal
* Feeling of incomplete evacuation
* General feeling of discomfort and malaise.
How is it diagnosed?
There are no specific tests to diagnose constipation. The patient
comes to know himself when he has trouble in passing stool. The
doctor is then informed who will prescribe medications.
What is the treatment?
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 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. If the person is leading a sedentary
lifestyle, the doctor will delineate an exercise regime to
regulate activity of the alimentary tract. Bowel habits may also
need to be improved to prevent another bout in the future.
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. People who are dependent on
laxatives need to slowly stop using them. For most people,
stopping laxatives restores the colon’s natural ability to
contract.
Treatment for constipation may be directed at a specific cause.
For example, the doctor may recommend discontinuing medication or
performing surgery to correct an ano-rectal problem such as rectal
prolapse, a condition in which the lower portion of the colon
turns inside out.
People with chronic constipation caused by ano-rectal dysfunction
can use biofeedback to retrain the muscles that control bowel
movements. Biofeedback involves using a sensor to monitor muscle
activity, which is displayed on a computer screen, allowing for an
accurate assessment of body functions. A health care professional
uses this information to help the patient learn how to retrain
these muscles.
Surgical removal of the colon may be an option for people with
severe symptoms caused by colonic inertia. However, the benefits
of this surgery must be weighed against possible complications,
which include abdominal pain and diarrhoea.
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