Bowel movements should be regular and ideally at least once daily. The stool should be soft but firm and pass out without any pain or straining. However, bowel habit varies from person to person. It is normal to have a bowel movement between 3 times a day and 3 times a week. The stool may also vary among different bowel movements even within the same day. Constipation is defined by having :
- fewer than 3 bowel movements per week.
- passing hard stools.
- straining to defecate.
- feeling of incomplete bowel movement after defecating.
Pain may be present when passing stool and at times manual intervention may be necessary to remove the stool and facilitate defecation. Constipation is a symptom and its presentation may vary among individuals but most people who are constipated experience two or more of the features above.
Causes of Constipation
Constipation is not always due to any underlying disease. It is often associated with a lack of fibre intake, low water and fluid consumption, insufficient food intake and a sedentary lifestyle (lack of exercise). Changes in lifestyle and psychological stress may also contribute to constipation. With age and the use of certain medication, the bowel movements may also become less frequent and more strained. Drugs such as opioid painkillers, antihistamines, antidepressants, sleeping tablets, certain types of antacids, hypertension medication, antipsychotics ad anticonvulsants are more likely to cause constipation. Overuse of laxatives may also lead to constipation.
Apart from a decreased stool bulk and fluid, it is also believed that constipation arises due to slower than normal gastrointestinal motility – the movement in the bowels due to the action of the muscles in wall of the alimentary tract. This can be measured by a test to assess bowel transit time where a special dye is ingested and the time for food to move from the mouth to the anus is then recorded. Constipation may also be further exacerbated by dysfunction of the muscles controlling the external anal sphincter. A significant number of constipation cases are due to no known cause and there is no indication that it is a part of a disease, diet, lifestyle or other physiological factor. Often in these cases, constipation is the only symptom present. This type of persistent or recurrent constipation is known as functional constipation. If this constipation occurs with episodes of abdominal pain or discomfort and bloating for no known reason then it may be a part of irritable bowel syndrome (IBS).
Constipation may also be due to several diseases. Some of these conditions may be involve the bowel while others may indirectly impact on bowel habit. Usually other signs and symptoms are also present and indicate that the constipation is just one part of the clinical presentation. In these cases constipation can be classified as acute, where it occurs for less than 3 weeks, or chronic it persists for more than 3 weeks.
Some of the diseases where constipation is seen includes :
- Haemorrhoids (piles)
- Bowel obstruction either caused by a mass, twisting or abnormal position.
- Hypothyroidism (underactive thyroid gland)
- Spinal cord injury particularly the portion of the cord that sends nerves to the bowels and anal sphincters.
- Colorectal cancer
- Diabetes mellitus (sugar diabetes)
- Parkinson’s disease
- Multiple sclerosis
Constipation is a very common symptom that can occur with various other diseases that are not listed above. Sometimes constipation arises during and after a severe illness like an infection even though it does not involves the bowels specifically.
Diet for Constipation
Dietary modification should include :
- More fibre intake preferably in the form of raw vegetables and fruit. Some high fibre cereals contain sufficient daily fire intake in just one meal.
- Drinking between 1.5 to 2 litres of water per day.
- Eating regularly.
- Avoiding foods that may constipate a person.
Modification of the diet should also be combined with lifestyle changes like exercising regularly.
Remedies for Constipation
Senna is a herbal remedy that is widely used for constipation. It has now available in many over-the-counter (OTC) laxative medications. Cascara is another effective herbal remedy for chronic constipation although it is not as widely available. Psyllium husk is a plant-based remedy that is now being utilised in OTC constipation medications and fibre supplements. Constipation sufferers attempt many complementary therapies such as massage, acupuncture and homeopathy. These therapies should not replace prescription medication especially when the constipation is a symptom of some underlying disease.
Treatment for Constipation
The underlying disease should be treated and once managed appropriately, constipation may ease significantly or resolve.
Laxatives are the first choice of treatment for constipation and should be used alongside dietary modification, lifestyle changes and bowel retraining. It is important to dedicate a period of time at least once or twice a day where to attempt to defecate without any interruption. Even if unsuccessful, with time the body will become conditioned to have a bowel movement around that time. The best times are in the morning after waking and before bedtime so that the need to have a bowel movement will not disrupt daily activities.
There are a range of laxatives on the market which may work differently. Some soften stool, others increase bowel motility, add bulk to the stool or provide lubrication for the movement of stool within the bowels. It is advisable to consult with a doctor and use a specific laxative as prescribed for a short period of time before considering changing the type of laxative. There is other medication that can increase the fluid secretion into the bowels but this has to be prescribed by a doctor and used carefully to prevent other complications like dehydration over time.
If left untreated and in severe cases, the stool may become impacted in the large bowel. Fecal impaction may require a more aggressive approach to treatment as it can complicate further and lead to severe distension of the bowels known as a megacolon. At this point surgery will be necessary.