Constipation

For most people, constipation is an occasional annoyance that is relieved within a few days that is brought on by a known cause. For other patients, constipation is a daily struggle that leaves them unable to relieve their bowels, feeling uncomfortable, and can lead to serious health problems. Constipation is defined by having infrequent bowel movements which are difficult to pass, hard stools, and straining significantly while attempting to pass these stools. Normal bowel movements vary by individual. Some patients will have three daily movements while others may have one movement every other or every third day. There is no standard normalcy for frequency of bowel movements provided the patient is going when needed and feels as though they have emptied their bowels after going.

CONSTIPATION SYMPTOMS

Symptoms of constipation include the passing of hard, dry stools three times per week, usually accompanied by bloating and straining, or experiencing discomfort while trying to eliminate. Constipation can be defined by the patient as a recognizable condition when they experience it.

CONSTIPATION CAUSES

Constipation can be caused by a variety of factors. Dehydration, medication, stress, illness, lack of physical activity or exercise, a tendency to hold bowel movements longer than reasonable or necessary, pregnancy, age, and a low fiber diet can cause constipation. A normal bowel movement is moved through the system via muscle contraction of the lower intestine. When these muscles aren’t able to undulate properly, or the bowels are too dry and compacted, the flow of the bowels is interrupted. Sometimes too much water in the bowels makes it difficult to pass a bowel movement. If the muscles of the bowel are unable to properly coordinate, it is not uncommon for this to cause straining and an inability to excrete movements. The overuse of laxatives can actually cause constipation as it encourages the muscles in the lower digestive tract to stop undulating.

CONSTIPATION RISK FACTOR

Risk factors for constipation may include a low exercise lifestyle, a low fiber diet, being an older adult, being ill or bedridden, low fluid intake, and medications that are known to cause constipation.

CONSTIPATION DIAGNOSIS

A physical examination is typically required to find the cause of constipation, however this is typically a condition that a patient can self diagnose simply in reference to their own discomfort. Finding a defining cause may entail a rectal exam to be certain there isn’t any bowel impaction or obvious obstruction, a stool analysis to determine any hidden traces of blood, a barium enema which highlights the intestinal tract to allow for a detailed x-ray, a colonoscopy, an examination of the bowel and rectum with a sigmoid scope, or an anorectal manometry which inflates a tiny balloon in the lower intestines to determine muscle coordination and strength. Electrolyte disturbances, low blood calcium, thyroid disorders, and medication reviews are also considered when diagnosing the cause of constipation.

CONSTIPATION TREATMENT

Hemorrhoids, anal fissures, cracks in the anus, and rectal bleeding can occur when constipation hits. Chronic constipation can lead to bowel impaction, which can lead to severe discomfort. A fecal impaction, or bowel impaction, becomes so hard and dry it can not be eliminated from the body in any type of normal fashion. Because it can become life threatening if left in the intestinal tract as an obstruction, fecal impactions may need to be manually removed, which requires general anesthesia.

Chronic constipation can also lead to the chronic use of laxatives, which can cause lazy bowel syndrome, as well as poor vitamin and mineral absorption and malnutrition. Chronic use of laxatives can cause damage to the bowels and intestinal tract. This adds to constipation and creates a viscous cycle.

The fastest, easiest, and safest method of treatment involves changes in lifestyle. Dietary changes, liquid intake (non-caffeinated) changes, and changes in exercise habits are the best ways to treat constipation. Medications that are causing chronic constipation may need to be changed if possible. Biofeedback has been successfully used to treat constipation related to pelvic floor dysfunction, or uncoordinated muscles. Stool softeners and mineral oils as well as milk of magnesia can be gentle aids to assisting constipation.