Diarrhea/ Constipation

Constipation

Constipation can be a variety of anatomical or functional problem ,serious causes of constipation should be ruled out, like cancer (especially if patient is older than 50 years). Diet and life style changes and bio feedback may be helpful in treatment of constipation.

What is Constipation? When to Visit a Doctor?

Constipation is a symptom meanings need to strain to have a bowel movement, infrequent bowel movements or decrease in the volume or weight of stool.

About 80 percent of people suffer from constipation at some time during their lives and brief periods of constipation are normal. If the change in bowel habit is persistent (more than 3 weeks) or if there are any warning signs (blood in stool, loss of weight or loss of appetite) a person should visit a doctor.

What Causes Constipation?

Anatomic causes

  • Cancer

  • Stricture

Functional causes

  • Irritable bowel syndrome

  • Slow transit constipation

  • Pelvic outlet dysfunction

Medical causes

  • Medication

  • Disorders of nervous system

    • Parkinson’s disease

    • Stroke

    • Spinal cord injuries

  • Disorders of endocrine system

    • Thyroid disease

What Factors Contribute to Constipation?

  • changes in habits or lifestyle, such as travel, pregnancy, and old age

  • abuse of laxatives

  • inadequate fiber and fluid intake

  • sedentary lifestyle

  • environmental changes

  • repeatedly ignoring the urge to have a bowel movement

Constipation as a Side Effect of Certain Medication:

  • Pain killers

  • Antidepressants/Tranquilizers

  • Blood pressure medication

  • Diuretics

  • Iron supplements/Calcium supplements

  • Laxative dependence or abuse

How Can the Cause of Constipation Be Determined?

Serious causes of constipa tion should be ruled out, like cancer (especially if patient is older than 50 years).

  • A through history of medical conditions.

  • Digital examination of the anorectal area.

  • Barium enema given into the rectum. An x-ray of the abdomen can show strictures, obstructions, and other problems.

  • Colonoscopy allows the physician to view the entire length of the large intestine, and help identify abnormal growths, inflamed tissue, ulcers, and bleeding.

  • A sigmoidoscopy allows the physician to view a portion of the large intestine.

  • After excluding any mechanical cause of obstruction if functional constipation is diagnosed, further investigation can be carried like “marker studies,” in which the patient swallows a capsule containing markers that show up on ¬x-rays taken repeatedly over several days, (may ¬provide clues to disorders in muscle function within the intestine-slow-transit colon – ‘sleepy’ colon or pelvic floor dysfunction).

In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific.

How is Constipation Treated?

  • Diet modifications, diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. Foods such as beans, whole grains, bran cereals, fresh fruits and vegetables are high fiber diet. Limiting foods such as ice cream, cheeses, meats, and processed foods can also be helpful.

  • Lifestyle changes, increased water intake, regular exercise, and designating a specific time each day to have a bowel movement may be helpful to some patients.

  • Laxatives

  • Eliminating or changing medication

  • Biofeedback, to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control release of bowel movements.

  • In rare circumstances surgical procedures may be necessary to treat constipation.**

What Can Be Complications of Constipation?

Constipation can cause hemorrhoids by straining to have a bowel movement, or anal fissures when hard stool stretches the sphincter muscle.

Straining may cause rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening.

Fecal impaction can occur in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the tool.

Obstructed Defecation Syndrome (ODS)

Normal urges to defecate but an impaired ability to expel the faecal bolus

Symptoms:

  • Repeated unsuccessful attempts at defecation

  • Straining

  • Rectal bleeding

  • Evacuation by finger

  • Perineal and lower abdominal pain

Other screening tests i.e. barium enema, and CT colography (virtual colonoscopy) may not be as effective and reliable as FOBT or colonoscopy


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