Dr.Souvik Banerjee, MD.

 

Constipation - Overview

Constipation is a condition in which the patient has fewer bowel movements than normal or when their bowel movements are more difficult than normal. Medically, constipation is referred to as a functional disorder that causes excessive straining during a bowel movement either with difficulty or with incomplete or infrequent, hard stools.

If somebody has less than three bowel movements a week, it is medically termed as constipation. Patients with constipation can only pass stools when there is an urge to do so; if there is no urge, it is difficult to pass stools. Constipation is not only limited to sluggishness or slowness of the bowel movements but may also be associated with psychological and various other medical disorders.

Constipation can sometimes interfere with the patient’s ability to function normally, preventing them from going about their daily tasks with ease. Most of the individuals suffer from chronic constipation, while some can develop sudden constipation, which needs immediate attention. Constipation is linked to erratic bowel habits, diet, hormones, medications and some diseases of the large intestine, also called the colon.

Constipation can be present differently in different people; therefore, it is essential to understand the patient’s lifestyle and psychological factors in the development of constipation. Individuals with constipation tend to resort to all sorts of treatment, including the use of laxatives. The distress is caused when the constipation becomes so bad that some people have to undergo frequent enema or need to remove stools manually.

It is essential to undergo a medical evaluation to know the reason for constipation. It is important to identify the cause and treat constipation accordingly. Homeopathy provides a wonderful treatment for constipation.

Constipation - Causes

Causes of constipation are as follows:

1.      Lifestyle: Lifestyle: Lifestyle: Lifestyle causes of constipation are quite common these days, especially with our poor dietary habits and lack of exercise. Some of them are listed below:

o   low fibre intake

o   low fluid intake

o   ignoring the call to stools

o   lack of exercise

o   sedentary lifestyle

2.      Social factors

o   During early childhood, if a child is not comfortable passing stools during certain situations – such as while dining, getting late for school, while eating or while travelling – it can lead to a reduced urge or fear to pass stools, thus giving rise to constipation.

o   Too much scolding, punishing or some form of fear can also lead to a decreased urge to pass stools.

o   Sexual, physical or mental abuse in the forms of embarrassment or punishment can lead to constipation, especially in children.

3.      Medical factors

o   Intestinal disease: Blockage in the intestine or rectum may slow or stop stool movement. Some of these intestinal diseases are narrowing of the large intestines, pressure over the intestine due to excess weight, anal fissure, tuberculosis and colon cancer.

o   Nerve problems around the intestine: This makes the intestines function slowly, which could lead to diabetes causing autonomic neuropathy, stroke, spinal cord disease, multiple sclerosis and Parkinson's disease.

o   Weakness of the pelvic muscles

o   Hormones: This includes problems like hypothyroidism, pregnancy and the associated hormonal changes, and diabetes.

 

Risk factors

Factors that increase the risk of constipation are as follows:

·        advanced age

·        mental stress

·        women get constipated more often than men

·        low-fibre diet

·        dehydration

·        limited physical activity

·        certain medications that include sedatives or narcotics that slow the body down

Constipation - Symptoms

A patient may be having chronic constipation if they have two or more of the following symptoms persisting for more than months:

·        straining to pass stools

·        lumpy or hard stools

·        a sensation of incomplete evacuation or a feeling of having to pass stools again

·        feeling of blockage in the rectum that is not allowing stools to pass out

·        passing stools less than three times a week

·        needing help to pass stools, example: pressing hands on the abdomen or using a finger to remove stools from the rectum

 

Types

1.      Normal-transit constipation

o   Normal-transit constipation is a part of constipation, present with normal stool movement but with associated abdominal pain and bloating.

o   It is seen in individuals with increased emotional stress, who can easily feel better with laxatives.

2.      Slow-transit constipation

o   In order to expel the contents of the colon forward, the intestine undergoes a sequence of synchronised muscular contractions. These coordinated movements pass through the nerves present in the gut wall. Any abnormality or delay in the coordination of a nerve can decrease gut motility, thereby causing constipation.

o   This is generally diagnosed in the early days of life, when the child is born and there is a delay in passing stools. These individuals suffer severe forms of constipation and a lack of control over bowel movements. They are constantly anxious and socially withdrawn, with emotional disturbances.

3.      Evacuation disorders

o   Stools are not propelled out after reaching the anus. Patients experience prolonged straining to pass soft stools with heaviness in the anal area and thus need to insert their finger and manually remove the faeces.

o   The exact reason still remains unknown. Those who do not respond easily to medication may require relaxation therapy.

 

Types

The patient must look for the following associated alarming signs:

·        sudden onset of constipation

·        fever

·        weight loss

·        lump upon examining the stomach

·        blood in stools

Constipation - Diagnosis

The diagnosis is based on the following:

·        Clinical history and physical examination: it is very important for our doctors to understand the patient’s perspective of constipation – the exact symptoms they suffer from. Our doctors will also conduct a physical examination of the patient’s abdomen to look for distension, hard stool or mass.

·        Psychological assessment: constipation could well be linked to emotional disturbances or life situations. During a thorough case evaluation, our doctors will be on the lookout for such causes.

·        Investigations : Routine blood tests to rule out hormonal disorders and a stool test to check for blood in the stool may be advised.

 

Complications

Piles: this is the most common complication of constipation.

Anal fissures: fissures are tears in the walls of the rectum, leading to pain and discomfort. They get worse by dry, hard stools.

Faecal impaction: faecal impaction can sometimes lead to a number of other complications, including swelling of the rectum, loss of sensation and a lack of control over urine and stools or rectal prolapse.

Psychological complications

·        affecting the mood, i.e., anxiety and irritability

·        social withdrawal due to complications

·        interference in day-to-day activities

·        negative impact on health

Constipation - Treatment

A study conducted at the Research Institute for Gastroenterology and Liver Disease, Tehran, Iran, showed that anxiety and depression have a prevalence rate of 34.6% and 23.5%, respectively, in patients with chronic constipation.