One of the commonest medical problems known to man, Constipation can be very distressing.
It can also carry serious complications if not well treated.
What is Constipation?
Constipation happens when there is difficulty passing faeces because they are hard and the activity of the bowels is ineffective in pushing out the motions as usual towards the rectum and anus.
How does it happen?
As the body digests food material, it passes through from the small to large bowels.
Liquid from the food materials in the bowels usually collects back into the blood from the bowels.
Thus, the bowel contents become harder, more solid as they travel down the large bowel and towards the anus
When the body takes in too much fluid, the faecal matter gets hard.
In addition, it is the contraction (squeezing and relaxing) motions of the muscles in the bowel that pushes the contents through from the top to bottom.
If they are not able to do so, constipation will result.
Causes of Constipation
Below is a list of conditions where one or both of those changes described above could occur:
- Diets containing food without fibre or roughage - these types of food contain a lot of water.
- They also are known to promote bowel motions - fruits, vegetables, and whole grains.
- Children, in particular, need support for eating healthy foods to prevent problems like constipation and obesity.
- Lack of exercise. People with sedentary lifestyles or elderly people who are less active tend to struggle with bowel movements.
- This also includes people who have chronic immobility problems.
- Physical activity contributes to better performance of the bowel muscles.
- Certain medication - they cause constipation as a side effect.
- They will include medicines containing opiates like Codeine or Morphine; some anticonvulsants and antidepressants; some drugs used to treat Hypertension like Diuretics or Calcium Channel Blockers.
- On the other hand, there are also medications for treating constipation - laxatives; of which there is a wide range of different types.
- When people overuse laxatives, however, they can eventually lead to constipation.
- This is because the body has become reliant on the effect of the laxatives and struggles to return to its own natural function.
- Certain conditions like Irritable Bowel Syndrome (IBS) and Pregnancy can cause constipation.
- Hormones during pregnancy slow down the bowel activity leading to sluggish movements and thus constipation.
- In IBS, we think the bowel functions abnormally but we do not know why.
- Other IBS symptoms - pain in the tummy, bloating, episodes of diarrhoea or constipation.
- Certain types of food - Milk, for example, are known to cause constipation in some people.
- This affects a lot of babies
, youngchildren and adults.
- This affects a lot of babies
- Lifestyle habits - avoiding regular use of the toilet, not drinking enough water, or changes to the daily routine can all contribute to constipation.
- Having to 'hold the bowels' for long periods and ignoring the natural urge can lead to the loss of that urge over a period of time - developing dry, hard stools.
- From very young ages, people should cultivate the habit of drinking plenty of water on a regular basis.
- Usually taking water with food, and in between meals periodically should be a regular
- Develop the habit of drinking more water on hot days and after any form of physical exertion.
- Usually, taking at least 1.5L a day ( 3 small 500ml water bottles) should be the aim, and one way of knowing that you are taking plenty of water is that your urine will appear a light amber/yellow colour and not dark yellow or brown.
- Soft drinks or fruit juices or alcohol should not replace water, and they may contain sugar and extra calories which can have a detrimental effect
- Changes to routine - such as travelling frequently, different time zones, or relocating to different climates can all contribute as the times for eating, sleeping, using the toilet all change and affect the bowel.
7. Age - Apart from less frequent activity that may affect some elderly people, it is known that metabolism slows down as we age and this can contribute to constipation.
8. Finally, long term ill health and many conditions can affect the bowel function including Diabetes, Hypothyroidism, Cancer and Neurological conditions including those affecting the spine.
How do we treat constipation?
For mild problems, drinking plenty of water and ensuring plenty of high fibre foods as well as avoiding low fibre foods (processed food, high carb or starchy foods sugary drinks) should help treat an episode of constipation and prevent it over the long term
These are natural methods for treating Constipation and also include: having a regular routine for opening the bowels such as on waking every morning; and exercise
Avoid 'holding' stools where possible, and relieve your bowels as soon as you have the urge to do so.
We know that lifting the knees above the hips can ease bowel movements - this is done by placing the feet on a short stool.
The method may benefit some people
Medical treatments - Laxative
For cases that don't respond to simple natural/lifestyle changes, laxatives are useful.
Laxatives soften the stool, easing bowel movements.
There are various types: stimulants, lubricants, stool softeners/enemas, osmotics, fibre supplements, saline laxatives and a few others.
Many are available over the counter (OTC); while others will need a prescription
Be careful with laxatives as excessive use can cause complications.
Ideally, using laxatives as a solution should only happen when other (natural) measures don't work.
It's important to supervise regular whenever a clinician recommends this.
When constipation does not respond to any medical treatment, (as a last resort), surgery to remove part of the large bowel is the next step.
This includes removal of the portion of the anus or rectum causing constipation.
Finally, there is a serious complication of Constipation known as Fecal impaction.
It is a painful condition where the faeces are so hard they will not pass through the bowels.
They do not respond to laxatives or stool softeners that to provide relief.
In this event, a procedure called 'manual evacuation' will relieve the problem.
Manual evacuation involves having the faeces taken out of the bowels and rectum to clear the blockage.
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