Constipation: Conditions, Symptoms and Treatments

Common Causes of Constipation

• Low-Fiber Diet: Not eating enough fruits, vegetables, and whole grains.
• Inadequate Water Intake: Dehydration makes stools hard and difficult to pass.
• Lack of Physical Activity: Sedentary lifestyle slows down bowel movement.
• Ignoring the Urge to Go: Delaying bowel movements can lead to harder stools.
• Medications: Painkillers, antidepressants, iron supplements, and antacids can cause constipation.
• Changes in Routine: Travel, stress, or changes in diet can affect bowel habits.
• Medical Conditions: Conditions like hypothyroidism, diabetes, irritable bowel syndrome (IBS), or neurological disorders.
• Pregnancy: Hormonal changes and pressure on the intestines can slow digestion.
• Aging: Older adults may experience slower metabolism and weaker bowel muscles.
• Overuse of Laxatives: Can reduce the bowel's ability to function properly over time.

Medical Conditions That Can Cause Constipation

• Irritable Bowel Syndrome (IBS): A chronic condition affecting bowel habits.
• Hypothyroidism: Low thyroid hormone levels slow down metabolism and digestion.
• Diabetes: High blood sugar can damage nerves controlling the digestive system.
• Neurological Disorders: Conditions like Parkinson’s disease, multiple sclerosis, or stroke can affect bowel function.
• Depression: Can slow bodily functions, including digestion.
• Spinal Cord Injuries: Can impair nerve signals to the bowel.
• Colon or Rectal Cancer: Tumors can block the bowel or slow movement.
• Intestinal Obstruction: Physical blockages prevent stool from passing.
• Pelvic Floor Dysfunction: Muscles don't work properly to allow bowel movements.
• Chronic Kidney Disease: May disrupt electrolyte balance, affecting digestion.

Symptoms of Constipation

These can vary from person to person. If you are experiencing any of the following issues, you are likely at a higher risk of constipation:

• Having less than three bowel movements per week.
• Passing hard stools.
• Experiencing pain during bowel movements.
• Feeling rectal blockage.

Certain individuals are more susceptible to constipation due to their lifestyle and health conditions. These include:

• Older adults over the age of 65 may have a sedentary lifestyle or underlying medical conditions that contribute to constipation.
• Individuals with serious medical conditions, such as spinal cord injuries, which can affect bowel movements.
• Pregnant women may experience hormonal changes and increased pressure on the intestines from the growing baby.

When to Visit a Doctor for Constipation?

While occasional constipation is common and often manageable with lifestyle changes, certain signs indicate the need for medical attention. You should consult a doctor if you experience:

Serious Symptoms that Require Emergency Care

If you experience any of the following symptoms, it is advisable to seek medical attention promptly: discomfort or a worsening condition.

• Sudden onset of constipation
• Constipation is unresponsive to dietary changes
• Presence of blood in stool
• Rectal bleeding
• Persistent abdominal or lower back pain
• High fever and vomiting
• Unexplained weight loss

Diagnosis for Constipation

In addition to a general physical examination and a digital rectal examination, physicians utilize various tests and procedures to diagnose constipation and identify the underlying cause:

• Blood tests: Your physician will check for general conditions such as hypothyroidism or high calcium levels.
• X-ray: This imaging technique helps determine if there is a blockage in the bowels and if stool is present throughout the colon.
• Sigmoidoscopy: It is a procedure in which a flexible tube with a light is inserted into the rectum and lower colon for examination.
• Colonoscopy: This diagnostic procedure involves using a flexible tube with a camera to examine the entire colon.
• Anorectal manometry: a test where a tube is inserted into the anus and rectum to measure muscle coordination.

The balloon expulsion test measures the time taken to expel a water-filled balloon from the rectum. Colonic transit study involves swallowing a capsule with a marker to track its progress through the large intestine over 24-48 hours.

An X-ray of the rectum during defecation involves inserting a soft barium-based paste into the rectum, which is then passed out along with the stool. Barium is visible on X-rays and can help identify issues like prolapse or muscle coordination problems.

MRI defecography, similar to barium defecography, involves inserting a contrast gel into the rectum and passing it through. The MRI scanner visualizes and evaluates the functionality of the muscles involved in defecation. This test is useful in diagnosing conditions that may lead to constipation, such as rectocele or rectal prolapse.

Medical Treatments for Constipation

This typically starts with changes to your diet and lifestyle to improve the movement of stool through your bowels. If these changes are not effective, your doctor may suggest medication or surgery.

• Laxatives: Bulk-forming, stimulant, osmotic, stool softeners. Helps to stimulate or ease bowel movements.
• Prescription Medications: Improve bowel function in chronic or severe cases.
• Enemas and Suppositories: Soften stool and stimulate bowel movement quickly, often used for severe or immediate relief.
• Biofeedback Therapy: Helps patients with pelvic floor dysfunction learn how to coordinate bowel muscles.
• Manual Evacuation: In rare cases, stool may be removed by a healthcare provider if severely impacted.
• Surgery: For serious cases like bowel obstruction or when other treatments fail, such as in cases of rectal prolapse or colonic inertia.
• Dietary and Lifestyle Counseling: Helps patients make long-term changes in fiber intake, hydration, and activity levels.

Lifestyle Changes for Constipation

To relieve constipation, your doctor may recommend the following diet and lifestyle modifications:

• Increase your fibre intake: Fiber can increase the weight of your stool and promote faster bowel movements. Gradually incorporate more fresh fruits, vegetables, whole-grain breads, and cereals into your daily meals.
• Follow a recommended fibre intake: Your doctor may advise a specific amount of fibre to consume each day. Aim for around 14 grams of fibre per 1000 calories in your regular diet.
• Start slowly and progress gradually: A sudden increase in fibre intake can lead to bloating and gas. Begin with small changes and work progressively towards your fibre goal over a few weeks.
• Engage in regular exercise: Physical activity helps stimulate muscle activity in your bowels. Strive to exercise almost every day of the week. If you are not currently active, consult your doctor to determine if you are fit enough to start an exercise program.
• Respond to the urge to have a bowel movement: Take your time in the bathroom and allow yourself sufficient time without distractions or feeling rushed.

Prevention of Constipation

To prevent constipation, it is important to make some lifestyle changes. Here are some preventive measures you can take:

• Stay hydrated by drinking 8-10 glasses of water daily.
• Avoid alcohol and caffeinated drinks, as they can contribute to dehydration and worsen constipation.
• Include fibre-rich foods in your diet, such as fruits, vegetables, whole grains, and cereals.
• Limit the consumption of low-fiber foods like meat, milk, and cheese.
• Engage in daily exercise for at least 30 minutes to promote regular bowel movements.
• Consider taking laxative supplements for a short period under the guidance of a healthcare professional.

Home Remedies for Constipation

• To alleviate constipation naturally, consider the following guidelines for a healthier lifestyle: Increase fibre intake to 25-31 grams daily through fresh fruits, vegetables, and fibre-rich cereals.
• Stay hydrated by drinking an adequate amount of water to aid in constipation relief.
• Engage in regular physical activity to promote bowel movement. - Establish a routine for visiting the restroom daily. - Avoid delaying bowel movements to prevent complications.