Constipation

Constipation is a prevalent digestive issue that affects people of all ages, causing discomfort and frustration. It is characterised by infrequent bowel movements or difficulty passing stools, which can lead to bloating, abdominal pain, and a feeling of incomplete evacuation. In this article, we will explore the different aspects of constipation, including its types, symptoms, and causes, to help you better understand this condition and seek appropriate treatment.

What is Constipation?

Constipation is a digestive disorder characterised by fewer than three bowel movements per week, with stools that are typically hard, dry, and difficult to pass. The severity of constipation can vary from person to person, and it may be accompanied by other symptoms such as straining during bowel movements, a feeling of incomplete evacuation, and abdominal bloating. Various factors can contribute to constipation, including diet, lifestyle, medications, and underlying health conditions, making it essential to identify the root cause for effective treatment.

Constipation can be broadly classified into two main categories, each type has its own set of characteristics and underlying causes. These include:

• Primary constipation: Primary constipation, or functional constipation, arises from the digestive system's function rather than an underlying medical condition or medication side effects. Primary constipation can be further divided into several subtypes:

  • Normal transit constipation: This is the most common type of constipation, where individuals have a normal colon function but still experience symptoms such as difficulty passing stools, hard stools, bloating, and abdominal pain.

  • Slow transit constipation: Characterised by slow movement of food through the intestines, this constipation leads to infrequent bowel movements, diminished urgency, and straining during defecation.

  • Outlet constipation: Also referred to as pelvic floor dysfunction constipation, this type occurs due to issues with the muscles around the anus and rectum, making it difficult to pass stools even when they reach the rectum.

  • Idiopathic constipation: This type is diagnosed when no underlying cause can be identified for the constipation symptoms despite thorough medical evaluation.

• Secondary constipation: Secondary constipation occurs due to an underlying medical condition, medication use, or lifestyle factors. Some common causes include dehydration, metabolism issues (such as diabetes or hypothyroidism), side effects of medications (like opioids, iron supplements, or certain antidepressants), neurological conditions (such as Parkinson's disease or multiple sclerosis), muscle disorders (like scleroderma or myotonic dystrophy), and other conditions (such as colon cancer or pelvic prolapse).

The early signs of constipation include:

• Changes in bowel movement frequency

• Difficulty passing stools

• Ignoring the urge to have a bowel movement

• Recent changes in diet or physical activity

• Feeling of incomplete emptying after a bowel movement

Constipation is characterised by a variety of symptoms that can vary in intensity and frequency among individuals. Common symptoms include:

• Infrequent bowel movements: One of the primary signs of constipation is having fewer than three bowel movements per week. This irregularity can lead to discomfort and concerns about digestive health.

• Difficulty passing stool: Individuals with constipation often experience straining during bowel movements. The stool may be hard, dry, and difficult to pass, which can be painful.

• Abdominal discomfort: Many people may experience abdominal discomfort or cramping associated with constipation. This discomfort may feel like bloating or a sensation of fullness in the abdomen.

• Feeling of incomplete evacuation: After a bowel movement, individuals may feel that they have not fully emptied their bowels. This sensation can contribute to ongoing discomfort and the urge to go again soon after.

• Rectal pain: Constipation can lead to rectal pain or discomfort, particularly if there is straining involved. This pain may also result from haemorrhoids or anal fissures, which can develop due to hard stools.

• Nausea: In some cases, constipation may cause feelings of nausea, particularly if there is significant abdominal distension or discomfort.

Constipation can stem from various factors, including lifestyle choices, medical conditions, and medications. Some of the causes of constipation include:

• Lifestyle factors: Poor dietary habits, such as low fibre intake, can lead to constipation. A lack of physical activity and inadequate hydration also play significant roles, as these factors can slow down digestion and stool movement.

• Medical conditions: Certain medical conditions, including irritable bowel syndrome (IBS), diabetes, hypothyroidism, and neurological disorders like Parkinson’s disease, can disrupt normal bowel function and contribute to constipation.

• Medications: Certain medications, such as antacids containing aluminium, anticholinergics, antispasmodics, anticonvulsants, calcium channel blockers, diuretics, iron supplements, and narcotic pain medicines, can cause constipation as a side effect.

• Changes in routine: Travelling, changes in diet, or disruptions in daily routine can affect bowel habits, leading to temporary constipation. Stress and anxiety can also impact digestive health, contributing to irregular bowel movements.

• Ageing: As people age, changes in metabolism, muscle tone, and diet can increase the likelihood of constipation. Older adults may also be more prone to medical conditions and medications that contribute to the issue.

• Hormonal changes: Hormonal fluctuations, such as those occurring during pregnancy, can affect bowel function. Increased progesterone can slow down intestinal motility, leading to constipation.

Several risk factors can increase the likelihood of experiencing constipation, including:

• Pregnancy

• Ageing

• Lack of physical activity

• Low-fibre diet

• Dehydration

• Certain medications (such as antacids containing aluminium, anticholinergics, antispasmodics, anticonvulsants, calcium channel blockers, diuretics, and iron supplements)

• Underlying medical conditions (digestive disorders, hormonal imbalances, and neurological conditions)

Constipation can lead to several complications if left untreated, affecting both physical health and quality of life. The complications of constipation include:

• Haemorrhoids: Straining during bowel movements can result in haemorrhoids, which are swollen blood vessels in the rectal area. This can lead to pain, itching, and bleeding.

• Anal fissures: Hard stools can cause small tears in the lining of the anus, known as anal fissures. These can be painful and may result in bleeding during bowel movements.

• Faecal impaction: Severe constipation can lead to faecal impaction, where stool becomes hard and lodged in the rectum. This condition can require medical intervention for removal and may cause discomfort and pain.

• Bowel obstruction: Chronic constipation may increase the risk of bowel obstruction, where the intestines become blocked. This serious condition can lead to severe pain, vomiting, and may require surgical treatment.

• Rectal prolapse: In some cases, prolonged straining can cause rectal prolapse, where part of the rectum protrudes from the anus. This can require surgical repair.

Preventing constipation involves adopting healthy lifestyle habits and making dietary changes that promote regular bowel movements. Some of the preventative measures may include:

• High-fibre diet: Incorporating a diet rich in fibre is crucial. Foods such as fruits, vegetables, whole grains, legumes, and nuts can help soften stool and promote bowel regularity.

• Adequate hydration: Drinking plenty of fluids, especially water, is essential for maintaining hydration and preventing hard, dry stools. Aim for at least eight glasses of water per day, adjusting based on activity level and climate.

• Regular physical activity: Engaging in regular physical activity can stimulate intestinal function and promote bowel motility. Aim for at least 30 minutes of moderate exercise most days of the week.

• Routine bowel habits: Establishing a regular bathroom routine can help train the body to have consistent bowel movements. Setting aside time each day, especially after meals, can encourage this habit.

• Avoiding delaying bowel movements: Responding promptly to the urge to have a bowel movement can prevent constipation. Ignoring these urges can lead to harder stools and increased difficulty passing them later.

• Limiting processed foods: Reducing the intake of processed foods, which often contain low fibre and high fat, can help maintain digestive health and prevent constipation.

• Monitoring medications: If taking medications known to cause constipation, discuss alternatives or preventive measures with a doctor. Adjustments can often be made to minimise this side effect.

Diagnosing constipation involves a thorough assessment of symptoms, medical history, and various tests to determine the underlying causes and appropriate treatment options. These include:

• Medical history: The diagnosis typically begins with a doctor reviewing the patient's medical history and symptoms. Patients may be asked about their bowel habits, dietary intake, fluid consumption, physical activity, and any medications they are taking.

• Physical examination: A physical examination may be conducted to check for signs of constipation or related conditions. This can include abdominal palpation to assess for bloating or tenderness and a rectal examination to evaluate the anal area and assess stool consistency.

• Blood tests: These can help identify underlying conditions, such as hormonal imbalances or metabolic disorders.

• X-rays: Abdominal X-rays may be used to visualise the colon and assess for faecal impaction or obstruction.

• Colonoscopy: This procedure involves using a flexible tube with a camera to examine the interior of the colon and rectum, helping to rule out structural issues or diseases.

• Anorectal manometry: This test measures the pressure and function of the rectal and anal muscles, providing insight into potential muscle dysfunction.

• Defecography: This imaging test evaluates the mechanics of bowel movements, helping to identify any abnormalities in how the rectum and anus function during defecation.

• Stool tests: These tests can include stool culture for harmful bacteria, stool fat tests to assess malabsorption, and faecal occult blood tests to detect hidden blood, which may indicate gastrointestinal bleeding.

Effective treatment and management of constipation depend on identifying the underlying causes and severity of symptoms. Some of the treatment and management options include:

• Dietary changes: Increasing fibre intake is essential for promoting regular bowel movements. Incorporating fruits, vegetables, whole grains, and legumes can help soften stool. Additionally, staying hydrated by drinking plenty of water is crucial for preventing hard stools.

• Physical activity: Regular exercise can stimulate intestinal function and improve bowel motility. Engaging in activities such as walking, jogging, or yoga can help alleviate constipation and support overall digestive health.

• Bowel habits: Establishing a regular bowel routine can aid in preventing constipation. Setting aside time each day, especially after meals, can encourage consistent bowel movements. Responding promptly to the urge to have bowel movement is also important.

• Over-the-counter medicines: Laxatives, stool softeners, and fibre supplements are available over-the-counter and can provide relief for occasional constipation. However, these should be used cautiously and not relied upon long-term without consulting a doctor.

• Prescription medications: For more severe or chronic cases of constipation, prescription medications such as linaclotide, lubiprostone, or prucalopride may be prescribed to help promote regular bowel movements.

• Medical procedures: In cases of severe constipation, particularly with faecal impaction or bowel obstruction, medical procedures may be necessary. Manual removal of impacted stool or more advanced interventions like bowel irrigation may be required.

• Alternative therapies: Some individuals may find relief through alternative therapies, such as acupuncture or biofeedback, which can help improve bowel function and reduce stress-related constipation.

Living with constipation can be challenging, but several lifestyle and dietary changes can help manage and prevent this condition. These include:

• Increasing your intake of dietary fibre is crucial, with adults aiming for 22 to 34 grams per day. High-fibre foods include fresh fruits, vegetables, whole grains, beans, lentils, and nuts.

• Staying hydrated is also essential, so aim to drink at least four to six cups of water each day and consider other hydrating options like naturally sweetened fruit and vegetable juices.

• Regular exercise, such as 150 minutes of moderate-intensity activity per week or even short walks after meals, can help stimulate bowel movements.

• Establishing a consistent schedule for toileting, diet, and exercise can also prevent constipation.

• If possible, avoid medications that can cause constipation, such as pain relievers, antidepressants, and certain antacids.

• For those with underlying medical conditions like diabetes or hypothyroidism, or those taking medications that can cause constipation, such as strong pain medicines, personalised advice from a doctor is crucial.

If you are experiencing chronic constipation that persists for more than four weeks, it's time to consult a doctor. Infrequent or painful bowel movements that do not improve with lifestyle changes and over-the-counter medications also warrant medical attention. Symptoms such as faecal impaction, blood in the stool, severe abdominal pain, or significant weight loss require immediate evaluation.

• Managing constipation involves a combination of dietary and lifestyle modifications. Increasing fibre intake through foods like fruits, vegetables, whole grains, and legumes is essential.

• Staying hydrated by drinking plenty of water and consuming high-water content foods can help soften stools.

• Regular physical activity and establishing consistent routines for toileting, diet, and exercise are also beneficial.

• Recognising the symptoms of chronic constipation and knowing when to seek medical advice is crucial for effective constipation treatment and prevention.

• By implementing these strategies and working closely with doctors when necessary, individuals can find relief from constipation and improve their overall digestive health.