Constipation Causes, Symptoms And Treatment

Constipation is infrequent bowel action when it happens twice a week or less. It involves force to pass hard stools. This force may be accompanied by a sensation of pain or incomplete evacuation. Simply constipation is the passage of hard stools less frequently than the patient's normal routine. It is not a disease, but may be a symptom of another medical problem. It may last for a short or long period of time. It affects people of all ages. It is more common in the elderly populations. It affects 8% of middle aged people, 20% of elderly and 3% of young adults. It is estimated to be twice as common in women as men. It is also very common in late pregnancy due to fetal pressure and increased progesterone levels. It is also very common in bed-ridden patients due to decreased mobility and movements.

Causes

The most common causes that leads to the development of constipation are,

• Poor diet & Dehydration
• Irritable bowel syndrome & Poor bowel habit
• Laxative abuse
• Mechanical compression
• Nerve damage
• Colonic motility disorders
• Lack of exercise and poor mobility
• Electrolyte abnormalities
• Travel
• Hormone disturbances & Pregnancy
• Fissures and haemorrhoids
• Medication & Medical causes
• Immobility
• Poor bowel habit

Certain medications or supplements also have the ability to cause constipation or worsen it such as,

• Anticholinergic drugs
• Antacids
• Anticonvulsants—used to prevent seizures
• Calcium channel blockers
• Diuretics
• Iron supplements
• Opioid analgesic
• Some medicines used to treat depression
• |Growth hormone antagonist
• Immunosuppressant
• Lipid-lowering agent
• CNS stimulant
• Cytotoxic drugs

Constipation can also occur in some diseases or medical conditions,

• Psychiatric disorders (e.g. stress, depression)
• Metabolic disorders (e.g. diabetes, hypothyroidism)
• Gastrointestinal disease (e.g. haemorrhoids)
• Neurological disorders (e.g. Parkinson’s disease)

Symptoms:

The most common symptoms of constipation includes,

• Inability to pass stools at regular intervals
• Production of abnormally hard stools
• Straining at stool
• Abdominal pain and discomfort
• Sensation of incomplete evacuation
• Mild abdominal distension
• Headache
• Anorexia

Treatment

The standard treatment plan of constipation includes,

Laxatives

Laxatives can cause retention of fluid in colonic contents. They directly or indirectly act on the colonic mucosa to decrease net absorption of water and electrolytes or increase intestinal motility. As a result, they cause less absorption of salts and water due to decreased transit time.

There are four main types:

1. Bulk-forming laxatives e.g. ispaghula husk (powder)

2. Osmotic laxatives e.g. lactulose (liquid)

3. Stimulant laxatives e.g. senna (tablets), bisacodyl (tablets, suppositories), sodium picosulphate (liquid), glycerol (suppositories)

4. Saline laxatives e.g. magnesium salts (powder)

Glycerin

Acute constipation may be cured by the use of glycerin suppository. It is used as a 3g suppository. It exerts its effect by osmotic action in the rectum. The onset of action is usually less than 30 minutes. If it is not effective then low doses of bisacodyl or senna, or saline laxatives (e.g., milk of magnesia) may be alternative effective options.

Castor Oil

Castor oil is metabolized in the gastrointestinal tract to an active compound, ricinoleic acid. Ricinoleic acid stimulates the secretory processes, decreases glucose absorption, and promotes intestinal motility. It usually results in a bowel movement within 1 to 3 hours after its administration.

Non- Drug treatment

Lifestyle modifications are considered as the first line treatment for constipation. You should take a diet rich in high fiber content such as fruit, vegetables, cereals, grain foods and whole meal bread. You should increase your fluid intake to improve the stool frequency and decrease the need for laxatives. Try to start regular exercise to relax and contract the abdominal muscles. It helps the food  to move more efficiently through the gut.