Constipation

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass or both. The stool is often hard and dry. Chronic constipation is characterized by the presence of symptoms for at least three months out of the preceding 12 months.

Symptoms

Constipation is a clinical diagnosis based on symptoms Patients typically experience other symptoms such as:

• Straining with bowel movements
• Excessive time is needed to pass a bowel movement.
• Hard stools
• Pain with bowel movements secondary to straining.
• Abdominal pain
• Abdominal bloating.
• the sensation of incomplete bowel evacuation.

Signs and symptoms of chronic constipation include:

• Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements.
• Feeling as though there’s a blockage in your rectum that prevents bowel movements.
• Feeling as though you can’t completely empty the stool from your rectum.
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum.

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement.

• Tiny tears in the skin around the anus (anal fissure)
• A blockage in the intestines (bowel obstruction)
• Colon cancer
• Narrowing of the colon (bowel stricture)
• Other abdominal cancer that presses on the colon
• Rectal cancer
  • Rectum bulge through the back wall of the vagina (rectocele

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

• Damage to the nerves that control bodily functions (autonomic neuropathy)
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Stroke

Difficulty with the muscles involved in elimination.

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• The inability to relax the pelvic muscles to allow for a bowel movement.
• Pelvic muscles that don’t coordinate relaxation and contraction correctly (dyssynergia)
• Weakened pelvic muscles.

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes
• Overactive parathyroid gland (hyperparathyroidism)
• Pregnancy
• Underactive thyroid (hypothyroidism)

Risk factors

Factors that may increase your risk of chronic constipation include:

• Elderly
• Female
• Dehydration
• Low fibre diet
• Less physical activity
• Taking certain medications, including sedatives, opioid pain medications, some antidepressants, or medications to lower blood pressure
• Having a mental health condition such as depression or an eating disorder

Complications 

The most common complications associated with constipation are discomfort and irritation. The difficulty passing a bowel movement can lead to:

• Haemorrhoids: Straining to have a bowel movement may cause swelling in the veins in and around your anus.
• Rectal bleeding
• Anal fissures(tears in skin around the anus) A large or hard stool can cause tiny tears in the anus.
• Rectal prolapse(the large intestine detaches inside the body and pushes out of the rectum)
• Faecal impactionChronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
• Intestine that protrudes from the anus (rectal prolapse).Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus

Prevention

The following can help you avoid developing chronic constipation.

• Include plenty of high-fibre foods in your diet, including beans, vegetables, fruits, whole-grain cereals and bran.
• Make sure children who begin to eat solid foods get plenty of fibre in their diets.
• Limit the amounts of fibre such as processed foods, dairy and meat products.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular exercise.
• Try to manage stress.
• Don’t ignore the urge to pass stool.
• Try to create a regular schedule for bowel movements, especially after a meal.

DIAGNOSIS

• The diagnosis is mainly done based on symptoms, medical history, and any medications or underlying conditions.
• Physical examination, including a rectal exam
• Blood teststo check your blood count, electrolytes, and thyroid function

Some cases need additional tests to identify the cause of your symptoms. Tests may include the following:

Marker study

A marker study also called a colorectal transit study, is used to test how food is moving through your colon.

You may also be asked to eat a diet high in fibre during the test.

Anorectal manometry

Anorectal manometry is a test used to evaluate anal sphincter muscle function. For this test, a healthcare professional will insert a thin tube with a balloon tip into your anus.

When the tube is inside, they will inflate the balloon and slowly pull it out. This test allows them to measure your anal sphincter’s muscle strength and see whether your muscles are contracting properly.

Barium enema X-ray

A barium enema X-ray is a type of test used to examine the colon. For this test, you’ll drink a special liquid the night before the test to clean out the bowel.

The actual test involves the insertion of a dye called barium into your rectum, using a lubricated tube. The barium highlights the rectum and colon area. This allows a better view of these areas on an X-ray.

Colonoscopy

In this test, a healthcare professional will examine your colon using a colonoscope. This is a tube fitted with a camera and light source.

A sedative and pain medication is often given, so you’ll likely not even remember the examination and should feel no pain.

To prepare for this test, you’ll be on a liquid-only diet for 1 to 3 days. You may have to take a laxative or enema the night before the test to clean out the bowel.

Treatment

Treatment for chronic constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through your intestines.

Diet and lifestyle changes

• Increase your fibre intake. Adding fibre to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.

A sudden increase in the amount of fibre you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.

• Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.

Training your pelvic muscles

• Biofeedback training involves working with a therapist who uses devices to help you learn to relax and tighten the muscles in your pelvis. Relaxing your pelvic floor muscles at the right time during defecation can help you pass stool more easily.
• During a biofeedback session, a special tube (catheter) to measure muscle tension is inserted into your rectum. The therapist guides you through exercises to alternately relax and tighten your pelvic muscles. A machine will gauge your muscle tension and use sounds or lights to help you understand when you’ve relaxed your muscles.

Medication

If those changes don’t help, you may require medications.

Laxatives

Several types of laxatives. Each works somewhat differently to make it easier to have a bowel movement e.g.: fibre supplements, Stool softeners, Enemas, and suppositories etc.

Surgery

Surgery may be an option if you have tried all the treatments and your chronic constipation is caused by a blockage, rectocele, or stricture.

For people who have tried other treatments without success and who have abnormally slow movement of stool through the colon, surgical removal of part of the colon may be an option. Surgery to remove the entire colon is rarely necessary.

OUTLOOK

Constipation is a common problem that affects people as they get older when they use certain medications, or if they don’t have much fibre in their diet.

Most cases of constipation are mild and easily treated with changes in diet and exercise.

If you’re experiencing chronic constipation or constipation along with other bowel changes, it’s important that you talk with your healthcare professional.