CONSTIPATION

Most people think constipation means not having frequent enough bowel movements. In reality, constipation is more complicated and more subtle than that, with a range of symptoms that you may not always recognize.
“People think if they are having a bowel movement every day, they can’t be constipated,” says Lee. She points out that the medical definition of constipation actually requires a person to have just one of many symptoms that include:
·         Fewer than three bowel movements per week
·         Straining to start or complete a bowel movement
·         Stool consistency that looks like rocks and pebbles
·         A feeling of incomplete emptying
Lee says that because of this range of symptoms, many people don’t know when they’re constipated. Depending on the severity, constipation can cause problems like abdominal pain and gas. Excessive straining during bowel movements may also cause hemorrhoids (swollen anal veins), anal fissures (tears) and rectal prolapse, where part of the rectum sticks out through the anus.

=>   What is CONSTIPATION?

-   Constipation occurs when a person has difficulty emptying the large bowel.
-   Constipation is difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation.
-   Constipation refers to bowel movements that are infrequent or hard to pass. The stool is often hard and dry.
Constipation can happen for many reasons, such as when stool passes through the colon too slowly. The slower the food moves through the digestive tract, the more water the colon will absorb and the harder the feces will become. Sometimes, constipation results from a blockage in the large intestine. In this case, a person will need urgent medical attention. At other times, it may simply be due to a lack of fiber or water.

  =>   What are the SIGNS & SYMPTOMS of Constipation?

Signs and symptoms of constipation may include rectal bleeding and/or anal fissures that are caused by hard or small stools, lower abdominal discomfort, and straining to have a bowel movement.
The main symptoms of constipation are:
·         difficulty passing stool
·         straining when passing stool
·         passing less stool than usual
·         lumpy, dry, or hard stool
Other symptoms include:
·         pain and cramping in the abdomen
·         feeling bloated
·         nausea
·         a loss of appetite

=>   What CAUSES Constipation?

The causes of constipation can be divided into congenital, primary, and secondary. The most common kind is primary and not life-threatening. It can also be divided by the age group affected such as children and adults.
Primary or functional constipation is defined by ongoing symptoms for greater than six months not due to an underlying cause such as medication side effects or an underlying medical condition. It is not associated with abdominal pain, thus distinguishing it from irritable bowel syndrome. It is the most common kind of constipation, and is often multifactorial. In adults, such primary causes include: dietary choices such as insufficient dietary fiber or fluid intake, or behavioral causes such as decreased physical activity. In the elderly, common causes have been attributed to insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity, side effects of medications, hypothyroidism, and obstruction by colorectal cancer. Evidence to support these factors however is poor.
Secondary causes include side effects of medications such as opiates, endocrine and metabolic disorders such as hypothyroidism, and obstruction such as from colorectal cancer. Celiac disease and non-celiac gluten sensitivity may also present with constipation. Cystocele can develop as a result of chronic constipation.
The following are some common causes of constipation:
i)                           Lack of Fiber in the Diet
Constipation can be caused or exacerbated by a low-fiber diet, low liquid intake, or dieting. Dietary fiber helps to decrease colonic transport time, increases stool bulk but simultaneously softens stool. Fiber promotes regular bowel movements, especially when a person combines it with proper hydration.
High fiber foods include:
·         fruits
·         vegetables
·         whole grains
·         nuts
·         lentils, chickpeas, and other legumes
Low fiber foods include:
·         high fat foods, such as cheese, meat, and eggs
·         highly processed foods, such as white bread
·         fast foods, chips, and other premade foods
ii)                       Physical Inactivity
Low levels of physical activity may also lead to constipation. Some past studies have found that physically fit people, including marathon runners, are less likely to experience constipation than other people, although the exact reasons for this remain unclear. A study from 2013 notes that increasing mobility might help improve constipation among older adults. People who spend several days or weeks in bed or sitting in a chair may have a higher risk of constipation.
iii)                   Irritable Bowel Syndrome (IBS)
People with functional intestinal difficulty, such as irritable bowel syndrome (IBS), have a higher risk of constipation than people without the condition.
A person with IBS may experience:
·         abdominal pain
·         bloating
·         distension
·         changes in the frequency or consistency of stools
With IBS, constipation can fluctuate over time. When constipation is not present, there may instead be loose stools with diarrhea.
iv)                    Changes in Routine
When a person travels, for example, their usual routine changes. This can affect the digestive system. In an article from 2008, scientists asked 83 people about the digestive changes they experienced while traveling outside of the United States. The results showed that 9% of people experienced constipation when they went to another country. Eating meals, going to bed, and using the bathroom at different times than usual could increase the risk of constipation.
v)                        Overuse of Laxatives
Some people worry that they do not use the bathroom often enough, and they take laxatives to try to solve this problem. Laxatives can help with bowel movements, but regular use of certain laxatives allows the body to get used to their action. This may cause a person to continue taking laxatives when they no longer need them. The person may also need higher doses to get the same effect. In other words, laxatives can be habit forming — especially stimulant laxatives. This means that the more a person depends on laxatives, the greater their risk of constipation when they stop using them.
Overuse of laxatives can also lead to:
·         dehydration
·         an electrolyte imbalance
·         internal organ damage
Some of these complications can become life threatening. For this reason, people should talk to a healthcare professional before they start using laxatives.
vi)                    Some Medications
Some medications can also increase the risk of constipation. These include:
·         Opioid pain relief drugs: These include codeine (present with acetaminophen in Tylenol), oxycodone (OxyContin), and hydromorphone (Dilaudid).
·         Tricyclic antidepressants: These include amitriptyline (Elavil) and imipramine (Tofranil).
·         Certain anticonvulsants: Examples include phenytoin (Dilantin) and carbamazepine (Tegretol).
·         Calcium channel blockers: These lower blood pressure, and certain types lower heart rate. They include diltiazem (Cardizem) and nifedipine (Procardia).
·         Antacids that contain aluminum: These include Amphojel and Basaljel.
·         Antacids that contain calcium: One example is Tums.
·         Diuretics: These remove excess fluid from the body. They include hydrochlorothiazide (Hydrodiuril) and furosemide (Lasix).
·         Iron supplements: Doctors prescribe these to treat iron deficiency anemia.
vii)                Not Drinking Enough Water
Regularly drinking enough water can help reduce the risk of constipation. Other suitable fluids include naturally sweetened fruit or vegetable juices and clear soups. It is important to note that some liquids can increase the risk of dehydration and make constipation worse for some people. For example, those who are prone to constipation should limit their intake of caffeinated sodas, coffee, and alcohol.
viii)            Colorectal Problems
Some health conditions that affect the colon can impede and restrict the passage of stool, leading to constipation.
Examples of such conditions include:
·         cancerous tumors
·         a hernia
·         scar tissue
·         diverticulitis
·         colorectal stricture, which is an abnormal narrowing of the colon or rectum
·         inflammatory bowel disease (IBD)

=>   TREATMENT of Constipation

Constipation usually resolves itself without the need for prescription treatment. In most cases, making lifestyle changes — such as getting more exercise, eating more fiber, and drinking more water — can help. Allowing time for defecation, without stress or interruption, may also help. People should also not ignore the urge to have a bowel movement.
The treatment of constipation should focus on the underlying cause if known. The National Institute of Health and Care Excellence (NICE) break constipation in adults into two categories - chronic constipation of unknown cause and constipation due to opiates.  In chronic constipation of unknown cause, the main treatment involves the increased intake of water and fiber (either dietary or as supplements). The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. A large volume or high enema can be given to cleanse as much of the colon as possible of feces. However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract.
i)                           Fiber Supplements
Soluble fiber supplements such as psyllium are generally considered first-line treatment for chronic constipation, compared to insoluble fibers such as wheat bran. Side effects of fiber supplements include bloating, flatulence, diarrhea, and possible malabsorption of iron, calcium, and some medications. However, patients with opiate-induced constipation will likely not benefit from fiber supplements.
ii)                       Laxatives
If laxatives are used, milk of magnesia or polyethylene glycol are recommended as first-line agents due to their low cost and safety. Stimulants should only be used if this is not effective. In cases of chronic constipation, polyethylene glycol appears superior to lactulose. Prokinetics may be used to improve gastrointestinal motility. A number of new agents have shown positive outcomes in chronic constipation; these include prucalopride and lubiprostone. Cisapride is widely available in third world countries, but has withdrawn in most of the west. It has not been shown to have a benefit on constipation, while potentially causing cardiac arrhythmias and deaths.
iii)                   Physical Intervention
Constipation that resists the above measures may require physical intervention such as manual disimpaction (the physical removal of impacted stool using the hands. Regular exercise can help improve chronic constipation.
iv)                    Surgical Intervention
In refractory cases, procedures can be performed to help relieve constipation. Sacral nerve stimulation has been demonstrated to be effective in a minority of cases. Colectomy with ileorectal anastomosis is another intervention performed only in patients known to have a slow colonic transit time and in whom a defecation disorder has either been treated or is not present. Because this is a major operation, side effects can include considerable abdominal pain, small bowel obstruction, and post-surgical infections. Furthermore, it has a very variable rate of success and is very case dependent.