Constipation

General Illness Information


Medical Term:

CONSTIPATION

Common Name: CONSTIPATION

Description: Constipation is a condition in which a person has hard, dry stools causing difficult, uncomfortable or infrequent bowel movements. In most cases, constipation is harmless, but can indicate an underlying disorder.

Acute constipation begins suddenly and noticeably. Chronic constipation begins insidiously and persists for months or years.

Causes: Causes for constipation are listed below:

  • Insufficient fiber in the diet. Fiber adds bulk, holds water and creates easily passed, soft feces;
  • Inadequate fluid intake;
  • Inactivity; depression;
  • Hypothyroidism; hypercalcemia;
  • Anal fissure;
  • Irritable bowel syndrome;
  • Back pain;
  • Chronic kidney failure;
  • Colon or rectal cancer;
  • Side-effect of certain drugs e.g. antidepressants, iron salts, aluminum hydroxide (contained in some antacids), bismuth salts, narcotics and tranquillizers.

Prevention:

  • Eat a well-balanced, high fiber diet;
  • Exercise regularly;
  • Drink at least 8 glasses of water a day.

Signs & Symptoms

  • Hard feces;
  • Infrequent bowel movements, sometimes accompanied by abdominal swelling;
  • Straining during bowel movements;
  • Pain or bleeding with bowel movements;
  • Sensation of continuing fullness after a bowel movement;
  • Abdominal bloating.

Risk Factors

  • Use of certain drugs, including: belladonna, calcium-channel blockers, beta-adrenergic blockers, tricyclic antidepressants, narcotics, atropine, iron, antacids;
  • Sedentary life style;
  • Poor diet;
  • Stress;
  • Illness requiring complete bed rest;
  • Extremes of life (very young and very old).

Diagnosis & Treatment

General Measures:

  • Set aside a regular time each day for bowel movements. The best time is often within 1 hour after breakfast. Don’t try to hurry. Sit at least 10 minutes, whether or not a bowel movement occurs;
  • Drinking hot water, tea or coffee may help stimulate bowel;
  • Attempt to eliminate medications that may cause or worsen constipation;
  • Enemas if other methods fail

Medications:

If constipation persists for 3 or 4 days, use a non-prescription, disposable enema for temporary relief.

For occasional constipation, you may use stool softeners, mild non-prescription laxatives or enemas. Don’t use laxatives or enemas regularly as this can cause dependency. Avoid harsh laxatives and cathartics, such as Epsom salts. The best laxatives are bulk-formers, such as bran, psyllium, polycarbophil and methylcellulose.

Three main classes of laxatives are : 1) Bulk forming agents, 2) Osmotic  laxatives, 3) Stool softeners.

Bulk forming agents (bran, psyllium, polycarbophil and methylcellulose). Increased bulk stimulates the natural contractions of the bowel and also bulkier stools are softer and easier to pass. Bulking agents act gently and slowly and are among the safest method to promote regular bowel movements. These agents are to be taken in small amounts at first and the dose is increased slowly until regularity is achieved. Bulking agents should always be taken with plenty of fluids.

Osmotic  laxatives – appropriate for short term use. Osmotic agents work by pulling large amounts of water into the the large intestine making the stools soft and loose. These laxatives work within 3 hours and are useful  for treating constipation rather  than for preventing it. Usual dose is 15 to 30 ml. once or twice daily. Some of the osmotic laxatives are listed below.

Milk of magnesia 15-30 mL  twice daily, Magnesium citrate 15-30 mL twice daily, Phosphate of soda 15-30 mL twice daily, Lactulose (Chronulac) 15-30 mL twice daily, Sorbitol 15-30 mL twice daily, Alumina-magnesium (Maalox, Mylanta), Polyethylene glycol (MiraLax) 17 g in 8 oz of water once daily.

Stool softeners e.g.Docusate sodium (Colace) 100 mg twice daily. Stool softeners  increase the amount of water the stools can hold, thus increasing the bulk which in turn stimulates the natural contractions of the bowel allowing the softened stools to move easily through the bowels.

Stimulant laxatives such as senna, cascara, bisacodyl and phenolphthalein are often used to empty the bowels before diagnostic procedure and to prevent and treat constipation caused by drugs that slow the contractions of the large intestines, such as narcotics. Prolonged use of stimulant laxatives can damage the large intestine.

Activity:

Exercise and good physical fitness helps maintain healthy bowel patterns.

Diet:

  • Drink at least 8 glasses of water each day;
  • Include bulk foods, such as bran and raw fruits and vegetables, in your diet. Increase fiber to approximately 15 gm/day;
  • Adding prunes and prune juice to the diet may be beneficial;
  • Avoid refined cereals and bread, pastries and sugar.

Possible Complications :

  • Hemorrhoids; laxative dependency;
  •  Hernia from excessive straining;
  • Uterine or rectal prolapse;
  •  Spastic colitis; bowel obstruction;
  • Chronic constipation;
  • Depression in severe cases;
  • Fluid and electrolyte depletion: laxative abuse;
  • Rectal ulceration (“stercoral ulcer”) related to recurrent fecal impaction;
  • Laxative abuse

Prognosis

Usually curable with exercise, diet and adequate fluids.

Other

Nothing Specified.

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