Dr Ian Berkowitz

GASTROENTEROLOGIST

Constipation

Constipation is a condition of the digestive system where an individual has hard feces that are difficult to expel. In most cases, this occurs because the colon has absorbed too much water from the food that is in the colon. The slower the food moves through the digestive tract, the more water the colon will absorb from it. Consequently, the feces become dry and hard. When this happens, defecation (emptying the bowels) can become very painful.

Here are some key points about constipation. More detail and supporting information is in the main article.

Constipation generally occurs because too much water is absorbed from food

Causes of constipation include physical inactivity, certain medications, and aging

Some cases of constipation can be relieved by lifestyle changes

Laxatives should only be used as a last resort

Causes 

A diet that contains a good quantity of fiber helps prevent constipation.

Constipation happens when the colon absorbs too much water; this can occur if the muscles in the colon are contracting slowly or poorly, causing the stool to move too slowly and lose more water.

These are the most common causes of constipation:

1) Lack of fiber in diet

People whose diets include a good quantity of fiber are significantly less likely to suffer from constipation. It is important to consume foods rich in fiber such as fruits, vegetables, and whole grains. Fiber promotes bowel movements and prevents constipation. Foods that are low in fiber include high-fat foods, such as cheese, meat, and eggs.

2) Physical inactivity

Constipation can occur if someone becomes too physically inactive; this is especially the case in older adults. For individuals who have been bedridden for a long time, perhaps for several days or weeks, their risk of having constipation is significantly increased. Experts are not sure why. Some believe that physical activity keeps our metabolism high, making the processes in our body happen more rapidly. Older adults tend to have a more sedentary life compared with younger people and are therefore at higher risk of constipation. Physically active people are much less likely to become constipated than inactive people.

3) Some drugs

The most common medications to cause constipation are:

Narcotic (opioid) pain drugs including codeine (Tylenol), oxycodone (Percocet), and hydromorphone (Dilaudid)

Antidepressants including amitriptyline (Elavil) and imipramine (Tofranil)

Anticonvulsants including phenytoin (Dilantin) and carbamazepine (Tegretol) iron supplements

Calcium channel blocking drugs including diltiazem (Cardizem) and nifedipine (Procardia)

Aluminum-containing antacids including Amphojel and Basaljel

Diuretics including chlorothiazide (Diuril)

4) Milk

Some people become constipated when they consume milk and dairy products.

5) Irritable bowel syndrome

People who suffer from irritable bowel syndrome (IBS) get constipation much more frequently, compared with the rest of the population.

6) Pregnancy

Pregnancy brings about hormonal changes that can make a woman more susceptible to constipation. Also, the uterus may compress the intestine, slowing down the passage of food.

7) Aging

As we get older, our metabolism slows down, resulting in less intestinal activity. The muscles in the digestive tract do not work as well as they used to.

8) Changes in routine

When we travel, our normal routine changes; this can have an effect on our digestive system, which sometimes results in constipation. Meals are eaten at different times, we might go to bed, get up, and go to the toilet at different times. All these changes can raise the risk of constipation.

9) Overuse of laxatives

Some people believe we should go to the toilet at least once a day - this is not true. However, to make sure this happens, some people self-medicate with laxatives. Laxatives are effective; they do help bowel movements. However, using them regularly allows the body to get used to their action and gradually the dose needs to increase to get the same effect. Laxatives can be habit-forming. When we become dependent on them, there is a significant risk of constipation when they are stopped.

10) Not going to the toilet when needed

If individuals ignore the urge to have a bowel movement, the urge can gradually go away until the individual no longer feels the need to go. The longer it is delayed, the drier and harder the stool will become.

11) Not drinking enough water (dehydration)

If constipation is already present, drinking more liquids might not relieve it. However, regularly drinking plenty of water reduces the risk of constipation. Many sodas and drinks contain caffeine which can cause dehydration and worsen constipation. Alcohol also dehydrates the body and should be avoided by individuals who are constipated or very susceptible to constipation.

12) Problems with the colon or rectum

Tumors can compress or restrict the passages and cause constipation. Also, scar tissue (adhesions), diverticulosis, and abnormal narrowing of the colon or rectum (colorectal stricture). People with Hirschsprung disease are susceptible to constipation (a birth defect in which some nerve cells are absent in the large intestine).

13) Some diseases and conditions

Diseases that tend to slow down the movement of feces through the colon, rectum, or anus can cause constipation; these include the following:

Neurological disorders - MS (Multiple Sclerosis), Parkinson's disease, stroke, spinal cord injuries, chronic idiopathic intestinal pseudo-obstruction.

Endocrine and metabolic conditions - uremia, diabetes, hypercalcemia, poor glycemic control, hypothyroidism.

Systemic diseases - these are diseases that affect a number of organs and tissues, or affect the body as a whole, they include lupus, scleroderma, amyloidosis.

Cancer - mainly due to pain medications and chemotherapy. Also, if a tumor blocks or squeezes the digestive system.

Treatments for constipation

In the majority of cases, constipation resolves itself without any treatment or risk to health. The treatment of recurring constipation can include lifestyle changes such as doing more exercise, eating more fiber, and drinking more water. Usually, laxatives will successfully treat most cases of constipation - but should be used with care and only when necessary. In more difficult cases, the person may need a prescription medication. It is important to understand the cause of constipation - there could be an underlying illness or condition. Some people with recurring constipation use a daily diary where they record their bowel movements, stool characteristics, and other factors that may help both the doctor and patient devise the best treatment. Some gastroenterologists comment that there are people who do not allocate enough time for their defecation. Set aside enough time to allow your toilet visit to be unstressed and uninterrupted, and do not ignore an urge to have a bowel movement.

OTC laxatives

Only use these laxatives as a last resort:

Stimulants - they make the muscles in the intestines contract rhythmically. These include Correctol, Dulcolax, and Senokot.

Lubricants - they help the stool move down the colon more easily. These include mineral oil and Fleet.

Stool softeners - they rehydrate (moisten) the stool. These include Colace and Surfak.

Fiber supplements - these are perhaps the safest laxatives. They are also called bulk laxatives. They include FiberCon, Metamucil, Konsyl, Serutan, and Citrucel and should be taken with plenty of water.

Osmotics - they facilitate the movement of fluids through the colon. These include Cephulac, Sorbitol, and Miralax.

Saline laxatives - these draw water into the colon. These include milk of magnesia.

Chloride channel activators - these require a prescription and include lubiprostone (Amitiza).

5-HT-4 agonists - they increase the secretion of fluid in the intestines and speed up the rate at which food passes through the colon. They include Prucalopride.

If the constipation does not respond to any treatment, as a last resort, surgery to remove part of the colon may be undertaken. In the procedure, the problem segment(s) of the anal sphincter or rectum are removed.

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