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Constipation – Causes, Consequences and Treatment

Constipation involves an inability to pass stools frequently or pass them completely. An estimated 10% of the population in industrialized nations suffer from persistent or regular constipation, with older adults being five times more likely than younger people to experience the problem. The lifestyle and physical changes that often accompany advancing age such as decrease in physical activity and lack of exercise, insufficient fluid intake, bad eating habits, poor bowel habits and medicinal treatments for other conditions can all lead to constipation.

Diet gradually changes as older adults switch from high-fiber fresh foods, which they have difficulty to chew and digest, to processed foods. Older people who live alone often lack interest in cooking, relying instead on convenience foods. Moreover, stomach acids are not produced as readily as they once were which leads to digestive problems. And, as older people cut back on regular meals, they also tend to forget to drink enough fluids. This contributes to the problem of constipation too, because water adds volume to the stool and makes it easier to pass.

Injuries and chronic diseases like arthritis often force older people to opt for a more sedentary lifestyle and diminished mobility usually adds to the problem of constipation. And last but not least, older adults tend to take many different medications for numerous ailments which can also make their constipation worse.

Frequency of Defecation

Constipation is defined as the infrequent and difficult passage of stool. Normal frequency ranges from daily to every third day, with many perfectly healthy people falling outside both ends of this range. As a matter of fact, passing stool daily is usual for only about half of all adults. However, if you do not have a bowel movement at least every three days, the intestinal contents may harden, making defecation difficult or even painful.

Implications of Constipation

Though bothersome, constipation is a symptom rather than a disease and it is usually not a reason for big concern. However, sometimes it can be a symptom of a serious underlying condition such as irritable bowel syndrome or even cancer. Constipation can cause hemorrhoids due to straining or it can cause fissures due to hard stool stretching the sphincters. As a result, bleeding can occur. The fissures in turn can then initiate bouts of chronic constipation. Fecal impaction can also occur in young children and older adults as a consequence of constipation. This condition may be accompanied by a loss of control, with liquid stool flowing around the hard impaction. Rectal prolapse is yet another possible serious side effect of constipation.

Causes of Constipation

The most common cause of constipation is a diet high in saturated fats, processed meats and refined sugars and low in fiber. But these are certainly not the only causes of constipation. Other likely factors include:

  • Irritable bowel syndrome or spastic colon is one of the major causes of constipation. Spasms of the colon slow down the movement of the intestines which may allow the stool to harden.
  • Hormonal disturbances. Underactive thyroid gland or some other hormonal disturbances can cause hardening of the stool.
  • Pregnancy. Constipation in pregnancy is possibly also due to hormonal changes but besides that it can be a result of compression of the intestines by the heavy womb.
  • Fissures and hemorrhoids. As it was mentioned earlier, some conditions of the anus can be caused by constipation but they can also be the cause of constipation as they produce a spasm of the anal sphincter muscle, delaying a normal bowel movement.
  • Other diseases. Lupus, scleroderma, multiple sclerosis, Parkinson’s disease and some other neurological or muscular disorders can lead to constipation.
  • Loss of body salts. Depletion of body salts, either through frequent urination or from vomiting or diarrhea, can produce hardened stools.
  • Mechanical compression. Scarring, inflammation around diverticula (diverticulitis), tumors, and cancer can compress the intestine, causing constipation.
  • Nerve damage. Injuries to the spinal cord as well as tumors pressing on the cord affect the nerves that lead to the intestine and thus result in constipation.
  • Laxative overuse. When used over extended period of time, increasingly higher doses of laxatives are needed to soften the stool. Such abuse can make the bowel insensitive and unable to work properly.
  • Medications. Antacids containing aluminium, diuretics, pain medications, antispasmodic drugs, antihistamines, medications for Parkinson’s disease, tranquilizers, antidepressants, anticonvulsants and iron supplements are all potential culprits. Moreover, antibiotic therapy destroys beneficial gut bacteria, leading to either constipation or diarrhea.
  • Travel. Many people, especially children, experience constipation when traveling far from home. This may be due to changes in environment, daily regimen, physical activity, diet and different chemical and biological properties of local drinking water.
  • Ignoring the urge. Repeatedly ignoring the urge to defecate (e.g. in order to avoid public restrooms or when travelling) can result in constipation as the body responds by discontinuing the impulse.

In addition to all that, many people constantly worry about lack of normal regularity. Such worries are, however, in most cases unfounded as each person has their own natural frequency. Once this is recognized, “constipation” usually disappears.

Laxatives and Enemas

Short-term use of over-the-counter laxatives can help to relieve temporary constipation but their overuse can affect the bowel’s ability to advance the intestinal contents and eventually make the condition worse. In addition, overuse of the popular lubricant, mineral oil, can reduce the absorption of fat-soluble vitamins A, D, E and K and prevent certain medications from being fully absorbed into the body. Likewise, regular long-term use of enemas can also lead to the loss of bowel function by impairing the natural bowel muscle action.

Laxatives Overview

Bulk-forming laxatives containing fiber are generally considered the safest option but they can interfere with the absorption of some medications. Fiber absorbs water and makes the stool softer and heavier. Bulk-forming laxatives include methylcellulose (Citrucel), psyllium (Metamucil), calcium polycarbophil (FiberCon, Fiber-Lax, Equilactin), wheat dextrin (Benefiber) and bran (in food and supplements).

Stool softeners, also known as emollient laxatives or wetting agents provide additional moisture to the stool, preventing excessive dehydration. They include products containing the surfactant docusate, such as Colace, Dialose and Surfak.

Stimulant laxatives are used to bring almost immediate relief. They work by inducing rhythmic muscular contractions in the small or large intestine. However, stimulants can lead to dependency and can damage the bowel if used daily for long periods of time. They include bisacodyl (Dulcolax, Feen-a-Mint), phenolphthalein (Correctol, Ex-Lax) and castor oil (Neoloid, Purge). Dried plums and some plant extracts such as cascara sagrada and senna (Fletcher’s Castoria, Senokot) can also be used to treat constipation.

Lubricant laxatives grease the stool to make it slip through the intestine more easily. The mineral oil is the most commonly used lubricant.

Osmotic laxatives are hydrating agents based on salts or carbohydrates that retain water in the intestine for easier movement of stool. Osmotics include products such as Milk of Magnesia, Fleet Phospho-Soda , lactulose, Kristalose, MiraLax and Epsom salts.

Treating and Preventing Constipation

Add fiber to your diet. Lack of fiber is considered to be the chief cause of constipation. Undigested fiber absorbs water, making the stool softer and heavier so that it can move more easily through the gut. Hence, dietary improvements should be the first thing to do for most people suffering from constipation. Cut down on foods known to increase the chances of constipation, namely animal fats (red meat, eggs and dairy products), refined sugars (rich desserts, candies and other sweets) and processed foods. But more importantly, you should eat more of those foods proven to reduce the chances of constipation, namely fiber-rich foods (whole grains, bran cereals, brown rice, oatmeal, nuts, beans, vegetables and fruits). Prunes and figs are especially suitable because they contain substances that stimulate the colon. Whatever you choose to eat, make sure to drink plenty of fluids as dehydration can easily cause constipation.

Get regular exercise. Physical activity and regular exercise help to stimulate intestinal activity. A brisk everyday 30 minute walk can do wonders. Exercises to firm up abdominal muscles can be especially beneficial.

Maintain good bowel habits. Set aside a time every day, e.g. after breakfast or dinner, for an undisturbed visit to the restroom. Do not ever ignore the urge to have a bowel movement.

Make laxatives your last option. There are several types of laxatives and they work in different ways. Your doctor, not you, should determine when a laxative is really needed and which one suits you best.

Diagnosing Constipation: Is There Another Problem?

Though standard treatment methods mentioned above may help relieve constipation, you should contact your doctor if blood or pus appears in the stool or the symptoms are severe or even disabling and last longer than three weeks.

A physical examination by your doctor will be needed to rule out organic disease. You will be asked about your bowel habits, diet and exercise. The exam should focus on signs of disease such as hypothyroidism, anemia or weight loss. Your doctor will need to know about the origin of any abdominal scars and any previous surgeries or injuries to the nervous system and may need to check for rectal prolapse. A digital exam of the rectum can be used to detect fissures, fecal impaction or obstructing lesions.

A barium enema, a special x-ray of the colon and rectum, will show whether you have an enlargement of the colon that can be caused by long-term constipation. A colorectal transit study may be performed to track the movement of stool through the bowel. You will be given special capsules to swallow that show up on x-ray to see how long it takes for them to pass through your digestive system. Yet another diagnostic option is the anorectal manometry test to check how your muscles and nerves in and around your rectum are functioning. Furthermore, your doctor may also need to do a sigmoidoscopy to exclude rectal disease. In order to rule out a diagnosis of cancer a colonoscopy and a computerized tomography scan may be ordered.

Where to Get More Information: Constipation Experts