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Constipation: All you need to know

Constipation is a clinical condition manifested by infrequent bowel movements or difficulty passing stools that persists for several weeks or longer. It is one of the most common digestive problems, especially among older people, with women at a higher risk than men. Depending on the severity, constipation can cause abdominal pain or gas and may lead to chronic clinical conditions such as hemorrhoids (swollen anal veins), anal fissures (tears), and rectal prolapse (rectum stretches out protudes from anus).

A person suffering from constipation may exhibit the following signs and symptoms:

• Few bowel movements – less than three per week

• Difficulty in passing stool

• Painful and strenuous bowel movement

• Hard, dry or lumpy stools appearing like rocks and pebbles

• Uneasiness and abdominal pain

• A feeling of incomplete emptying and fullness

• Bloating

If an individual experiences one or more of these symptoms, constipation may be considered chronic. The risk factors for chronic constipation include age, gender, quantity of water intake, eating habits, activity levels, and medications.

Causes of Constipation

Constipation has many possible causes ranging from poor diet to more severe disorders. The most common factors triggering constipation include:

• Eating an unhealthy and  low fiber diet 

• Less water intake and dehydration

• Sedentary lifestyle

• Certain medications and dietary supplements

• Overuse or misuse of laxatives and other drugs

• Clinical conditions like:

• Blockages in the colon or rectum

• Neurological problems with the nerves around the colon and rectum

• Weak pelvic muscles or associated disorders

• Hormonal fluctuations

• Long-term conditions like diabetes

• Hyperparathyroidism or hypothyroidism

• Pregnancy

• Gastrointestinal disorders like Irritable Bowel Syndrome

• Mental conditions like stress or eating disorder

Need for Medical Interventions

It is advisable to visit a doctor in case of unexplained and significant changes in bowel habits. Healthcare experts recommend seeking medical advice if one experiences prolonged symptom associated with one or more of the following conditions:

• Constipation that lasted for more than two weeks

• Blood in the stool or rectal bleeding

• Persistent and chronic pain in the abdomen 

• Severe pain during bowel movement

• A drastic change in size, shape, and consistency of the stool

• Unexplained weight loss

• A sudden change in bowel movements

• Vomiting

• Fever

The healthcare professional may carry out certain tests to diagnose chronic clinical conditions, such as colorectal cancer or irritable bowel syndrome (IBS).

Diagnosis and Treatment

Most cases of constipation are mild and can be treated easily by dietary modifications, lifestyle changes, and exercise. However, chronic patients need proper diagnosis and suitable medical intervention as they may be indicative of underlying disease. The diagnostic procedure for constipation includes:

• Analyzing the clinical and medicinal history

• Assessing the symptoms and determining their severity

• Conducting physical examination, including a rectal exam

• Blood tests 

• Additional tests to identify the cause of the symptoms such as:

• Colorectal Transit Study - to test how food is moving through the colon.

• Anorectal Manometry - to evaluate anal muscle function.

• Colonoscopy - for inspecting the colon internally

• Barium Enema X-ray – for detailed examination of the colon and related internal structures.

The core treatment strategy to relieve constipation involves dietary modification and lifestyle measures. The general dietary recommendations to treat constipation include:

• Drink 1.5 to 2 quarts of fluids every day.

• Limit consumption of low-fiber food, alcohol, and caffeinated drinks. 

• Add fiber-rich foods to the diet, ensuring a daily intake of 20 and 35 grams.

In addition, lifestyle interventions like physical activity may help alleviate the symptoms. Doctors recommend carrying out at least 150 minutes of moderate exercise every week, aiming for 30 minutes daily at least five days per week. However, the physical activity level may vary depending on the age, gender, and clinical condition of the individual. Getting bowel training to ensure passing stool 15 to 45 minutes after breakfast each day is another successful strategy to relieve the symptoms of constipation. In cases where home remedies are not effective, an over-the-counter laxative may be administered under medical supervision. These may include:

• Fiber supplements

• Osmotic agents, such as polyethylene glycol solution, milk of magnesia, etc.

• Stool softeners

• Lubricants, such as mineral oil

• Stimulants

For chronic constipation, the healthcare provider may introduce prescription drugs to treat the condition. Other treatment strategies generally employed for chronic constipation may include:

• Biofeedback therapy to retrain the muscles

• Enema to empty the abdomen

• Manual removal of feces to provide relief

• Surgery to remove any blockage

Tips for Prevention of Constipation

1. Eat a balanced diet and include plenty of high-fiber foods in each meal.

2. Reduce the intake of processed foods and dairy and meat products.

3. Drink plenty of fluids like lemon water, coconut water, etc.

4. Keep yourself hydrated by increasing your water intake.

5. Stay active and do regular exercise.

6. Manage your stress and stay happy

7. Don't ignore the urge to pass stool.

8. Create a regular schedule for bowel movements.

9. For bowel sensitivity, avoid high-fructose fruits as they can cause gas (apples, pears, and watermelon)

10. Take probiotic supplements, if necessary.