Constipation – Causes And Treatments

FOROYAA Newspaper (Serrekunda)

Publisher

21 May 2011

Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these “types” of constipation probably is different, and the approach to each should be tailored to the specific type of constipation.

Constipation also can alternate with diarrhoea . This pattern commonly occurs as part of the irritable bowel syndrome . At the extreme end of the constipation spectrum is faecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool.

The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.

Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people. Contrary to popular belief, there is no evidence that “toxins” accumulate when bowel movements are infrequent or that constipation leads to cancer .

It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumours of the colon). Constipation also requires an immediate assessment if it is accompanied by worrisome symptoms such as rectal bleeding , abdominal pain and cramps, nausea and vomiting , and involuntary loss of weight. In contrast, the evaluation of chronic constipation may not be urgent, particularly if simple measures bring relief.

What causes constipation?

Theoretically, constipation can be caused by the slow passage of digesting food through any part of the intestine. More than 95% of the time, however, the slowing occurs in the colon.

Habit

Bowel movements are under voluntary control. This means that the normal urge people feel when they need to have a bowel movement can be suppressed. Although occasionally it is appropriate to suppress an urge to defecate (for example, when a bathroom is not available), doing this too frequently can lead to a disappearance of urges and result in constipation.

Diet

Fibre is important in maintaining a soft, bulky stool. Diets that are low in fibre can, therefore, cause constipation. The best natural sources of fibre are fruits, vegetables, and whole grains.

Laxatives

One suspected cause of severe constipation is the over-use of stimulant laxatives [for example, senna (Senokot), castor oil, and certain herbs]. An association has been shown between the chronic use of stimulant laxatives and damage to the nerves and muscles of the colon, and it is believed by some that the damage is responsible for the constipation. It is not clear, however, whether the laxatives have caused the damage or whether the damage existed prior to the use of laxatives and, indeed, has caused the laxatives to be used. Nevertheless, because of the possibility that stimulant laxatives can damage the colon, most experts recommend that stimulant laxatives be used as a last resort after non-stimulant treatments have failed.

Hormonal disorders

Hormones can affect bowel movements. For example:

? Too little thyroid hormone (hypothyroidism ) and too much parathyroid hormone (by raising the calcium levels in the blood ) can cause constipation.

? At the time of a woman’s menstrual periods , oestrogen and progesterone levels are high and may cause constipation. However, this is rarely a prolonged problem.

? High levels of oestrogen and progesterone during pregnancy also can cause constipation.

Diseases that affect the colon

There are many diseases that can affect the function of the muscles and/or nerves of the colon. These include diabetes , scleroderma , and intestinal pseudo-obstruction. Cancer or narrowing (stricture) of the colon that blocks the colon likewise can cause a decrease in the flow of stool.

Central nervous system diseases

A few diseases of the brain and spinal cord may cause constipation, including Parkinson’s disease , multiple sclerosis , and spinal cord injuries.

Colonic inertia

Colonic inertia is a condition in which the nerves and/or muscles of the colon do not work normally. As a result, the contents of the colon are not propelled through the colon normally. The cause of colonic inertia is unclear. In some cases, the muscles or nerves of the colon are diseased. Colonic inertia also may be the result of the chronic use of stimulant laxatives as described above. In most cases, however, there is no clear cause for the constipation.

Pelvic floor dysfunction

Pelvic floor dysfunction (also known as outlet obstruction or outlet delay) refers to a condition in which the muscles of the lower pelvis that surround the rectum (the pelvic floor muscles) do not work normally. These muscles are critical for defecation (bowel movement). It is not known why these muscles fail to work properly in some people, but they can make the passage of stools difficult even when everything else is normal.

What treatments are available for constipation?

There are many treatments for constipation, and the best approach relies on a clear understanding of the underlying cause.

Dietary fibre (bulk-forming laxatives)

The best way of adding fibre to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fibre supplements can be useful.

Fibre is defined as material made by plants that is not digested by the human gastrointestinal tract. Fibre is one of the mainstays in the treatment of constipation. Many types of fibre within the intestine bind to water and keep the water within the intestine. The fibre adds bulk (volume) to the stool and the water softens the stool.

There are different sources of fibre and the type of fibre varies from source to source. Types of fibre can be categorized in several ways, for example, by their source.

The most common sources of fibre include:

? fruits and vegetables,

? wheat or oat bran,

? synthetic methyl cellulose (for example, Citrucel), and

Stimulant laxatives

Stimulant laxatives cause the muscles of the small intestine and colon to propel their contents more rapidly. They also increase the amount of water in the stool, either by reducing the absorption of the water in the colon or by causing active secretion of water in the small intestine.

Exercise

People who lead sedentary lives are more frequently constipated than people who are active. Nevertheless, limited studies of exercise on bowel habit have shown that exercise has minimal or no effect on the frequency of bowel movements. Thus, exercise can be recommended for its many other health benefits, but not for its effect on constipation.

Surgery

For individuals with problematic constipation that is due to diseases of the colon or laxative abuse, surgery is the ultimate treatment. During surgery, most of the colon, except for the rectum (or the rectum and part of the sigmoid colon), is removed.

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