Chronic Constipation

Constipation is one of the common gastrointestinal symptoms where an individual may have difficulty in passing stools or experience infrequent bowel movements. Infrequent bowel movements may vary from person to another, where some pass three stools in a week or more severely some pass out one stool in a week. Individuals who have constipation find it painful while passing stool and may experience straining or feeling of incomplete empty of stool.

Some of the causes of constipation include poor dietary habits such as low fibre diet, hormonal and central nervous system disorders, lack of physical activity, pregnancy, use of certain medications, ignoring the urge to have a bowel movement and dehydration.

Your doctor may collect the medical history, perform physical examination and may order certain tests to confirm the cause for the condition. Some of the tests performed include blood tests, abdominal X-ray, barium enema, defecography and colonic transit (marker) studies.

• Barium enema: It is an X-ray procedure where liquid barium is administered through the anus into rectum and colon and the X-rays of these structures are obtained. The barium outlines the colon and helps in visualizing the abnormality more clearly.
• Defecography: This procedure is modified procedure of barium enema. In this method thick paste of barium is inserted through the anus into the rectum and the patient will be asked to pass out (defecate) barium. An X-ray captures images of the pelvic floor muscles while patient is defecating. It enables the doctor to look for any abnormalities of rectum and pelvic floor muscles during defecation.
• Colonic transit (marker) studies:It is an X-ray procedure that evaluates the movement of food through the lower gastrointestinal tract or intestine. In this procedure an individual will be advised to swallow a capsule for one or more days that contains small plastic pieces which are released in intestine and appear on X-ray. The X-ray will be taken after 5 to 7 days. In normal condition, all of the plastic pieces released from the capsule will be excreted in the stool. But in constipated individuals the plastic material remains in colon or rectum which concludes the abnormality in colon (colonic inertia) or pelvic floor dysfunction, respectively.

Constipation is a common condition and can be treated effectively. There are several treatment options to treat constipation and they include:

• High-fibre diet: Fibres bind to the intestine, absorb water and retain water within the intestine that softens the stool and also adds volume to the stool. The best way to administer fibres is through fibre-rich food such as fruits, vegetables, wheat or oat bran, and synthetic agents. Fluids such as water and juice will help to prevent dehydration and constipation. Individuals who are having constipation must avoid caffeine, alcohol and cola drinks as they may worsen the condition by casing dehydration.
• Laxatives: Laxatives may be prescribed to loosen the stool and is recommended in individuals for whom dietary modification showed no improvement. Different types of laxatives used for constipation include:
  • Lubricative laxatives: These laxatives containing mineral oil remain in intestine, coat the particle of the stool and prevent the retention of water from the stool making the stool soft and defecate easily.
  • Stool softeners (emollient laxatives): They contain a wetting agent, docusate, which facilitate the entry of more water in the colon into the stools and soften the stool.
  • Hyperosmolar laxatives: These are undigestible and unabsorbable compounds which remain within the colon and help to retain water in the colon resulting in a softer stool.
  • Saline laxatives: These are undigestible and unabsorbable compounds which remain within the colon and help to retain water in the colon resulting in a softer stool.
  • Stimulant laxatives: Stimulant laxatives stimulate the movement of intestinal muscles and push the stools rapidly. They also increase the water in stool by reducing absorption of water in the colon or by causing secretion of water in small intestine.
• Biofeedback: This method is often recommended for individuals with pelvic floor dysfunction. In this method certain exercises are taught to the patients to improve the movements of pelvic floor muscles that will help the patients learn relaxing and contracting muscles for proper defecation. During training, a pressure-sensing catheter will be placed in the rectum which measures the pressure generated by contraction of muscles. The pressure may be recorded and used as reference to teach the patients the way of relaxing and contracting muscles during defecation.
• Surgery: Surgery is performed in individuals who have intestinal disorders such as colonic inertia. During surgery, entire colon is removed except a part of the colon, the rectum. The cut ends of the small intestine are attached to the remaining rectum.

Constipation may cause certain complications such as haemorrhoids because of strain; anal fissures which are tears in the skin around anus that may cause bleeding and rectal prolapse where the rectum protrudes into the anus because of strain exerted during defecation.

It may also cause faecal impaction a condition where the hard stool may pack itself inside the intestine and rectum such that pushing does not help in passing the stool.

Although these complications are worrisome several treatment options are available to treat these complications.