Constipation is a symptom rather than a disease. This term is used to designate both infrequent defecation and difficulty passing stool.
The frequency of pooping considered normal ranges from a maximum of three bowel movements a day to a minimum of three bowel movements a week. But this criterion is not enough to establish the diagnosis of Constipation. Currently, to show whether a person has Constipation, several measures are taken into account: if it is necessary to make an excessive effort, the stools are hard or caprine, a sensation of complete evacuation is not achieved, the frequency of pooping is less than three weekly times…
it is one of the most common chronic digestive disorders. Its frequency may vary depending on the concept of Constipation used. For example, if only the number of stools per week is taken into account, it affects approximately 5% of the population. In contrast, if the criteria are broadened and the difficulty or effort in defecating is considered, the prevalence rises to 20-30%.
This problem is more frequent in women, sedentary people and those who follow a diet low in liquids and fibre (present in fruits and vegetables).
The most common cause of Constipation is dietary factors, especially a lack of fibre in the diet.
Some medications used to treat pain, depression, and heart conditions can also cause Constipation.
If along with Constipation, there is pain, blood appears in the stool, or the patient has lost weight, the cause may be a tumour in the intestine.
Physiological causes include:
- Intestinal hypomotility: The intestine muscles do not have enough strength to make the necessary contractions to expel stool.
- Intestinal hypermotility: Spasms or involuntary contractions appear in a part of the intestine that retains the stool, preventing proper evacuation.
- Rectal problems: The rectum muscles do not produce enough of a reflex for normal defecation, or there are local lesions that cause pain.
Weakness of the abdominal wall muscles: There is not enough pressure to evacuate.
Mechanical obstruction of the colon or rectum: When there are intrinsic or extrinsic injuries to the large intestine or anus.
The symptoms vary depending on each patient, whether occasional or chronic Constipation and the underlying pathologies.
The most common symptoms are stools less than three times a week, hard stools, the presence of gases, the need to exert great effort, pain when defecating, the need for manual manoeuvres to facilitate defecation, the sensation of anorectal obstruction, the sense of incomplete evacuation and feeling of the anorectal block.
The best way to prevent Constipation is to lead a healthy lifestyle with a diet rich in fibre, such as the Mediterranean diet.
In addition, it is advisable to drink plenty of fluids, approximately two litres of water a day, exercise regularly and get your body used to go to the bathroom when you have the urge to defecate instead of waiting.
To guarantee a sufficient intake of fibre, the Spanish Foundation of the Digestive System (FEAD) recommends taking daily, at least:
- Two servings of greens and vegetables. For example, a varied salad or a plate of cooked vegetables, either as elaborate dishes or as a side dish.
- Three pieces of fruit. A medium bit, a cup of strawberries or cherries, and two slices of melon. Preferably whole instead of juice, since the fibre is found mainly in the pulp and skin.
- 4-6 servings of cereals and derivatives. Preferably whole grain or enriched with wheat bran.
In addition, eating 2 to 5 weekly servings of legumes is recommended, which are also a great source of fibre.
We can classify Constipation into:
Acute or occasional Constipation: When the duration is less than six weeks, due to a stressful situation, a trip, changes in diet, lack of exercise, taking a medication… When this cause disappears, it resumes normal rhythm.
Chronic or habitual Constipation: When it lasts for at least 12 weeks (not necessarily consecutively during the previous 12 months). In these cases, it is necessary to establish a diagnosis to rule out that a disease causes it and adopt healthy habits that restore the normal defecation rhythm.
Given the number of circumstances that may be related to the onset of Constipation, it should be the doctor, after knowing the dietary habits, the taking of drugs and the existence of other diseases, who determines what studies are necessary to do.
These are the aspects that can provide essential information for diagnosis:
- Patient’s age.
- Coexistence of certain diseases.
- Description of the guiding symptom, that is, the one that predominates in each case.
- Existence of alarm symptoms that may require additional tests.
In addition to formulating the necessary questions to collect all the information cited, the doctor will perform a physical examination with which he can obtain signs suggestive of some relevant disease.
In some patients, it is necessary to carry out complementary tests to rule out structural lesions, such as a simple or abdominal X-ray. However, specific tests may also be indicated to assess the motor function of the colon.
The treatment of Constipation depends fundamentally on the cause that produces it. Most of the time, adding fibre to the diet will suffice.
If it is related to taking drugs, and these can be changed for others, it will be advisable to do so. However, on other occasions, it may be necessary to resort to surgery.
These are the main therapeutic measures available, which will be used depending on the symptoms, the underlying pathologies and other characteristics of the patient:
A brief explanation of defecation’s physiology can benefit the affected person. It is also essential to encourage the practice of physical exercise, the intake of much fluids, the adoption of a regular schedule for defecation, the importance of increasing the fibre content in the diet and the harm of repressing the urge to poop frequently.
dietary fibre supplements
An increase of 15-20 grams of fibre per day increases the volume of stools, decreases their consistency and reduces colonic transit time.
Laxatives are still the most used resource to treat Constipation. There are various types: volume-forming agents (mucilages), osmotic laxatives, contact laxatives, emollient agents, and preparations for rectal use. The health professional will determine when they are necessary and which is the most suitable for each case.
Surgery is considered the last resort for the treatment of chronic Constipation. Surgical options include various techniques whose results are not always definitive.
Biofeedback or anorectal rehabilitation
Biofeedback is a learning method that teaches patients to gain control of physiological function. It is used only in some instances of Constipation, in which defecation dyssynergia occurs when the external anal sphincter has an inappropriate contraction or failed relaxation during the attempt to defecate.
Constipation represents a widespread reason for consultation at any age. Anyone can have seasons of Constipation, especially coinciding with changes in diet or travel.
Elderly or inactive people have this disorder more often.
Here are some of the warning signs :
- If it occurs in infants, children or pregnant women.
- If it is abrupt onset or undergoes significant changes in its evolution.
- If it is associated with unjustified weight loss.
- If the stools are accompanied by blood or are black.
- If there is also severe abdominal pain, vomiting and fever.
- If it is related to taking drugs, that can cause it.
- If it persists despite the recommendations of a health professional.