Constipation: Risk Factors, Causes, Symptoms & Treatment
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| Facts You Need to Know About Constipation |
Constipation
Constipation includes infrequent bowel action when it happens twice a week or less that involves straining to pass hard stools and which may be accompanied by a sensation of pain or incomplete evacuation. Chronic constipation is defined as delay or difficulty in stooling for at least 2 weeks’ duration.
The word constipation meaning in Urdu is “QABZ”.
In simple words, the passing of hard stools is less than the patient's own normal pattern. Constipation is not an illness itself. However, it may be a symptom of another medical condition. Constipation may last for a short or long period.
It may be related to a diet low in fiber, lack of time or routine for toileting, or passage of a painful stool resulting in a fear of defecating. Stool retention over time may result in encopresis (involuntary fecal soiling).Other causes of constipation include anatomic (fissures), neurogenic (Hirschsprung disease), hypotonic (cerebral palsy), and endocrine (cystic fibrosis, hypothyroidism) disorders. Certain medications such as opioids, antacids, and anticonvulsants, among others, can also contribute to constipation.
Constipation affects people of all age groups but is more common in the elderly population. It affects up to 20% of elderly people, 8% of middle-aged, and 3% of young people. Constipation is reported to be twice more common in women than men.
Patient Groups At Risk Of Constipation
Elderly Patients
Older patients are more inclined to the development of constipation. It might very well be because of a sedentary lifestyle and poor mobility. These reasons lessen colonic action, poor eating routine, deficient liquids admission, absence of activity. Simultaneous infection states and utilization of medications that incline to constipation have all been distinguished as contributory variables.
Pregnant Women
Constipation is more common in late pregnancy (up to 40% of women). It is because of the fetal pressure and increased progesterone levels. This causes a decrease in peristaltic movements and delayed bowel emptying caused by the displacement of the uterus against the colon.
Bed-Ridden Patients
Constipation is more common in bed-ridden patients due to decreased mobility.
Formula-Fed Babies
It is reported that constipation affects between 5% and 10% of children. It is more common in formula-fed babies. Newborn babies also have constipation if they cry a lot at the time of passing stools.
Constipation In Babies
It is reported that when babies start consuming solid food, then they develop a form of constipation called infant constipation.
Causes Of Constipation
Constipation is caused by poor diet & dehydration, irritable bowel syndrome & Poor bowel habits, hormonal disturbances & pregnancy, laxative abuse, fissures, and hemorrhoids.
Other causes of constipation include certain medicines and diseases, nerve damage, colonic motility disorders, and electrolyte abnormalities. Lack of exercise, poor mobility, and mechanical compression can also cause constipation.
Drugs commonly involved in constipation are anticholinergic, antacids, anticonvulsants, calcium channel blockers, diuretics, iron supplements, antidepressants, and opioid analgesics.
Different diseases such as hemorrhoids, Parkinson’s disease, stress, depression, diabetes, and hypothyroidism are also involved in causing constipation.
Symptoms Of Constipation
The most common symptom of constipation is the inability to pass stools at regular intervals which results in the production of abnormally hard stools.
You may have abdominal pain and discomfort, feeling of incomplete evacuation, headache, slight anorexia, straining at stool, and minimal abdominal distension.
Treatment Of Constipation
Before maintenance therapy can be initiated, the removal of feces (disimpaction) of the patient is important. There are no controlled studies that compare the efficacy of the oral and rectal routes. However, oral therapy (mineral oil, polyethylene glycol, bisacodyl) is recommended over rectal therapy because it is less invasive and might achieve better adherence.
Rectal therapy incorporates phosphate soda enemas, mineral oil enemas, glycerin suppositories in infants, and bisacodyl suppositories in older children.
After disimpaction, regular stool production is promoted by using a combination of behavioral, dietary, and medication therapies. These therapies are also effective in preventing reimpaction.
Dietary interventions include adequate fluid and fiber intake. The impact of cow’s milk on constipation is not known with certainty.
Certain medications such as polyethylene glycol 3350, mineral oil, lactulose, and sorbitol should be titrated to produce one to two soft stools daily. Polyethylene glycol may be the most effective and best tolerated in children. Stimulant laxatives might be needed intermittently.
The standard treatment plan for constipation may include laxatives, glycerin, and castor oil.
Laxatives
Laxatives exert their action by causing retention of fluid in colonic contents. They may act either directly or indirectly on the colonic mucosa and cause a decrease in the net absorption of water and electrolytes. They also increase intestinal motility. Thus, they cause less ingestion of salts and water because of diminished transit time.
Four main types of laxatives are used for the treatment of constipation.
- Stimulant laxatives (Senna, bisacodyl, sodium picosulphate, and glycerol)
- Saline laxatives (Magnesium salts)
- Bulk-forming laxatives (Ispaghula husk)
- Osmotic laxatives (lactulose)
If laxatives treatment is needed for over multi-week, the individual ought to be encouraged to counsel a doctor to decide whether there is a hidden reason for constipation that requires treatment with specialists other than intestinal medicines
For some bedridden or geriatric patients, or others with a severe form of constipation, bulk-forming laxatives stay the principal line of treatment.
Castor Oil
Castor oil is recommended for the treatment of constipation. It comes under the classification of stimulant laxatives. It may moreover be used to get out the assimilation lots before a gut evaluation/operation.
The metabolism of castor oil occurs in the gastrointestinal tract to an active compound, ricinoleic acid. Ricinoleic acid decreases glucose assimilation, animates the secretory cycles, and advances intestinal motility.
It works by expanding the movement of the digestive organs, helping the stool with coming out. It ordinarily brings about a defecation within 1 to 3 hours after its organization.
Glycerin
Glycerin suppository is used for the treatment of acute constipation. It is administered as a 3g suppository. It performs its action by causing osmosis in the rectum. The onset of action is usually less than 30 minutes. If it is not effective then low doses of bisacodyl or senna, or saline laxatives (e.g., milk of magnesia) may be alternative effective options.
Lifestyle Modifications Effective In Constipation
Lifestyle modifications are considered the primary line treatment for constipation. You should take a diet rich in high fiber content like natural products, vegetables, cereals, grain food varieties, and entire feast bread.
You should build your liquid admission to further develop stool recurrence and lessen the requirement for intestinal medicines. Attempt to begin customary exercise to unwind and get muscular strength. It assists the food with moving all the more effectively through the gut. You must exercise daily.