Understanding Constipation

Understanding constipation: Symptoms, treatment and prevention

What is constipation?

Your digestive system is remarkably efficient. In the space of a few hours it extracts nutrients from the foods you eat and drink, processes them into the bloodstream and prepares leftover material for disposal. That material passes through six metres or more of intestine before being stored temporarily in the colon, where water is removed. The residue is excreted through the bowels, normally within a day or two.

Depending on your diet, your age and your daily activity, regularity can mean anything from three bowel movements a day to one every three days. Nonetheless, the longer faecal material sits in the colon, the harder the stool becomes and the more difficult it is to pass. A normal stool should not be either unusually hard or soft, and you shouldn't have to strain unreasonably to pass it.

What causes constipation?

Our busy, modern lifestyles may be responsible for most cases of constipation: not eating enough fibre or drinking enough water, not getting enough exercise, and not taking the time to respond to an unmistakable urge to defecate. Emotional and psychological problems can contribute to the problem. Persistent, chronic constipation may also be a symptom of health conditions, including irritable bowel syndrome, colorectal cancer, diabetes, Parkinson's disease, multiple sclerosis, an under-active thyroid gland and depression.

Bowel habits tend to vary with age and circumstances. Bottle-fed babies, for example, tend to have firmer stools and more bouts of constipation than breast-fed babies. Some children become constipated when they start school or other activities because they are embarrassed to ask permission to use the toilet. Toddlers often become constipated during toilet training if they are unwilling or afraid to use the toilet. Being sensitive to pain, children may avoid the toilet if they have minor splits or tears in the anus from straining or other irritations.

Older people, especially those who are more sedentary, tend to develop constipation more often as well.

Some medications can also cause constipation,  including narcotic-type pain killers including codeine, iron supplements and some medicines used to control blood pressure.

What are the symptoms of constipation?

    Hard, compacted stools that are difficult or painful to pass

    Straining during bowel movements

    No bowel movements in three days

    Stomach aches that are relieved by bowel movements

    Bloody stools due to haemorrhoids and anal fissures

    Leaks of wet, almost diarrhoea-like stool between regular bowel movements.

Seek medical advice if:

    Constipation is associated with a temperature and lower abdominal pain, and your stools are thin or loose; these symptoms may be an indication of diverticulitis or other bowel disease.

    You have blood in your stools; this may be from a fissure or haemorrhoid but could also be a sign of colorectal cancer; changes in your bowel movement pattern, such as passing pencil-thin stools, may also signal colorectal cancer.

    Your constipation develops after you start a new prescription drug or take vitamin or mineral supplements; you may need to discontinue the medication or change the dose.

    You or your child has been constipated for two to three weeks, with recurrent abdominal pain; this could be a sign of lead poisoning or other serious ailment.

    You are elderly or disabled and have been constipated for a week or more; you may have an impacted stool.

    You are losing weight even though you aren't dieting.

    You have severe pain with bowel movements.

Diagnosing constipation

Occasional constipation does not justify visiting a doctor, but you should seek professional advice for a persistent problem. Your GP will first examine your abdomen for any sign of a hardened mass and may conduct a rectal examination. To check for problems affecting the body, your GP may take blood samples. They may advise an examination of your colon with a sigmoidoscope, a flexible tube with a magnifying viewer, which is inserted into the rectum. You might also need to be advised to have a barium enema, which coats the intestinal lining so it can be seen on an X-ray or a colonoscopy, where a specialist puts a camera inside the rectum and into the colon.

What are the treatments for constipation?

Most cases of constipation respond to conservative treatment, such as dietary and exercise changes or mild laxatives. Severe or chronic cases will prompt your GP to test for other diseases.

Your GP will probably start treatment by recommending more fibre or bulk in your diet. Your GP will also encourage you to take adequate time for moving your bowels and not to suppress the urge to have a bowel movement. Increasing your exercise is also important if you lead a sedentary lifestyle. For stubborn constipation in children or adults, the GP may recommend a nondigestible sugar called lactulose or specially formulated electrolyte solutions. Suitable laxatives are available over the counter for short-term use in constipation in children and adults.

Faecal impaction is a more serious form of constipation that sometimes affects elderly people and disabled people. To release hardened material in the rectum, a doctor inserts a gloved finger and manually breaks up the solidified stool. A gentle enema using warm water or mineral oil may also be helpful.

How can I prevent constipation?

The key to preventing constipation is simple enough: Drink adequate amounts of water - six to eight glasses a day is a good rule - get sufficient fibre by eating fruits, vegetables and grains, and exercise regularly. Reduce stress and always respond immediately to the call of nature. This combination will result in a more efficient bowel function.

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