What is constipation? How is it defined?
Constipation is a problem associated with the digestive system where the patients evacuate less than three bowel movements in a week. Mostly, the stool would be rigid or very dry. However, the severity and symptoms of constipation vary between individuals. Generally, it is described as discomfort or difficulty in bowel movement. Constipation invariantly affects the individual quality of life both physically and mentally.
What are the signs and symptoms of chronic constipation?
Constipation is very common and may be treated by simple home remedies, supplements or medications. But for some cases, they may progress to chronic constipation. Signs and symptoms of chronic constipation includes:
- Less bowel movements than usual
- Straining during the bowel movement
- Bloating and nausea
- Sensation of incomplete evacuation
- Hard or lumpy stools
- Abdominal cramps
- Stomachache
- Loss of appetite
- Stools that cause tearing and bleeding of the anus
What is Bristol stool scale?
It is a tool that categorizes the appearance of stools. It describes the size, shape, color, and consistency. The scale was developed in 1997 by a team of doctors at the British Royal Infirmary in Bristol, England. Since then it has been used as a tool in many gastrointestinal disorders.
The seven types of stool are:
| Stool Type | Description | |
| Type 1 | Separate hard lumps like nuts, difficult to pass | Observed during constipation |
| Type 2 | Sausage-shaped, similar to type 1 | Observed during constipation |
| Type 3 | Sausage-shaped but with cracks on the surface | Ideal stools and they are easily passed out |
| Type 4 | Like a sausage or snake, smooth and soft | Ideal stools and they are easily passed out |
| Type 5 | Soft blobs and smooth with clear-cut edges | Tending towards diarrhea |
| Type 6 | Mushy stool, fluffy pieces with ragged edges | Indicates diarrhea |
| Type 7 | Watery, no solid pieces, entirely liquid | Indicates diarrhea |
Risk factors and Causes
Factors that may increase the risk of chronic constipation includes:
- Infants
- Old age
- Pregnancy
- Women who have just given birth
- People who have just undergone surgery'
Constipation occurs when the large intestine absorbs too much water from the stool, resulting in dry and hard stools. It may also be due to inadequate contraction of bowel walls to expel the waste product. There also several other factors which may lead to or worsen constipation:
- Inadequate fluid intake
- Insufficient dietary fiber in diet
- Absence of physical activity or exercise
- Ignoring urge to defecate
- Consuming too much dairy products
- Irritable bowel syndrome
- Certain medical conditions such as depression or eating disorders
- Stress
Constipation due to endocrine disorders
Hormones in our body is crucial in maintaining the balance of fluids. Diseases such as diabetes, hyper- and hypo-parathyroidism cause imbalance of the hormones which may lead to constipation.
Constipation due to medications
Some drugs that may cause constipation:
- Antacids containing calcium or aluminium
- Overusing laxatives resulting in dependency
- Opioids
- Anti-Parkinsonian agents
- Tricyclic anti-depressant
- Anti-cholinergic
- Diuretics
- Calcium channel blockers
- Iron supplements
- Anti-histamines
- Problems with the colon or rectum (secondary to diseases) such as anal fissure, chronic renal failure, colon or rectal cancer, hypercalcemia etc.
Diagnosis of constipation
Diagnosis is done to find out the cause of constipation by asking the patients about symptoms, family and medical history and their regular habits. Based on the answers, physical examinations and tests are then carried out by healthcare professionals. Some key questions include:
- How many times do you have a bowel movement in a week?
- How long or frequent the symptoms are?
- How do your stools look like?
- Do you look red streaks in your stools?
- Are there streaks of blood on your toilet paper when you wipe?
Physicians may also find out more about your medical history, such as:
- Have you undergone any surgery to your digestive tract?
- Have you recently lost or gained weight?
- Do you have a history of anemia?
Questions about daily routine include:
- What are your eating habits?
- What is your level of physical activity?
- What medicines, including supplements, and complementary and alternative medicines, do you take?
From the above information, healthcare professionals will then recommend the appropriate treatment or lifestyle changes. If the problem persists, further tests would be required such as blood test, urine test, stool test or imaging tests. Endoscopy may also be performed to find out the underlying reason for constipation.
Preventing constipation
Here are some ways to prevent constipation:
- Ensure sufficient hydration by taking plenty of fluids daily
- Eating a well balanced diet at regular timings to promote normal bowel function.
- Having sufficient fruits of vegetables in the diet
- Consuming bran cereal, prunes, legumes, grains, etc.
- Regular exercise
- Managing stress
Prognosis of Constipation
Constipation is not a life-threatening disease or disorder. However, chronic constipation may have serious complications which include:
- Rectal bleeding from exertion to pass stools
- Anal fissure, or small tears around the anus
- Hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum
Treating chronic constipation
Most often, acute or short-term constipation does not require much medical interventions. But in some cases, it may develop into a chronic condition where it may require medical intervention and greater lifestyle modifications. Some medications that healthcare professionals may provide are laxatives to encourage bowel movement, or steroid-containing ointment for treating hemorrhoids that arise from constipation.
However, medications should not be relied on in the long term. Drinking enough liquids and ensuring sufficient fiber in the diet are some ways to promote bowel movement.
In addition, a high fiber diet, not only benefits the bowel, it may promote healthy cholesterol levels, among many other health benefits. A change in lifestyle like allocating a specific time for bowel movement may be helpful. In severe cases, surgical intervention may be needed to treat constipation.
Disadvantages of common medications used in constipation
Laxatives
Most of the time, laxatives are commonly prescribed for the treatment of constipation to promote bowel movement. However, overuse of laxatives may result in the bowel's dependency on the medications and result in decreased bowel movement when the medication is stopped. Laxatives are also not recommended in certain groups of people such as pregnant mothers.
Topical Steroids
Steroidal ointments are prescribed for relief of itching, swelling and inflammation caused by anal fissure and hemorrhoids. Steroids may cause changes to the skin such as thinning when used for long term.
Reference
- Mayo Clinic. Over-the-counter laxatives for constipation: Use with caution. 2022 March. Available on: https://www.mayoclinic.org/diseases-conditions/constipation/in-depth/laxatives/art-20045906
- Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011;25 Suppl B(Suppl B):16B-21B. Available on: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206564/
- Dolgun E, Yavuz M, Celik A, Ergün MO. The effects of constipation on the quality of life of children and mothers. Turk J Pediatr. 2013 Mar-Apr;55(2):180-5. Available on: http://www.turkishjournalpediatrics.org/uploads/pdf_TJP_1181.pdf