Constipation is a condition in which bowel movements become sluggish causing difficulty in passing stools. It is a condition that causes disturbances in the digestive system. Obstinate constipation can lead to the accumulation of toxins, which then perfuse into the circulatory system and get carried all through the body.
Symptoms Associated with Constipation
Although, constipation itself is a symptom, it could lead to the occurrence of other symptoms. The following signs may indicate constipation:
- Fewer than three bowel movements per week
- Hard, dry, small stools
- Difficulty in passing stools
- Straining to pass stools
- A sensation of incomplete evacuation
- Bloating
- Abdominal pain or discomfort
- Headache
- Impaired appetite
- Bad taste in the mouth
- Nausea
- Tired feeling
Sometimes, constipation can lead to complications like hemorrhoids or fissures. In very severe cases, it can even lead to rectal prolapse (where a portion of the intestine protrudes from the anus).
Pathophysiology of Constipation
The inner walls of the large intestines have convoluted mucous membranes. These are called crypts. They are present so that maximum absorption of water and nutrients can take place here. As the food moves from the stomach to the large intestine, water gets absorbed by the body and the left-over food forms waste products or stools. The peristaltic movement of the large intestine propels the stool towards the rectum. So, by the time the stool reaches the rectum, it is solid, because most of the water has been absorbed.
Constipation can occur if:
- The large intestine absorbs too much of water, making the stool hard.
- The peristaltic movement of the intestines is not good enough and the stools move very slowly. The more the stools stay in large intestines, the harder they will become, because of water absorption.
Causes of Constipation:
Lack of sufficient fiber in the diet – Fiber is that part of fruits and vegetables which our body cannot digest. It helps to increase the bulk of stools and prevents constipation. Surveys show that Americans eat an average of 5 to 14 grams of fiber daily, which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often eat too much refined and processed foods, from which natural fiber has been removed.
Inadequate consumption of liquids – As discussed above, the large intestine absorbs water from food. Consuming sufficient liquids will ensure that the stools do not become excessively dehydrated. This will keep them soft and they will be easier to pass. However, liquids that contain caffeine and alcoholic beverages interfere with the water cycle of the body and cause dehydration.
Lack of physical activity – Though a direct co-relation has not yet been established, constipation is found to be more prevalent in sedentary individuals.
E.g. Constipation often occurs during an illness, if a person is restricted to bed. A lack of physical activities is linked with constipation in older people also.
Certain medications – There are certain medicines that cause constipation because they interfere with the normal nutrient-water cycle of the body. E.g. pain medicines that have narcotics, antacids that contain aluminum and calcium, blood pressure medications, antiparkinson drugs, antidepressants, iron supplements, diuretics, etc.
Changes in life – – During pregnancy, there are a lot of hormonal changes in the body. Also, the fetus directly compresses the intestines. This reduces the peristaltic movement of the intestine, causing constipation. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity. Travelers also often face this problem because their normal diet and biorhythmic patterns are disrupted, and the body takes time to adjust to new routines.
Abuse of laxatives – Over-the-counter Laxatives are an effective means of counteracting constipation. However, with time, your body gets used to the dose and the dosage needs to keep increasing, in order to be effective. The use of laxatives could become habit forming, and eventually, you may not be able to pass stool without them.
Ignoring the urge to pass stools – Ignoring the urge to pass stools may eventually cause one to stop feeling the urge to pass them, which can lead to constipation. For eg: Being uncomfortable using public toilets or inaccessibility during a busy work day.
Certain illnesses- There are some diseases that can make the intestines sluggish. These include certain neurological problems, systemic conditions, metabolic and endocrine disorders.
Diagnosis of Constipation
If the physician suspects an underlying pathology behind the problem, he may advise the patient any of the following tests:
Physical examination – The physician will perform a rectal examination to evaluate the tone of the muscles of the anal sphincter. He will look out for any tenderness in the area.
Blood tests – The physician may advise the patient to get blood and thyroid tests done to eliminate the possibility of thyroid or other metabolic disorders.
Additional tests – Extensive testing is usually carried out for cases with severe symptoms, which cannot be relieved by dietary and lifestyle changes.
These are:
Colorectal transit study – The patient is given capsules containing small markers that are visible on x-ray. The movement of the marker is then followed by a series of x-rays. This test enables the physician to understand how well food moves in the intestines.
Anorectal function tests – These are a series of tests conducted to diagnose constipation caused by abnormal functioning of the anus or rectum (anorectal function). These include anorectal manometry balloon expulsion tests, defecography, etc.
Barium enema X-ray – The patient is given a barium liquid to drink. This liquid coats the inside of the colon and rectum and makes it visible on the X-ray. This test is especially useful if the physician is suspecting an intestinal obstruction.
Sigmoidoscopy or colonoscopy – An examination of the rectum and the lower or sigmoid colon is called a sigmoidoscopy; and the examination of the rectum and entire colon is called a colonoscopy. In both examinations, a tube is inserted through the anus to inspect the respective areas directly. This test also enables the physician to take a sample of the intestinal lining for biopsy.
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