Constipation - Causes, Symptoms, Diagnosis and Treatment

Constipation Is Tragedy Of Nutrition - Anonymous!


Introduction


Constipation is a symptom rather than a disease which results in infrequent bowel movements or strenuous passage of stools that persists for several weeks or longer. It can transpire for many reasons, such as changes in diet or routine or due to inadequate of fiber intake.

Though occasional constipation is very common, some people encounter chronic constipation that can interfere with their ability in the daily tasks due to blockage in the large intestine and such person will need urgent medical attention.


Other key features that usually define constipation include:

  • Stools are dry and hard.

  • Bowel movement is painful and stools are difficult to pass.

  • Have a feeling that you have not fully emptied your bowels.

Constipation can be broadly divided into 3 classes based upon the underlying physiologic cause;


1. Normal-transit constipation - In normal transit constipation the colon movements are unaltered and moves at a normal rate. But patients may experience other arduous in stool passage, for example due to harder stools


2. Slow-transit constipation - In slow-transit constipation colonic motility is decreased and bowel movements are infrequent, leading to more severe symptoms of straining and harder stools.


3. Pelvic floor dysfunction - Pelvic floor dysfunction is due to the failure of the pelvic floor muscles to relax pertinently during evacuation efforts. When this happens it makes stool passage much more difficult, regardless of whether stool transit in the colon is normal or delayed. Bottom line - The majority of persons perceived by a doctor have normal-transit constipation, followed by pelvic floor dysfunction, and slow-transit constipation. But some patients can have a combination of slow transit and pelvic floor dysfunction.



Just for knowledge 

Pelvic floor is the layer of muscles at the bottom of your pelvis that includes your bladder & bowel which pushes stool through your colon more easily and support to several other organs by wrapping around your pelvic bone. 

The pelvic organs include:
The bladder (the pouch holding your urine).
The uterus and vagina (in women).
The prostate (in men).
The rectum (the area at the end of the large intestine where your body stores solid waste).

Why pelvic muscles so important ?  

Lets take routine example - You’re able to go to the bathroom with no problem because your body tightens and relaxes its pelvic floor muscles but this will not work efficiently in case of pelvic floor dysfunction as body keeps tightening these muscles instead of relaxing them and results into : 
- Trouble evacuating (releasing) a bowel movement.
- An incomplete bowel movement.
- Urine or stool that leaks.



Causes


Constipation usually is caused by the slow passage of digesting food through any part of the digestive system. Most of the time, however, generally slowing occurs in the colon movement of material through the colon (large bowel) and high levels of estrogen and progesterone especially during pregnancy.


Lets walk through few causes of constipation -


a. Drugs i.e medication can also cause constipation. Then its recommended to stay hydrated by increasing fiber intake in the diet or taking stool softeners. If simple measures don't work, it may be possible to substitute a less constipating medication by consulting doctor immediately.


b. Habit - Bowel movements are under our own voluntary control. This means that the normal urge you feel when you need to have one can be suppressed easily. Although occasionally it is appropriate to suppress an urge to defecate (for example, when a bathroom is not available) but doing this too habitually can lead to a disappearance of appetite and result in constipation.


c. Diet - Fiber like fruits, vegetables, whole grains are important in maintaining a soft, bulky stool. Therefore, eating foods low in fiber can cause constipation. But ensure over-eating of fibers can also cause constipation.


d. Laxatives - Laxatives helps to relieve constipation work by artificially stimulating, or irritating, the nerves in the large intestine. This stimulation makes the intestinal muscles contract and move the stool out of the body. But over- use of stimulant laxatives constipation worsen issues connected with constipation for example, senna (Senokot), castor oil, and many herbs.


However, whether the laxatives products have caused the damage or whether the damage existed prior to the use of them. Nevertheless, because of the possibility that stimulant products can damage the colon, most experts recommend that they be used as a last resort after non-stimulant products have failed.


e. Hormonal disorders: Hormonal disorders like too little thyroid hormone (hypothyroidism) and too much parathyroid hormone (by raising the calcium levels in the blood) can affect bowel movements. At the time of a woman's menstrual periods, estrogen and progesterone levels are high. However, this is rarely a prolonged condition but high levels of estrogen and progesterone during pregnancy also cause constipation.


f. Other causes - People of all ages can have an occasional bout of constipation. There are also certain people and situations that are more likely to lead to becoming more consistently constipated (“chronic constipation”). These include:

  • Older age people tend to be less active, have a slower metabolism and less muscle contraction strength.

  • Being a woman, especially while you are pregnant and after childbirth changes in a woman’s hormones make them more prone to constipation. The baby inside the womb squishes the intestines, slowing down the passage of stool. So its mandatory for the pregnant women to stay active throughout 9 months period, stay hydrated and consume fiber rich foods.

  • Having certain neurological (diseases of the brain and spinal cord) and digestive disorders (see causes).


Just for knowledge 

 1. Laxatives contain chemicals that help increase stool motility and thus relieving temporary constipation and some laxatives work on your intestine, and others work on both your stool and intestine. 
 
 All laxatives are used to relieve constipation. But when misused or overused, they can cause problems, including chronic constipation. 
 
 2. Stool softeners - Stool softeners are used on a short-term basis to relieve constipation by people who should avoid straining during bowel movements because of heart conditions, hemorrhoids, and other problems. 
 
 Stool softeners come as a capsule, tablet, liquid, and syrup to take by mouth and are usually taken at bedtime.


Difference between stool softeners and laxatives 

Laxatives are products that help people to poop by causing bowel movements. Stool softeners are a type of laxative that works by drawing water into the stool, making it softer and more comfortable to pass. 

Stool softeners are a type of laxative, but not all laxatives are stool softeners and choice between them may depend on how quickly a person needs relief.


Symptoms


  • Fewer than three bowel movements a week.

  • Stools are dry, hard and/or lumpy.

  • Stools are difficult or painful to pass.

  • Stomach ache or cramps.

  • Bloated and nauseous.

  • You feel that you haven’t completely emptied your bowels after a movement.

  • Feeling as though there's a blockage in your rectum that prevents bowel movements

  • Straining or pain during bowel movements

  • A feeling of fullness, even after having a bowel movement

  • Experiencing a rectal blockage

  • Lower abdominal discomfort

  • Increased gas (flatulence) is a common symptom and side effect of high-fiber diets. The gas occurs because the bacteria normally present within the colon are capable of digesting fiber to a small extent.

How does constipation happen?



A food normally moves through the digestive tract as nutrients are absorbed. The partially digested food waste that remains after nutrients are absorbed moves from the small intestine to the large intestine which is called as colon.


The aforementioned colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stool remains in the colon too long, it can become hard and difficult to pass. The stool becomes dry, hard, and difficult to push out.


Bottom line - Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body.



Just for knowledge 

The colon is also known as the large bowel or large intestine. It is an organ that is part of the digestive system (also called the digestive tract) in the human body. 

The digestive system is the group of organs that allow us to eat and to use the food we eat to fuel our bodies.



Diagnosis and Treatment


Diagnosis


The most dominant step by the physician in the evaluation of constipation in an individual is to obtain a complete patient history. When talking to a doctor it is really helpful if patient prepares well to describe:

  • the nature of the symptoms,

  • when symptoms started and how long they have persisted,

  • past medical procedures, and

  • any medications being taken.

After doctor's evaluation from the information provided by the patient tries to examine the exact cause of constipation like -

  • If the symptoms of patient include infrequent call to stool (not feeling the need to have a bowel movement) that may suggest slow-transit constipation, while the perceived need to defecate but with an inability to evacuate is more suggestive of a functional outlet obstruction.

  • If defecation is painful, the doctor knows to look for anal problems such as a narrowed anal sphincter or an anal fissure. If small stools are the problem, eating foods low in fiber may be the cause. If the patient is experiencing significant straining, then pelvic floor dysfunction is likely.

  • If patient is suffering with functional fecal retention i.e The physician should obtain a complete past medical history if their was any situation in patient's life that he/she had to hold back of stool because of fear of a painful bowel movement. Social or environmental factors, such as lack of available toilet facilities, may contribute to constipation both in children and adults and should be considered as a possible cause

  • If patient also suffers symptoms like rectal bleeding, a decrease in bowel movement diameter, a constant sense of the need to defecate, unexplained weight loss, nausea, and vomiting. The presence of such above symptoms, or a significant family history of colorectal cancer, mandates complete colonic evaluation, preferably by colonoscopy.



Just for knowledge
Colonoscopy is a fiber optic (endoscopic) procedure in which a thin, flexible, lighted viewing tube (a colonoscope) is threaded up through the rectum for the purpose of inspecting the entire colon and rectum and, if there is an abnormality, taking a tissue sample of it (biopsy) for examination under a microscope, or removing it.

Treatment


After physical examination doctor may identify root cause of constipation. And further recommend blood tests to evaluate condition in detail. More specifically, blood tests are recommended to evaluate

- Thyroid hormone (to detect hypothyroidism)

- Calcium (to uncover excess parathyroid hormone) may be helpful.


Lets walk through few general tests recommended by doctor to evaluate severity of constipation.

1. Abdominal X-ray

This is used to detect large amounts of material in the colon usually can be visualized on simple X-ray films of the abdomen, and the more severe the constipation, the more visualized on X-ray.

2. Barium enema X-ray

This studies by inserting liquid barium through the anus to fill the rectum and colon. The barium outlines the colon on the X-rays and defines the normal or abnormal anatomy of the bowel and rectum. Tumors and narrowings (strictures) are among the abnormalities that can be detected with this test

3. Colonic transit (marker) studies Colonic transit studies are simple X-ray studies that determine how long it takes for food to travel through the intestines. And procedure is as follows -


Step 1 - Individuals swallow gelatin capsules for one or more days. Capsules contains small pieces of plastic that can be seen on X-rays. The gelatin capsules dissolve and release the plastic pieces into the small intestine.


Step 2 - The pieces of plastic then travel (as would digesting food) through the small intestine and into the bowel. After 5 or 7 days, an X-ray of the abdomen is taken and the pieces of plastic in the different parts of the bowel are counted. From this count, it is possible to determine if and where there is a delay in the colon.

Final step - Then in people who are not constipated, all of the plastic pieces are eliminated and nothing remains in the colon. When pieces are spread throughout the colon, it suggests that the muscles or nerves throughout the colon are not working, which is typical of colonic inertia. When pieces accumulate in the rectum, it suggests pelvic floor dysfunction.

4. Defecography In this procedure, a thick paste of barium is inserted into the rectum of a patient through the anus. X-rays then are taken while the patient defecates the barium. The barium clearly outlines the rectum and anus and demonstrates the changes taking place in the muscles of the pelvic floor during defecation and also provides information about anatomical abnormalities.


5. Ano-rectal motility studies assist to determine if the muscles of the anus and rectum are working normally. When the function of these muscles is impaired, the flow of material through the GI tracts is obstructed, thereby causing a condition similar to pelvic floor dysfunction.

6. Magnetic resonance imaging defecography appears to be an excellent way to study defecation, but the procedure is expensive and somewhat cumbersome. As a result, it is used in only a few institutions that have a particular interest in constipation and abnormalities of defecation.


Bottom line - Numerous underlying diagnoses and treatment can prevent constipation. And its important to ensure medications being taken should be carefully reviewed for possible causative or contributory drugs.



Just for knowledge 

What is gelatin capsule ?
This is a type of capsule that is in the form of liquid or powder, and which dissolves more quickly than any other capsules. These capsules are used for colonic transit (marker) studies.

Prevention


15 best foods to eat to help relieve constipation

1. Beans








They have more than 10 grams of soluble and insoluble fiber per cup serving that's more than almost any other fiber source. And beans include - baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, or kidney beans.

. 2. Kiwi







A 2013 study of adults reported in Advances in Food and Nutrition Research found that eating kiwi promotes regular bowel movements as it has 2.5 grams of fiber and lots of vitamins and nutrients. So luscious green flesh of the kiwi is best to get relief from constipation.


3. Sweet potatoes






One medium baked sweet potato with skin has 3.8 grams of fiber, and this high fiber content in sweet potatoes helps prevent and relieve constipation.

4. Popcorn







A filling 3 cups of air-popped popcorn contains 3.5 g fiber, and less than 100 calories and is really a good choice for a high-fiber snack that can help provide relief from constipation.But stay away from popcorn laden with butter as the high fat content not only contains lots of calories as the fats can cause constipation.


5. Nuts and seeds







Almonds, pecans, and walnuts have more fiber than other nuts. Just 1 ounce of almonds (about 23 nuts) contains 3.5 g fiber, 1 ounce of pecans (about 19 halves) contains 2.7 g fiber, and 1 ounce of walnuts (14 halves) has 1.9 g fiber.


On the flip side, seeds are another good fiber-filled choice for constipation relief. A scant 1 tablespoon of sesame seeds contains 1.1 g fiber, while 1 ounce of pumpkin seeds (about 85 seeds) has a whopping 5 g fiber.


But kindly note that nuts and seeds are high in calories, so keep portions small. Choose nuts and seeds that are raw or dry roasted, rather than roasted in oil.

6. Pears, plums, and apples









One large apple has more than 5 g fiber. With the skin, an average pear provides 5 to 6 grams of dietary fiber to regulate the digestive system. And its great for babies with constipation. So look for baby foods with pears as an ingredient.


Though fresh plums do not have much fiber, but dried plums i.e prunes have as many as 12 g fiber per cup and are excellent for relieving constipation.

7. Berries







Berries like raspberries, blackberries, blueberries and strawberries are tasty and easy to eat as all are easy to snack on and full of fiber. And eat them alone as a snack, try them on salads, or puree and freeze them for a cool summertime dessert.

8. Flaxseed