Constipation is irregular, infrequent or difficult passage of faeces. It is most often defined as having a bowel movement less than 3 times per week and often associated with hard stools or problems passing stools. People may suffer from pain while passing stools or may be unable to have a bowel movement after straining or pushing. It is the most common physiological disorder of the alimentary tract. It is characterized by incomplete evacuation of hard, dried stools. It occurs commonly in children, adolescents, adults on low fibre diets, patients confined to bed, in individuals and in elderly persons.
Constipation is a common gastrointestinal problem, which causes many expenses for the community with an estimated prevalence of 1% to 80%, worldwide, where the condition is characterized by a wide geographical variation. Constipation is common during cancer treatment.
Types of Constipation
There are three main types of constipation:
• Atonic constipation (lazy bowel): There is loss of muscle tone causing weak peristalsis due to lack of fluids, roughage and potassium, vitamin B Complex deficiency, irregular defecation habit and poor personelhygiene, excessive purgation or use of enema, sedentary lifestyle or lack of exercise.
• Spastic constipation: It results from excessive tone of the colonic muscle.
• Obstructive constipation: It occurs usually due to obstruction in the colon, cancer or any other obstruction due to inflammation or narrowing of the lumen.
Causes of Constipation
. Constipation can occur with:
- Overuse of laxatives (stool softeners)
- Low-fiber diet
- Lack of physical activity
- Not drinking enough water
- Delay in going to the bathroom when you have the urge to move your bowels
- Stress and travel can also contribute to constipation or other changes in bowel habits.
- A change in regular routine or travelling
- Use of medications such as antacids with aluminum or calcium, antidepressants, antihistamines, narcotics (such as codeine), antispasmodics, diuretics, tranquilizers, some heart medications
- Use of supplements such as iron and calcium
- Health conditions such as irritable bowel syndrome, colorectal cancer, eating disorders, under-active thyroid, diabetes, Parkinson’s disease, multiple sclerosis, celiac disease, and depression
. Other causes of constipation may include:
- Colon cancer
- Diseases of the bowel, such as – irritable bowel syndrome
- Mental health disorders
- Nervous system disorder.
Possible complications from constipation include:
• Cracks or tears in the rectum
• Weakening of the muscles and ligaments that hold the rectum in place
• Blockage of stool in the large intestine
• Faecal impaction is defined as the retention of solid faeces that prevents spontaneous evacuation.
Faecal impaction is common in care homes and can lead to faecal incontinence. This is a costly consequence of untreated constipation. A related term is faecal loading, which describes the retention of faeces of any consistency.
Risk of constipation in Elderly people
For older adults in the community and in care settings, the risk of developing constipation may be increased by:
• Muscular weakness that limits general movement and the possibility of physical exercise as well as the ability to visit shops and carry shopping.
• Less mobile patients who experience a loss of sensation, or those who ignore the signal to empty their bowels to avoid inconveniencing a carer or because the toilets are inaccessible. In care settings, they may be offered a bed pan or commode and be unable to empty their bowels due to poor positioning or lack of privacy.
• Changes in the diet, including patients reducing fluid and fibre intake for fear of incontinence
• Difficulty swallowing, which results in requirement for thickened fluids and modified consistency diets. This can restrict consumption of adequate fibre and fluid
• Poor dentition, which can impact on dietary intake, including fibre-containing foods
• Limited care assistance available at mealtimes for dependent individuals, to ensure appropriate diet and fluid provision.
• Development of co-morbid medical conditions and resulting poly-pharmacy including, in particular, analgesics and psychotropic drugs.
• Mental health disorders such as depression, anxiety, dementia and cognitive impairment.
• Use of a number of medicines that induce constipation, including antacids, calcium and iron supplements, as well as radiotherapy and opioid pain relief for cancer treatment.
• Socio-environmental factors including hospitalization and institutionalization.
Medications that can contribute to constipation include:
1. Pain medications (narcotics)
3. Antidepressant and anti-psychotic medications
4. Some seizure medications
5. Iron supplements
6. Sucralfate and some antacids such as TUMS
7. Some blood pressure medications
1. Behavior changes: It is best to establish a regular pattern of bowel movement. People who have a normal bowel pattern usually defecate at approximately the same time every day. Since the bowels are most active after awakening and after meals, the most optimal time for a bowel movement is usually within the first two hours after waking and after breakfast. When the signals to defecate are ignored, these signals become weaker and weaker over time. Encouraging and allowing persons to pay attention to these signals can help decrease constipation.
2. Laxatives: Laxatives are substances that can help relieve constipation. However, the long-term use of laxatives can make your body depend on them. Talk to your health care provider about the use of laxatives to manage your constipation.
Fibre supplements are widely available and can be found in forms such as powders, tablets and capsules. If you have trouble eating enough fibre and want to use fibre supplements, check with your health care provider first.
Bulk forming laxatives are natural or synthetic products that have a laxative effect by absorbing water and increasing faecal mass.
3. Diet: For long term treatment it is always preferable to choose for a proper dietary management because intake of laxatives for a long period is not good for health. Increasing intake of fiber and fluid may help to feel less constipated and bloated.
Nutritional guidelines for alleviating constipation:
When we experience constipation, it may be beneficial to include more insoluble fibre in the diet to promote regularity. It is important to increase fibre slowly over the course of a few weeks. Adding too much fibre too quickly can make constipation worse. Insoluble Fibre is not digested by the body and is excreted as waste. This is the type of fibre that promotes bowel regularity and discourages the development of haemorrhoids. Examples of foods that contain insoluble fibre include wheat bran, nuts, seeds, and skins on vegetables and fruits.
• Drink plenty of liquids.
• Gradually increase fibre intake.
• Eat 3-5 servings of fruits and vegetables daily.
• Choose foods that promote regularity.
• Try plum or prune juice.
• Try to include exercise or physical activity in daily routine.
• Talk to your healthcare team about medication or supplements to help with constipation.
Proper dietary and lifestyle management can help in maintaining the normal bowel movements to a great extent. Medical interventions are required only when constipation arises because of some structural or functional change in the gastrointestinal tract.
Exercise and Constipation
Exercise therapy has shown significant efficacy as a means of treating various intestinal diseases. Exercise, especially aerobic exercise, may be a viable and effective treatment for patients with constipation. Exercise helps constipation by lowering the time it takes food to move through the large intestine. This limits the amount of water that our body absorbs from the stool. Hard, dry stools are harder to pass. Aerobic exercise speeds up your breathing and heart rate. This helps to stimulate the natural squeezing (or contractions) of muscles in our intestines. Intestinal muscles that squeeze better will help to move stools out quickly. A regular walking plan — even 10 to 15 minutes several times a day can help the body and digestive system work at their best. Aerobic exercise includes running, jogging, swimming, or swing dancing, for example. All of these exercises can help keep the digestive tract healthy. Stretching may also help ease constipation, and yoga may, too.
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