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CONSTIPATION : SYMPTOMS AND CAUSES
Being constipated means your bowel movements are tough or happen less often than normal. Almost everyone goes through it at some point.
Although it’s not usually serious, you’ll feel much better when your body is back on track.
The normal length of time between bowel movements varies widely from person to person. Some people have them three times a day. Others have them just a few times a week.
Going longer than 3 or more days without one, though, is usually too long. After 3 days, your stool gets harder and more difficult to pass.
The main symptoms of constipation are:
- difficulty passing stool
- straining when passing stool
- passing less stool than usual
- lumpy, dry, or hard stool
Other symptoms include:
- pain and cramping in the abdomen
- feeling bloated
- a loss of appetite
Constipation on its own can be uncomfortable, but it typically is not life threatening.
However, it can become a problem if it is a symptom of a more serious underlying condition, such as colorectal cancer, or if it starts to cause further damage.
Damage that can arise as a result of severe constipation includes:
- rectal bleeding after straining
- anal fissure, which is a small tear around the anus
- symptomatic hemorrhoids (piles), which are swollen, inflamed blood vessels in the anus
- fecal impaction, which occurs when dried stool stagnates and collects in the rectum and anus, potentially leading to a mechanical obstruction
Other possible complications include a reduced quality of life and depression.
Seeking medical advice for constipation may help prevent complications.
The following are some common causes of constipation:
Lack of fiber in the diet
People with a high intake of dietary fiber are less likely to experience constipation.
This is because fiber promotes regular bowel movements, especially when a person combines it with proper hydration.
High fiber foods include:
- whole grains
- lentils, chickpeas, and other legumes
Low fiber foods include:
- high fat foods, such as cheese, meat, and eggs
- highly processed foods, such as white bread
- fast foods, chips, and other premade foods
Low levels of physical activity may also lead to constipation.
Some past studies have found that physically fit people, including marathon runners, are less likely to experience constipation than other people, although the exact reasons for this remain unclear.
A study from 2013 notes that increasing mobility might help improve constipation among older adults.
People who spend several days or weeks in bed or sitting in a chair may have a higher risk of constipation.
Some medications can also increase the risk of constipation. These include:
Opioid pain relief drugs: These include codeine (present with acetaminophen in Tylenol #3), oxycodone (OxyContin), and hydromorphone (Dilaudid).
Tricyclic antidepressants: These include amitriptyline (Elavil) and imipramine (Tofranil).
Certain anticonvulsants: Examples include phenytoin (Dilantin) and carbamazepine (Tegretol).
Calcium channel blockers: These lower blood pressure, and certain types lower heart rate. They include diltiazem (Cardizem) and nifedipine (Procardia).
Antacids that contain aluminum: These include Amphojel and Basaljel.
Antacids that contain calcium: One example is Tums.
Diuretics: These remove excess fluid from the body. They include hydrochlorothiazide (Hydrodiuril) and furosemide (Lasix).
Iron supplements: Doctors prescribe these to treat iron deficiency anemia.
Irritable bowel syndrome
People with functional intestinal difficulty, such as irritable bowel syndrome (IBS), have a higher risk of constipation than people without the condition.
A person with IBS may experience:
- abdominal pain
- changes in the frequency or consistency of stools
With IBS, constipation can fluctuate over time. When constipation is not present, there may instead be loose stools with diarrhea.
As people age, the prevalence of constipation tends to increase. Up to 40% of older people in the community and up to 60% of those in institutions may experience constipation.
The exact cause of this remains unclear. It may be that as people age, food takes longer to pass through the digestive tract. Many people also become less mobile, which may also contribute to constipation.
Medical conditions, medications, and a low intake of fiber or water may be other factors that lead to constipation with age.
Changes in routine
When a person travels, for example, their usual routine changes. This can affect the digestive system. In an article from 2008, scientists asked 83 people about the digestive changes they experienced while traveling outside of the United States.
The results showed that 9% of people experienced constipation when they went to another country.
Eating meals, going to bed, and using the bathroom at different times than usual could increase the risk of constipation.
Overuse of laxatives
Some people worry that they do not use the bathroom often enough, and they take laxatives to try to solve this problem. Laxatives can help with bowel movements, but regular use of certain laxatives allows the body to get used to their action.
This may cause a person to continue taking laxatives when they no longer need them. The person may also need higher doses to get the same effect.
In other words, laxatives can be habit forming — especially stimulant laxatives. This means that the more a person depends on laxatives, the greater their risk of constipation when they stop using them.
Overuse of laxatives can also lead to:
- an electrolyte imbalance
- internal organ damage
Some of these complications can become life threatening. For this reason, people should talk to a healthcare professional before they start using laxatives.
Not using the bathroom when necessary
If a person ignores the urge to have a bowel movement, the urge may gradually go away until they no longer feel the need to go.
However, the longer they delay, the drier and harder the stool will become. This will increase the risk of fecal impaction.
Not drinking enough water
Regularly drinking enough water can help reduce the risk of constipation.
Other suitable fluids include naturally sweetened fruit or vegetable juices and clear soups.
It is important to note that some liquids can increase the risk of dehydration and make constipation worse for some people. For example, those who are prone to constipation should limit their intake of caffeinated sodas, coffee, and alcohol.
Some health conditions that affect the colon can impede and restrict the passage of stool, leading to constipation.
Examples of such conditions include:
- cancerous tumors
- a hernia
- scar tissue
- colorectal stricture, which is an abnormal narrowing of the colon or rectum
- inflammatory bowel disease (IBD)
Some other medical conditions can also cause or contribute to constipation.
Neurological conditions: Multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries, and chronic intestinal pseudo-obstruction can lead to constipation.
Conditions that involve hormonal function, electrolytes, or renal function: These include uremia, diabetes, hypercalcemia, and hypothyroidism.
Intestinal blockage: This can occur if a tumor blocks or squeezes part of the digestive system.
Conditions that affect the digestive system: Constipation can occur with celiac disease, IBD, and other inflammatory conditions.
Cancer treatment: Chemotherapy and opioid pain relief medications, can also trigger constipation.
In children and babies
Constipation can sometimes affect children and babies. The following sections discuss this in more detail.
If a newborn does not pass meconium, their first solid stool, within 48 hours of birth, they may have Hirschsprung’s disease.
This is a condition wherein certain nerve cells are missing from part of the large intestine. Stool is unable to move forward in the affected area of colon, which causes a backup.
A healthcare provider will usually be able to spot these symptoms and recommend surgery as treatment. In most cases, the outlook is good for babies born with this condition.
If a breastfed baby goes a week without passing stool, this is not usually a problem. Breastfed infants do not usually experience constipation.
However, if parents or caregivers have concerns about a baby’s bowel movements, they can seek medical advice.
More commonly, constipation can occur:
- when an infant first starts taking formula feeds
- during weaning
- during potty training
- at times of stress
If an infant experiences constipation while consuming formula feed, they may benefit from drinking extra water between feeds. Parents and caregivers should not add extra water to the formula, however.
If the infant is already consuming solids, they may need more fiber and water in their diet. Fruit can be a good option. However, do not force children to eat if they do not want to, as this can cause or add to stress.
During potty training, constipation can occur if a child feels stressed, especially if other changes are occurring, such as starting at nursery. Giving the child plenty of time to empty their bowels may help.
Apart from not passing stool, some symptoms that indicate constipation in children include:
- a firm or distended abdomen
- low energy
- reduced appetite
According to one source, around 40% of women experience constipation during pregnancy.
This can result from:
- hormonal changes
- physical changes, such as when the uterus presses on the intestines
- dietary or physical activity changes
Many women take iron supplements during pregnancy. These can contribute to constipation and other changes in bowel habits.
Constipation usually resolves itself without the need for prescription treatment. In most cases, making lifestyle changes — such as getting more exercise, eating more fiber, and drinking more water — can help.
Allowing time for defecation, without stress or interruption, may also help. People should also not ignore the urge to have a bowel movement.
Laxatives can improve symptoms in the short-term, but people should use them with care and only when necessary. This is because some laxatives can have severe adverse effects.
The Food and Drug Administration (FDA) urge people to check with their doctor before using them, and to follow the instructions on the label with care.
If constipation persists, people should see a doctor. They may need stronger medication. The doctor may also test for any underlying conditions.
Keeping a record of bowel movements, stool characteristics, and dietary and other factors may help find a suitable treatment.
Some laxatives are available over the counter, while others are available with a prescription.
People should only consider using laxatives if making lifestyle changes has not helped. It is best to check with a doctor before use.
The following are some laxatives and stool softeners that may help ease constipation:
Fiber supplements: Also known as bulk-forming laxatives, these may be the safest option. FiberCon is one example. People should take these with plenty of water. Bulk-forming laxatives are available from pharmacies and to purchase online.
Stimulants: These cause the muscles in the intestines to contract rhythmically. Senokot is one example.
Lubricants: These help the stool move smoothly through the colon. One example is mineral oil (Fleet).
Stool softeners: These moisten the stool. Examples include Colace and Surfak.
Osmotics: These draw water into the colon to hydrate the stool and ease movement. Saline laxatives are a type of osmotic.
Neuromuscular agents: These include opioid antagonists and 5-HT4 agonists. They work at specific receptors to regulate movement through the gut.
Other treatment options
If laxatives do not work, a doctor may need to remove impacted stool manually or surgically.
If constipation does not respond to treatment or if there are other symptoms, a doctor may suggest an abdominal imaging study — such as a CT scan, MRI scan, or X-ray — to see if there is a blockage due to an underlying disease process in the gut.
If there is, a person may need specific prescription medications or surgery to resolve it. Depending on the results of the tests and the person’s response to medical or surgical therapy, they may also need further treatment.
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