World Constipation Awareness Month 2023

-Dr. Pramiti Rastogi

Constipation is a common and often uncomfortable condition that affects millions of people around the world. It is defined as having fewer than three bowel movements per week, or having difficulty passing stools that are hard, dry, or lumpy. Constipation can cause pain, bloating, gas, straining, and a feeling of incomplete evacuation.

Types Of Constipation 

There are different types of constipation, depending on the underlying cause and duration. Some of the common types are:

– Functional constipation: This is the most common type of constipation, which occurs when the colon does not contract or move stools properly. It can be caused by factors such as low-fiber diet, dehydration, lack of physical activity, stress, medication, or ignoring the urge to defecate.

– Chronic constipation: This is a type of functional constipation that lasts for more than three months. It can affect the quality of life and lead to complications such as hemorrhoids, anal fissures, fecal impaction, or diverticular disease.

– Slow transit constipation: This is a type of chronic constipation that is caused by a disorder of the nerves or muscles of the colon, which results in slow or reduced movement of stools. It can be due to genetic factors, hormonal disorders, autoimmune diseases, or nerve damage.

– Outlet constipation: This is a type of constipation that is caused by a problem in the pelvic floor muscles or the anal sphincter, which prevents the expulsion of stools. 

Causes of Constipation 

There are many reasons or factors that can contribute to constipation, such as:

– Diet: A low-fiber diet can make the stools hard and difficult to pass. Fiber adds bulk and softness to the stools, and helps them move through the colon. The recommended daily intake of fiber is 25 grams for women and 38 grams for men. Foods that are high in fiber include fruits, vegetables, whole grains, beans, nuts, and seeds.

– Fluids: A lack of fluids can also make the stools dry and hard. Fluids help to hydrate the stools and keep them soft.  

– Exercise: A sedentary lifestyle can lead to constipation, as physical activity stimulates the muscles of the colon and helps to move the stools. Exercises that are good for constipation include walking, jogging, cycling, swimming, and yoga.

– Medication: Some medications can cause constipation as a side effect, by affecting the nerves or muscles of the colon, or by reducing the fluid or fiber intake. Some of the common medications that can cause constipation are opioids, antacids, iron supplements, calcium supplements, antihistamines, antidepressants, and antispasmodics. 

– Medical conditions: Some medical conditions can cause constipation, either by affecting the function of the colon, or by interfering with the normal defecation process. Some of the common medical conditions that can cause constipation are irritable bowel syndrome, diabetes, hypothyroidism, Parkinson’s disease, multiple sclerosis, spinal cord injury, stroke, and pregnancy. If you have any medical condition that can cause constipation, you should seek medical advice and follow the appropriate treatment plan.

Common mistakes that worsens Constipation:

– Ignoring the urge to defecate: When you feel the urge to defecate, you should not delay or suppress it, as this can make the stools harder and drier, and increase the risk of fecal impaction. You should try to establish a regular bowel habit, and go to the toilet when you feel the need.

– Using laxatives excessively: Laxatives are medications that help to stimulate or facilitate bowel movements. They can be useful for occasional or short-term relief of constipation, but they should not be used for long-term or frequent use, as this can cause dependency, tolerance, or rebound constipation. 

– Straining too hard: Straining too hard or for too long can cause damage to the anal or rectal tissues, and lead to complications such as hemorrhoids, anal fissures, or rectal prolapse. 

– Eating too much or too little: Eating too much or too little can affect the bowel function, as both extremes can disrupt the normal digestion and motility of the colon. You should try to eat a balanced and moderate diet, and avoid foods that are high in fat, sugar, or salt, or foods that can cause gas, bloating, or intolerance. You should also eat at regular intervals, and avoid skipping meals or overeating.

The treatment of constipation depends on the cause, severity, and duration of the condition. Some of the common treatment options are:

– Dietary changes: Increasing the intake of fiber and fluids can help to soften and bulk up the stools, and make them easier to pass. You can also include foods that have a natural laxative effect, such as prunes, figs, kiwis, flaxseeds, or psyllium husk. You should also avoid foods that can worsen constipation, such as dairy products, red meat, processed foods, or alcohol.

– Lifestyle changes: Increasing the amount of physical activity can help to stimulate the colon and improve the bowel function. You can also practice some relaxation techniques, such as deep breathing, meditation, or massage, to reduce stress and anxiety, which can affect the bowel function. You should also maintain a good toilet hygiene, and use a comfortable and private place to defecate, and avoid distractions or interruptions.

– Medication: If dietary and lifestyle changes are not enough, you may need to use some medication to treat constipation. There are different types of laxatives, such as bulk-forming, osmotic, stimulant, lubricant, or stool softener, that work in different ways to help with bowel movements. You should use the type and dose of laxative that is suitable for your condition, and follow the instructions and precautions carefully. You should also consult your doctor before using any laxative, especially if you have any medical condition or are pregnant or breastfeeding.

– Surgery: In some rare cases, constipation may require surgery, if there is a structural or functional problem in the colon or the anus, such as a tumor, a stricture, a prolapse, or a nerve or muscle disorder. Surgery can help to remove the obstruction, repair the damage, or restore the function of the bowel. Surgery is usually the last resort, and is only considered after other treatments have failed or are not possible.

To prevent constipation, you should follow some simple measures, such as:

– Eat a high-fiber diet

– Drink plenty of fluids

– Exercise regularly

– Listen to your body

– Check your medication

Consequences of Constipation :

– Hemorrhoids: Hemorrhoids are swollen veins in the anus or lower rectum, that can cause pain, itching, bleeding, or prolapse. Hemorrhoids can be caused by straining or pressure during bowel movements, or by chronic constipation. Hemorrhoids can be treated with creams, ointments, suppositories, or surgery, depending on the severity and type.

– Anal fissures: Anal fissures are tears or cracks in the skin of the anus, that can cause pain, bleeding, or infection. Anal fissures can be caused by passing hard or large stools, or by chronic constipation. Anal fissures can be treated with creams, ointments, injections, or surgery, depending on the severity and location.

– Fecal impaction: Fecal impaction is a condition where a large mass of hard stool gets stuck in the rectum or colon, and cannot be expelled. Fecal impaction can cause severe pain, bloating, nausea, vomiting, or bowel obstruction. Fecal impaction can be caused by ignoring the urge to defecate, or by chronic constipation. Fecal impaction can be treated with enemas, laxatives, manual removal, or surgery, depending on the size and location.

– Diverticular disease: Diverticular disease is a condition where small pouches or sacs form in the wall of the colon, and become inflamed or infected. Diverticular disease can cause abdominal pain, fever, bleeding, or perforation. Diverticular disease can be caused by low-fiber diet, or by chronic constipation. Diverticular disease can be treated with antibiotics, painkillers, or surgery, depending on the severity and type.

As you can see, constipation is not only a nuisance, but also a potential threat to your health. Therefore, it is necessary to prevent constipation by following the measures mentioned above, and to seek medical help if you have persistent or severe constipation. Remember, a healthy bowel is a happy bowel!

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