Discomfort in the abdomen, which lasts for several days, pain in the intestines and a long pastime in the toilet - if you are familiar with such signs, most likely you suffer from constipation. This is an unpleasant condition when a person cannot be emptied in the usual way and must resort to a specific treatment. However, you should not immediately run to the pharmacy for laxatives, sometimes they can give the opposite effect and only aggravate the situation.
What is constipation?
Constipation is a problem; when the intestines move too slowly, the stool is often hard and dry. Other symptoms may include abdominal pain, bloating and feeling as if the person is not completely emptied. Complications include hemorrhoids and anal fissure. The normal frequency of bowel movements in adults is three times a week. Infants often have three or four bowel movements per day, while in young children it is usually reduced to two to three times.
Constipation has many causes. Common ones are: slow movement of the stool in the colon; irritable bowel syndrome; pelvic floor disorders. The main associated diseases include: hypothyroidism; diabetes; Parkinson's disease; celiac disease; sensitivity to shallow gluten; colon cancer; diverticulitis; inflammatory bowel disease. Medications that cause constipation include opioids, certain antacids, calcium channel blockers, and anticholinergics. Of those taking opioids, about 90% experience difficulty using the toilet. Constipation becomes a major problem when there is weight loss or anemia, blood is present in the stool, there is a history of inflammatory bowel disease or colon cancer in a person’s family, or this is a recent state of the body in older people.
The most common symptoms
Constipation is a symptom, not a disease. The most common is not frequent bowel movements, usually less than 3 chairs per week. However, people may have other complaints, including:
- tension with bowel movements;
- excessiveness in the process of defecation;
- hard stools;
- pain with bowel movements (secondary after exertion);
- abdominal pain;
- feeling of incomplete bowel movement.
Rome criteria are a set of symptoms that help standardize the diagnosis of constipation in different age groups. They help doctors better define the problem in a standardized way.
Types and causes of constipation
Causes of constipation can be divided into congenital, primary and secondary. The most common type is primary, not life threatening. It is also divided into affected age group, such as children and adults.
Primary or functional - determined by persistent symptoms for more than six months not due to a underlying cause, such as side effects of drugs or underlying medical conditions (not associated with abdominal pain, thereby distinguishing it from irritable bowel syndrome).
This is the most common type of constipation and often multifactorial. In adults, these primary causes include dietary options: inadequate fiber intake or fluid intake, or behavioral causes: physical activity decrease. In the elderly, common causes are attributed to inadequate intake of dietary fiber, fluid, decreased physical activity, side effects of drugs, hypothyroidism, and obstruction of colorectal cancer.
Secondary causes include side effects of drugs such as opiates, endocrine and metabolic disorders (hypothyroidism and obstacles: colorectal cancer). Celiac disease and non-cellular sensitivity of gluten may also be present with constipation. Cystocele often develops as a result of chronic constipation.
There are acute (from several days to several weeks) or chronic (from several months to a year) constipation. This, in the context of the accompanying symptoms, helps physicians discover the cause of constipation. People often describe their problems as perceptible bowel movements, hard stools with a lumpy or hard consistency, and excessive tension during bowel movements. Chronic constipation (symptoms of at least three days a month for more than three months), associated with discomfort in the abdominal cavity, is often diagnosed as irritable bowel syndrome.
Poor nutrition, previous abdominal surgery and certain medical conditions may contribute to this problem. Diseases associated with constipation include hypothyroidism, certain cancers and irritable bowel syndrome. Low fiber intake, inadequate amounts of fluid, poor ambulation, stiffness, or medications can provoke constipation. As soon as the presence of the disease is identified on the basis of the symptoms described above, it is necessary to find out the cause of a specific and unpleasant phenomenon.
Other warning signs and symptoms include a family or personal history of inflammatory bowel disease, over 50 years of age, changes in stool consistency, nausea, vomiting, and neurological symptoms such as weakness, numbness, and difficulty urinating.
Constipation occurs when too much water is absorbed. This can happen if the muscles in the colon contract slowly or poorly, causing the chair to move too slowly and lose more water.
More detailed reasons:
- Lack of fiber in the diet: people whose diets include a large amount of fiber are much less likely to suffer from constipation. It is important to consume foods rich in fiber, such as fruits, vegetables, and whole grains (fiber promotes bowel movement and prevents constipation) and reduce substances with a low fiber content and high in fat: cheese, meat and eggs.
- Lack of physical activity: constipation can occur if a person becomes physically inactive. This is especially true for older people, and those who have been bedridden for a few days or weeks. The risk of its occurrence increases significantly. Experts can't figure out why. Some believe that physical activity leads to a high metabolism, which speeds up the processes in the body. Old people tend to have a more sedentary lifestyle compared to younger people and therefore are at high risk of constipation.
- Medications: the most common drugs that cause constipation are: narcotic (opioid), including codeine (Tylenol); antidepressants, including amitriptyline (Elavil) and imipramine (Tofranil); anticonvulsants, including phenytoin and carbamazepine (Tegretol); blocking drugs, including diltiazem (Cardizem) and nifedipine (Procardia); aluminum-containing antacids, including Amphojel and Basaljel; diuretics, including chlorothiazide.
- Milk: drinking milk can also trigger this problem. Some people experience constipation when they consume large amounts of milk and dairy products. It is necessary to consult a doctor, he will help to make the right diet.
- Irritable Bowel Syndrome: People who suffer from the syndrome feel constipated much more often than the rest of the population.
- Pregnancy: is one of the reasons and causes hormonal changes that can make a woman more susceptible to constipation. In addition, the uterus constricts the intestines, slowing the passage of food.
- Old age: as a person gets older, metabolism slows down, which leads to a decrease in bowel activity. The muscles in the digestive tract do not work as well as they used to.
- Changes in the normal rhythm of life: the most common cause. When a person travels, his usual routine changes - it affects the digestive system, which sometimes leads to a problem with the stool. Food, sleep and toilet trips are used at different times. All these changes in the schedule can cause the risk of constipation.
- Use of a laxative: some people believe that a person should go to the toilet at least once a day, and they can be treated independently with laxatives. This causes the opposite effect.
Medical methods for the determination of constipation
A physical examination should include at least an abdominal and rectal examination. An abdominal examination can reveal mass if there is significant strain in the stool and discomfort. A rectal examination indicates whether the lower rectum contains any feces or not, and also provides information on stool consistency, hemorrhoids, blood, and any perineal disorders, including fissures and anal warts. Physical examination is performed manually by a doctor.
Functional constipation is common and does not require diagnostic testing. Usually, imaging and laboratory tests are recommended for individuals with more complex symptoms. Conducting serious research depends on the alleged underlying cause of constipation. Tests may include complete blood count, thyroid function, serum calcium and potassium, etc.
Abdominal X-rays, as a rule, are performed only if intestinal obstruction is suspected, can detect the extensive effects of fecal matter in the colon and confirm or rule out other causes of similar symptoms.
A colonoscopy is performed if there is an abnormality in the colon.
Treatment of constipation depends on the underlying cause and duration of the problem. Measures that can help is drinking enough fluids and more fiber. If this is ineffective, then laxatives are recommended for the formation of a bulk and osmotic agent, a stool softener or a type of lubricant. Stimulatory laxatives are usually reserved when other types are ineffective. In the general population, the level of constipation is 2-30%. Among older people living in a nursing home, the frequency of constipation is 50-75%.