Constipation: Symptoms, Common causes, Treatment and Prevention

 

 

Do you feel uncomfortable when passing stool? Do you strain unduly before you pass stool? Are the stools you pass hard, dry and lumpy? If so, you might be suffering from ‘Constipation’.

 

Cartoon illustration of the large bowel

 

 

Introduction

 

Constipation refers to the condition wherein a person experiences difficulty passing stool or emptying the large bowel in the absence of any disease causing large bowel obstruction.

 

If a person’s frequency of passing stool is less than 3 times a week, he or she is most likely suffering from constipation.

 

But people generally are more concerned with stool consistency and ease of passage than stooling frequency as self-reporting about constipation by frequency of stooling could be subjective and influenced by culture and social customs.

 

Although the accurate rate of occurrence of chronic constipation in diverse African populations is unknown, it has been estimated for example, that 29 per cent of the population of South Africa, and 48.4% of people in Cotonou, Benin Republic self-reported suffering from constipation.

 

Worldwide, women. the elderly and those living alone form the majority of those who seek care for chronic constipation. Constipation can however occur in all age groups including children and babies.

 

Chronic constipation is physically and mentally troublesome for many people, and can significantly diminish the quality of daily living and well-being. 

 

 

Symptoms of constipation

 

The following symptoms clearly indicate that one may be suffering from constipation:-

• Experiencing difficulty while passing stool

• A need to strain when passing stool

• Passing less stool than usual

• Passing stools that are lumpy, dry, or hard

• Experiencing pain and cramping in the abdomen

• Having a constant feeling of being bloated

• Feeling of incomplete passage of stool

• Nausea

• Loss of appetite

 

 

Complications

 

Constipation can be uncomfortable, but it is not typically life threatening.

 

Left untreated or in the presence of more serious underlying problems, chronic and severe constipation may cause additional damage, like:

• Rectal bleeding after straining

• Small tear around the anus (anal fissure)

• Bleeding hemorrhoids (piles), which are swollen, inflamed blood vessels in the anus

• Stool impaction, which occurs when dried stool collects and is retained in the rectum and anus, potentially leading to a mechanical obstruction and even death

• Depression and reduced quality of life.

 

Seeking early medical advice for constipation may help prevent complications.

 

 

Common causes of constipation

 

The causes of constipation are diverse. They range from eating habits to the kind of lifestyle one adopts. The most common causes include:-

 

• Lack of fibre in the diet

 

Fibre, combined with proper hydration, promotes regular bowel movements. Therefore, those whose diet lacks fibre are more likely to have constipation. Fibrous foods such as vegetables, fruits, nuts, whole grains, lentils, chickpeas, and other legumes are, therefore, absolutely necessary in one’s diet.

 

• Insufficient intake of fluids

 

Insufficient intake of fluids daily can cause chronic constipation as the gut absorbs as much of the little water available in stool. This results in a hard, lumpy and dry stool that proves difficult to pass.

 

• Sedentary lifestyle

 

People who have a completely sedentary lifestyle with very low levels of physical activity have a higher risk of constipation. Some studies conducted in the past have concluded that fit people are less likely to experience constipation than other people. In 2013, a study found increased mobility to improve constipation among older adults.

 

• Ignoring the urge to pass stool

 

Whether for reasons of pressure on one’s time or other reasons, ignoring the urge to pass stool whenever the urge is there can be a trigger for constipation. The longer stool stays in the large bowel un-evacuated the more water is absorbed from it and the harder, lumpier and drier it becomes.

 

• Medications

 

Some medications are known to increase the risk of constipation. Such medications include:

• Opioid pain relief drugs such as codeine, oxycodone, and hydromorphone

• Tricyclic antidepressants, amitriptyline and imipramine, for instance

• Certain anticonvulsants such as phenytoin and carbamazepine

• Calcium channel blockers lower blood pressure and some even lower the heart rate. They include diltiazem and nifedipine

• Antacids containing aluminum such as Amphojel and Basaljel

• Diuretics such as hydrochlorothiazide and furosemide

• Iron supplements that are prescribed by doctors to treat iron deficiency anemia.

 

• Co-occurring medical conditions

 

Various medical conditions including anxiety and depression, underactive thyroid, irritable bowel syndrome (IBS) and some other gut disorders and conditions, may cause poor bowel movements and therefore constipation. IBS for example is a functional intestinal difficulty with a high risk of constipation. IBS patients experience abdominal pain, bloating, distension, and changes in the frequency or consistency of stools. The exact cause of IBS is not known, but risk factors include; overactive or underactive contraction of muscles of the bowel, abnormalities in the nerve supply to the bowel, severe infection and inflammation of the bowel and changes in bowel microflora (I.e., the good bacteria that are essential to healthy life).

 

• Aging

 

As people grow older, the occurrence of constipation tends to increase. As many as 60 percent of older people in institutions may experience constipation.

 

 

Treatment of constipation

 

In most cases of constipation, there is no need for prescription treatment. A bottom up management approach to constipation is advised generally (see below):

 

Natural remedy/Education regarding stool hygeine

 

This  options may help to keep constipation at bay,  and include:

• Increasing the fibre intake

• Drinking lots of water

• Exercising regularly

• Establishing a routine

• Avoiding holding in stools

• Allowing time for passing stool

• Elevating the feet while passing stool

 

In case constipation persists after instituting this approach, it is advisable to see a doctor.

 

Doctors may consider it necessary to prescribe medications for your constipation especially when making lifestyle changes have not helped.

 

These medication include:

 

• Fibre supplements, e.g., Psyllium

• Stimulants, e.g. Bisacodyl, Senna, Cascara and Sodium picosulphate (SPS)

• Lubricants

• Stool softeners. e.g., Sodium docusate.

• Osmotics, e.g., Magnesium hydroxide or citrate, Lactulose and PEG 3350

• Neuromuscular agents

• Probiotics, e.g., genera of Bifidobacterium and Lactobacillus

 

Surgery

 

In case even medications do not work, it might be necessary to remove impacted stool manually or surgically. Also, when constipation is caused by disorders associated with the anus like rectal prolapse, anal fissure, anal cancer, special surgery will be needed to take care of such conditions.

Diagrammatic representation of a management approach to constipation. Click image to enlarge. Credit

 

 

Prevention of constipation

 

Constipation can be prevented if you adopt the following lifestyle changes

• Eat a well-balanced diet with plenty of fibre

• Drink plenty of water and other fluids every day

• Exercise regularly

• Reduce stress

• Avoid liquids that contain caffeine as these have a dehydrating effect

• Avoid milk, as dairy products may be constipating for some people

• Don’t ignore the urge to pass stool

• Allow time for passing stool

• See a doctor early when lifestyle changes and natural remedies fail to correct your constipation.

 

 

Conclusion

 

Constipation is a common functional large bowel disorder that is caused by poor dietary habits, lifestyle practices, medical conditions and other factors. In case you suffer from severe constipation and experience a lot of discomfort, it would be wise to consult a doctor early who check you out, make accurate diagnosis, run some tests and most probably prescribe appropriate medications or surgery especially when natural remedies and lifestyle changes have failed to take care of your problem.

 

 

References:

Sanchez, M.I., Bercik, P.: Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011 Oct;25 Suppl B(Suppl B):11B-15B. doi: 10.1155/2011/974573.

Sehonou, J., Kpossou, A.R., Sokpon, C.N.M., Cataria, H., Azandjeme, C., Vignon, K.R.: Functional Constipation in the General Population in Cotonou: Prevalence and Associated Socio-Demographic Factors. Open Journal of Gastroenterology, Vol.8 No.9, 2018

Liu, L.W.: Chronic constipation: current treatment options. Can J Gastroenterol. 2011 Oct;25 Suppl B(Suppl B):22B-28B.

 

 

 

Published: February 28, 2020

Last Updated: January 30, 2024

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