Constipation: Types and treatment

Constipation refers to bowel movements that are infrequent or hard to pass. It is a common cause of painful defecation, which experts say is occurs frequently in adults, as well as, children and even babies. Bowel movement varies from person to person and any number less than three to four times a week is regarded as a sign of constipation.

According to the Medical Director, City of David Hospital, Festac Town, Lagos State, Dr. Austeen Akaehomen, constipation in simple terms means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stool.

“Medically, constipation is defined as fewer than three stools per week, and severe constipation as less than one stool per week. Constipation in children usually occurs at three distinct points in time; after starting formula or processed foods (while an infant), during toilet training and soon after starting school (kindergarten). Infants who are breastfed rarely develop constipation.

“Severe constipation includes obstipation (failure to pass stool or gas), and fecal impaction, which can progress to bowel obstruction and become life threatening. For this reason, it is dangerous for stool to remain in the colon for a long time. Constipation is a symptom with many causes.”

Akaehomen, who stated that the causes are of two types explained that, “Obstructed defecation and colonic stool transit (or hypomobility causes can be divided into congenital (from birth), primary and secondary. The most common cause is primary and not life threatening. Primary or functional constipation is ongoing symptom for more than six months not due to any underlying cause such as medication side effects, or an underlying medical condition.”

The medical personnel further explained that, “constipation can be caused, or exacerbated by a low fibre diet. Fibre helps to make the stool bulky for easy passage through the alimentary canal. It is, however, important to add high fibre diet, which also requires the person to drink lots of water, or liquid, as low liquid intake can also lead to constipation.”

Akaehomen informed that many medications have constipation as a side effect and these include, opiods, diuretics, antidepressants, antihistamine and aluminium antacids.

“Certain calcium channel blockers such as Nifedipine and Verapamil can cause severe constipation due to dysfunction of mobility in the rectosigmoid colon. Constipation can also be caused by metabolic disorders like hypercalcaemia, hypothyroidism, diabetes and celiac disease,” he said

“Structural causes of constipation include spinal cord lesion, parkinsons, colon cancer, and pelvic floor dysfunction, while functional (neurological) causes of constipation, include anismus, descending perineum syndrome and Hirschsprung’s disease. Voluntary withholding of stool is a common cause of constipation. The choice to withhold can be due to factors such as fear of pain, fear of public restrooms or laziness, and unfamiliar or dirty environments,” the medical director stated.

He enumerated symptoms of constipation to include abdominal discomfort, feeling of bloating, bowel movements that are difficult to pass, very firm or made up of small hard pellets. Other symptoms include distention, abdominal pain, headache, a feeling of fatigue and nervous exhaustion, or a sense of incomplete emptying, even as he added that diagnosis is made from the patient’s description of the symptoms.

So, “Inquiring about dietary habits will often reveal a low intake of dietary fiber, inadequate amount of fluids, poor ambulation or immobility or medications that are associated with constipation. During physical examination, manually palpable lump of stool may be defecated on palpation of the abdomen.

“Rectal examination gives information about the consistency of the stool. This is because bowel habits are different from one person to another. There is no fixed time for someone to seek medical attention if one has not moved his or her bowels. Some people move bowels daily, while others every two to three days, so if you think there has been an increase in the time and there are other associated symptoms, it is advisable to seek medical help.”

On how to treat constipation, he said, “Treatment of constipation should focus on the underlying cause if known. In chronic constipation of unknown cause, the main treatment involves the increased intake of water and fibre, either directly or as supplements. Stimulant laxatives, including herbal laxatives should be used as a last resort and long-term use is unsafe and should be discouraged because they may permanently damage the intestine, and worsen constipation.

“Complications that can arise from constipation include hemorrhoids, anal fissures, rectal prolapsed and fecal impaction. Severe cases of constipation may exhibit symptoms of bowel obstruction (vomiting, very tender abdomen) and encopresis, where soft stool from the small intestine bypasses the mass of impacted fecal matter in the colon.”

Akaehomen, who said it is usually easier to prevent constipation than to treat it said, “Adequate exercise, fluid intake and a high fibre diet; fruits, veggies, whole grains etc are recommended. Children benefit from scheduled toilet breaks, once early in the morning and 30 minutes
after meals.”