Disease: Constipation

Overview

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Constipation is generally described as having fewer than three bowel movements a week.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms.

Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found.

Source: http://www.mayoclinic.com

Symptoms

Signs and symptoms of chronic constipation include:

  • Passing fewer than three stools a week
  • Having lumpy or hard stools
  • Straining to have bowel movements
  • Feeling as though there's a blockage in your rectum that prevents bowel movements
  • Feeling as though you can't completely empty the stool from your rectum
  • Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Constipation may be considered chronic if you've experienced two or more of these symptoms for the last three months.

When to see a doctor

Make an appointment with your doctor if you experience unexplained and persistent changes in your bowel habits.

Source: http://www.mayoclinic.com

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

  • Anal fissure
  • Bowel obstruction
  • Colon cancer
  • Narrowing of the colon (bowel stricture)
  • Other abdominal cancer that presses on the colon
  • Rectal cancer
  • Rectum bulge through the back wall of the vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause muscles in the colon and rectum to contract and move stool through the intestines. Causes include:

  • Autonomic neuropathy
  • Multiple sclerosis
  • Parkinson's disease
  • Spinal cord injury
  • Stroke

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

  • Inability to relax the pelvic muscles to allow for a bowel movement (anismus)
  • Pelvic muscles don't coordinate relaxation and contraction correctly (dyssynergia)
  • Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

  • Diabetes
  • Overactive parathyroid gland (hyperparathyroidism)
  • Pregnancy
  • Underactive thyroid (hypothyroidism)

Source: http://www.mayoclinic.com

Diagnosis

In addition to a general physical exam and a digital rectal exam, doctors use the following tests and procedures to diagnose chronic constipation and try to find the cause:

  • Blood tests. Your doctor will look for a systemic condition such as low thyroid (hypothyroidism).
  • Examination of the rectum and lower, or sigmoid, colon (sigmoidoscopy). In this procedure, your doctor inserts a lighted, flexible tube into your anus to examine your rectum and the lower portion of your colon.
  • Examination of the rectum and entire colon (colonoscopy). This diagnostic procedure allows your doctor to examine the entire colon with a flexible, camera-equipped tube.
  • Evaluation of anal sphincter muscle function (anorectal manometry). In this procedure, your doctor inserts a narrow, flexible tube into your anus and rectum and then inflates a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows your doctor to measure the coordination of the muscles you use to move your bowels.
  • Evaluation of anal sphincter muscle speed (balloon expulsion test). Often used along with anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.
  • Evaluation of how well food moves through the colon (colonic transit study). In this procedure, you may swallow a capsule that contains either a radiopaque marker or a wireless recording device. The progress of the capsule through your colon will be recorded over several days and be visible on X-rays.

    In some cases, you may eat radiocarbon-activated food and a special camera will record its progress (scintigraphy). Your doctor will look for signs of intestinal muscle dysfunction and how well food moves through your colon.

  • An X-ray of the rectum during defecation (defecography). During this procedure, your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.
  • MRI defecography. During this procedure, as in barium defecography, a doctor will insert contrast gel into your rectum. You then pass the gel. The MRI scanner can visualize and assess the function of the defecation muscles. This test also can diagnose problems that can cause constipation, such as rectocele or rectal prolapse.

Source: http://www.mayoclinic.com

Complications

Complications of chronic constipation include:

  • Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.
  • Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.
  • Stool that can't be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.
  • Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

Source: http://www.mayoclinic.com

Prevention

The following can help you avoid developing chronic constipation.

  • Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran.
  • Eat fewer foods with low amounts of fiber such as processed foods, and dairy and meat products.
  • Drink plenty of fluids.
  • Stay as active as possible and try to get regular exercise.
  • Try to manage stress.
  • Don't ignore the urge to pass stool.
  • Try to create a regular schedule for bowel movements, especially after a meal.
  • Make sure children who begin to eat solid foods get plenty of fiber in their diets.

Source: http://www.mayoclinic.com

Alternative medicine

Many people use alternative and complementary medicine to treat constipation, but these approaches have not been well-studied. Using a probiotic such as bifidobacterium or lactobacillus may be helpful, but more studies are needed. Fructooligosaccharide, a sugar that occurs naturally in many fruits and vegetables, may be helpful as well. Researchers currently are evaluating the usefulness of acupuncture.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

  • Increase your fiber intake. Adding fiber to your diet increases the weight of your stool and speeds its passage through your intestines. Slowly begin to eat more fresh fruits and vegetables each day. Choose whole-grain breads and cereals.

    Your doctor may recommend a specific number of grams of fiber to consume each day. In general, aim for 14 grams of fiber for every 1,000 calories in your daily diet.

    A sudden increase in the amount of fiber you eat can cause bloating and gas, so start slowly and work your way up to your goal over a few weeks.

  • Exercise most days of the week. Physical activity increases muscle activity in your intestines. Try to fit in exercise most days of the week. If you do not already exercise, talk to your doctor about whether you are healthy enough to start an exercise program.
  • Don't ignore the urge to have a bowel movement. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.

Source: http://www.mayoclinic.com

Risk factors

Factors that may increase your risk of chronic constipation include:

  • Being an older adult
  • Being a woman
  • Being dehydrated
  • Eating a diet that's low in fiber
  • Getting little or no physical activity
  • Taking certain medications, including sedatives, narcotics, some antidepressants or medications to lower blood pressure
  • Having a mental health condition such as depression or an eating disorder

Source: http://www.mayoclinic.com

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