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Constipation

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refers to a condition where bowel movements occur less frequently than normal, with hard stools or difficulty passing stools. Symptoms may include straining during bowel movements, spending a long time on the toilet, incomplete evacuation, a sensation of needing to defecate again shortly after a bowel movement, or requiring assistance, such as using fingers or water, to aid defecation.

Causes of Constipation
1. Medical Conditions
  • Diabetes
  • Hypothyroidism
  • Hypercalcemia
  • Neurological conditions: e.g., brain or spinal injuries, Parkinson's disease, multiple sclerosis.
  • Reduced mobility: Common in bedridden patients.
2. Medications
Certain medications can cause constipation, including:
  • Tricyclic antidepressants: e.g., amitriptyline, nortriptyline.
  • Antispasmodics: e.g., Buscopan®.
  • Parkinson's medications.
  • Anticonvulsants: e.g., Dilantin®.
  • Antihypertensives: e.g., diltiazem, verapamil, clonidine.
  • Opioids: e.g., morphine derivatives, codeine-containing medications.
  • Iron supplements in multivitamins.
  • Calcium or aluminum-containing antacids.
  • NSAIDs: e.g., diclofenac, piroxicam, indomethacin.
  • Other drugs: e.g., cholestyramine.
3. Intestinal Obstruction
  • Tumors: Colorectal cancer or benign growths.
  • Strictures.
  • Volvulus: Twisting of the intestine.
  • Rectal abnormalities: Rectocele, rectal prolapse, anal stenosis.
4. Dysfunctional Bowel or Defecatory Muscles
  • Anorectal dysfunction (anismus): Improper coordination of anal sphincter muscles.
  • Colonic inertia: Slow bowel movements within the colon.
  • Irritable bowel syndrome (IBS).
5. Other Factors
  • Sedentary lifestyle.
  • Low fiber and water intake.
  • Poor bowel habits.
  • Pale skin.
  • Blood or mucus in stools.
  • Unexplained weight loss.
  • Family history of colorectal cancer.
  • Severe abdominal pain, bloating, nausea, or vomiting alongside constipation.
1. Medical History
Doctors will ask about:
  • Difficulty and duration of symptoms.
  • Stool characteristics.
  • Medications and underlying conditions.
  • Family history of gastrointestinal diseases.
2. Physical Examination
  • Signs of tumors, such as swelling or dry skin (indicative of hypothyroidism).
  • Neurological symptoms potentially causing constipation.
3. Rectal Examination
  • Checks for anal inflammation, hemorrhoids, or tumors.
  • Evaluates the functionality of anal sphincter muscles.
4. Laboratory and Specialized Tests
  • Blood tests: For thyroid hormone levels or calcium levels.
  • Colonoscopy: To rule out colorectal cancer in patients with warning signs.
  • Transit tests: Observes stool movement through the colon.
  • Anorectal manometry: Measures anal sphincter pressure and function.
  • Balloon expulsion test: Assesses defecation mechanics.
Straining during defecation over a long period can lead to:
  • Pelvic floor muscle descent: Excessive descent can damage nerves controlling anal sphincter function.
  • Rectal prolapse: Protrusion of the rectum.
  • Solitary rectal ulcer syndrome: Formation of large ulcers in the rectum.
1. Treat Underlying Causes
For example:
  • Removing polyps in the colon.
  • Hormone replacement therapy for hypothyroidism.
2. Improve Bowel Habits
  • Establish a routine, particularly in the morning or after meals.
  • Respond to the urge to defecate promptly.
  • Avoid suppressing the urge, as this may lead to harder stools.
3. Dietary Changes
  • Increase fiber intake for mild cases of constipation. Severe cases may require careful adjustments to avoid bloating.
  • Drink plenty of water to soften stools.
4. Regular Exercise
  • Physical activity improves intestinal motility and prevents constipation.
5. Use of Laxatives
Various laxatives act differently:
  • Bulking agents.
  • Osmotic laxatives to retain water in the colon.
  • Stool softeners.
  • Stimulant laxatives.
  • Suppositories or enemas. Always consult a doctor or pharmacist before use.
6. Biofeedback Training
  • Helps patients learn proper techniques for defecation using feedback tools.
7. Surgery
  • May be necessary for patients with slow transit constipation unresponsive to medications.
8. Other Treatments
  • Botulinum toxin injections for refractory cases.
  • Colostomy: Diverts stool to exit through an opening in the abdomen.
Last modify: December 28, 2024

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