WHAT IS CONSTIPATION?
Given the range of normal, the term constipation may mean different things to different people. For some, constipation may mean infrequent bowel movements. To others, it is a hard, difficult-to-pass stool that requires excessive straining that may cause pain as it passes. And to others still, constipation may mean a bowel movement which does not completely evacuate and leaves the person with a sense as if they “still need to go.” Constipation is often associated with a bloating sensation, mild nausea, and mild cramping pain, all of which are generally relieved by bowel movements.
About 80 percent of people suffer from constipation at some time during their lives, and brief periods of constipation are normal. Constipation may be diagnosed if bowel movements occur fewer than three times weekly on an ongoing basis. Widespread beliefs, such as the assumption that everyone should have a movement at least once each day, have led to overuse and abuse of laxatives.
WHAT CAUSES CONSTIPATION?
Most often, constipation is due to any combination of three factors:
- A low fiber diet
- Poor fluid intake
- Lack of physical activity or exercise
The other causes that must be considered. First, specific medical conditions can cause constipation, including diabetes, low thyroid hormone (hypothyroidism) and depression. Other less common diseases such as scleroderma, Parkinson’s disease and multiple sclerosis can also contribute to constipation issues. Medications may also lead to constipation, including those commonly prescribed for pain relief, high blood pressure, antidepressants, psychiatric drugs and antacids.
Unfortunately, there can also be serious causes of constipation. Diseases that cause inflammation, such as diverticulitis or Crohn’s disease can cause excessive scarring and narrowing of the colon. In addition, tumours or growths in the colon can physically block the bowel.
WHEN SHOULD I SEE A DOCTOR ABOUT CONSTIPATION?
Any persistent change in bowel habit, increase or decrease in frequency or size of stool or an increased difficulty in evacuating warrants evaluation. Whenever constipation symptoms persist for more than three weeks, you should consult your physician. If blood appears in the stool, consult your physician right away.
HOW CAN THE CAUSE OF CONSTIPATION BE DETERMINED?
Constipation may have many causes, and it is important to identify them so that treatment can be as simple and specific as possible. Your doctor will want to check for any anatomic causes, such as growths or areas of narrowing in the colon.
Digital examination of the anorectal area is usually the first step, since it is relatively simple and may provide clues to the underlying causes of the problem. Examination of the intestine with either a flexible lighted instrument or barium x-ray study may help pinpoint the problem and exclude serious conditions known to cause constipation, such as polyps, tumours, or diverticular disease. If an anatomic problem is identified, treatment can be directed toward correcting the abnormality.
Other tests may identify specific functional causes to help direct treatment. For example, "marker studies," in which the patient swallows a capsule containing markers that show up on x-rays taken repeatedly over several days, may provide clues to disorders in muscle function within the intestine. Other physiologic tests evaluate the function of the anus and rectum. These tests may involve evaluating the reflexes of anal muscles that control bowel movements using a small plastic catheter, or x-ray testing to evaluate function of the anus and rectum during defecation.
In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific.
HOW IS CONSTIPATION AVOIDED OR TREATED?
Generally, constipation is treated by following the basics of good intestinal health:
- A high fiber diet
- Proper daily fluid intake
- Regular physical activity and exercise
Twenty-five to thirty-five grams of fiber is the recommended daily amount of dietary fiber. A diet rich in whole grain breads, cereals and fiber bars, in addition to fresh fruits and vegetables, often will improve bowel habits by adding bulk to the stool.
Drinking six to eight glasses of water per day helps relieve constipation by preventing stool from being hard, which makes it easier to pass stool through the colon.
Lastly, regular exercise, which can be as simple as taking a brisk walk for 30 minutes per day, will likely improve bowel movements.
There are many different over-the-counter laxatives available. The way in which laxatives work varies by laxative type, but they can be very effective for fast relief of constipation. Although it may be necessary to take laxatives on a regular basis, you should only do so after consultation with your medical provider.
Designating a specific time each day to have a bowel movement also may be very helpful to some patients. In some cases, bio-feed- back may help to retrain poorly functioning anal sphincter muscles. Only in rare circumstances are surgical procedures necessary to treat constipation. Your colon and rectal surgeon can discuss these options with you in detail to determine the best treatment for you.
WHO IS A COLON & RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions.
