For some adults, constipation is not an easy topic to discuss even with a doctor. However, it is an ailment which can be life-threatening in cases of extreme impacted bowels. In other cases, it may cause other maladies such as hemorrhoids.
Constipation is medically defined as fewer than three bowel movements (BM) per week. Severe constipation is defined as less than one bowel movement per week. Non-medically, constipation is defined differently to people. Some consider infrequent BMs as constipation, while others consider hard stools or straining as being constipated. Each of these definitions of the ailment is caused by something different and thus treatment needs to be tailored to each condition. The most important thing to remember is constipation is a symptom; not a disease.
What Causes Constipation?
Not drinking enough fluids – Fluids are absorbed in the intestine and the colon may not get enough water passed into it to keep stools soft if the person doesn’t drink enough. This can lead to hard dry stools.
Credit: Source: Microsoft OfficePoor diet – Foods not helpful for moving along stools are low in fiber and high in animal fat and/or refined sugar. Remember the statement about red meat staying in your system for a long time? It does take longer for unused meat product to be completely eliminated from the body than it does for unused fruit and vegetable products.
Credit: Source: MorguefileCaffeine and alcohol – Both of these cause Credit: Source: Morguefileexcessive urination which can lead to dehydration. The dehydration induces the body to absorb more water from the intestines and thus, less water is available to the colon to keep the stool soft.
Poor BM habits - A cycle of being “plugged up” may occur when a person ignores the body’s desire to eliminate.
Medications - Various medication prevent the body from eliminating waste matter. These include:
- Antacids containing aluminum hydroxide and calcium carbonate
- Antispasmodic medication
- Iron tablets
- Anticonvulsant medication
- Diuretics (they can work like caffeine and alcohol)
- Painkillers, narcotic-containing drugs
Laxative abuse – Habitual use of laxatives will create a dependency; it may also make the bowels insensitive to the laxatives so they stop working.
Irritable bowel syndrome (IBS, spastic colon) – A person with this disorder may experience among other symptoms, constipation alternating with diarrhea.
Pregnancy – During pregnancy, BMs are sometimes infrequent, usually due to dietary and activity changes, as well as body changes. Some conditions produce severe pain when trying to eliminate and this triggers a reflex spasm of the anal sphincter muscle which may delay a BM.
Intestinal obstruction – Some conditions such as gallstones or abdominal hernia, may interfere with the normal function of the bowels.
Mechanical problems of the anus and rectum – Sometimes body parts can malfunction and can cause constipation. An example of this is rectal prolapse.
Damage to nerves within the intestine – Conditions such as multiple scleroisis or spinal cord injuries or tumors may interfere with the function of the nerves supplying the intestine.
Connective tissue diseases – Conditions such as lupus can interfere with proper BM.
Thyroid malfunctioning – When the thyroid gland produces less thyroxin, hypothyroidism occurs and can cause constipation.
Metabolic disorders – Some of these disorders, such as lead poisoning can cause elimination problems.
Age – Older adults are more likely to experience problems with elimination for the following reasons:
- Poor nutrition and inadequate fluid intakeCredit: Source: Microsoft Office
- Lack of exercise
- More likely to be taking various medications that cause the problem
- More likely to have bad bowel habits
- Prolonged bed rest more likely
- Habitual use of enemas and laxatives more likely
Though there are many causes as evidenced by the above list, the majority of people with constipation have it due to poor dietary habits and inadequate fluid intake.
When to See a Doctor
Most occurrences of constipation do not require a doctor visit. However, there are times when it is necessary. Chronic constipation may indicate another health issue or lead to further health complications. Any unexplained onset of trouble with fully eliminating, a change in BM habits, or severe symptoms lasting longer than three weeks indicate a visit to the doctor is necessary. The following symptoms may indicate more serious health issues and should be checked out by a doctor as well:
- BMs more than three days apart even when changes have been made to diet and exercise
- Intense abdominal pain
- Blood in the stool
- The constipation is alternating with diarrhea
- Rectal pain
- Thin, pencil-shaped stools
- Unexplained weight loss
A general practitioner may refer a patient to a gastroenterologist who is a specialist who frequently evaluates constipation and is familiar with diagnostic testing of the condition.
While most patients don’t require extensive testing to determine the ailment, some do and those tests may include:
- Blood test to test hormonal imbalance
- Barium studies to look for obstruction of the colon
- Colonoscopy to look for obstruction of the colon
Treatment for Constipation
Treatment for the problems with elimination of fecal matter depends upon the underlying cause. Most treatments are changes in diet, increase in exercise and increase in fluid intake. Home remedies and over-the-counter (OTC) solutions include:
Credit: Source: MorguefileAdding more fiber to the diet – A minimum of five servings of fruits or vegetables daily is the best way to increase fiber. For those who need additional fiber to move the bowls, fiber supplements may have to be added. Fiber is not digested by the body’s gastrointestinal tract and therefore, one of the main treatments for constipation. Many types of fiber bind to the water in the intestine, thus keeping the water in the intestine where it then Credit: Source: Microsoft Officesoftens the stool in the colon.
Increasing fiber does cause gas and so it is wise to gradually increase the fiber. Fiber should be increased at a low dose and gradually increased. Some fibers contain sugar and diabetics should be aware of this when determining which supplement to buy.
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Lubricant laxaCredit: Source Wikimedia Commonstives – These type of laxatives contain mineral oil which stays within the intestine. The oil coats stool particles and keeps the water within the stool. Mineral oil is a short-term treatment as long-term use may lead to deficiencies of vitamins the oil absorbs. It can also cause pneumonia in very young or very old people as small amounts of oil may enter the lungs. In addition, the oil may counteract certain medications effectiveness.
Emollient laxatives (stool softeners) – Stool softeners contain docusate, a wetting agent that improves the ability of the water inside the colon to penetrate and mix with the stool. These are often used in long-term treatment and it may take a week or longer to be effective. Doses generally increase after the first or second week if there is no change in condition.
Saline laxatives - These laxatives contain non-absorbable ions such as magnesium, phosphate, sulfate and citrate. These ions stay in the colon and cause the colon to drawn in water, thus softening the stool. Magnesium also may mildly stimulate the muscles of the colon. The body absorbs some of the magnesium and is eliminated through the kidneys; thus, those with kidney problems should not use this type of laxatives.
Stimulant laxatives – These laxatives induce the small intestine andCredit: Photo by Angel Caboodle at en.wikipedia, Source: Wikimedia Commons colon muscles to push along their contents more rapidly. In addition, they increase the water in the stool by (1) reducing the absorption of water in the colon or (2) causing secretion of water in the small intestine. The most commonly used of these laxatives contain castor oil and aloe. These laxatives can cause cramping in the intestines more-so than other laxatives. The brand Ex-Lax is this type of laxative. Stimulant laxatives can cause diarrhea and subsequently dehydration and loss of electrolytes.
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Credit: Source: Microsoft OfficeEnemas – Enemas are meant to be used on occasion as frequent use can be harmful. There are numerous types of enemas. When the rectum is distended, all enemas stimulate the colon to contract and eliminate. The simplest type of enema is a tap water enema. Other types include:
- Saline enema which draws water into the colon
- Phosphate enema which stimulates the colon muscles
- Mineral oil enema which lubricates and softens the stool
- Emollient enema which contain soften agents
Suppositories – There are different types of suppositories, much like enemas, which all have different ways of acting on the colon and stool.
Combination products – There are many products available that combine types of laxatives. All of these combined types contain stimulants and therefore are not used for long-term treatment unless non-stimulants are ineffective.
Prescription Drugs are another category of treatment options for constipation. Hyperosmolar laxatives fall under this category. These laxatives are neither digestible nor absorbable and remain in the colon, retaining the water already there. This results in stool softening. These laxatives are safe to use long-term and have few side effects.[Credit: Source: Microsoft Office1] There are several other drugs doctors often prescribe to treat constipation.
Many people believe waste matter stuck in the body is absorbed by the body and therefore, dangerous to the person’s health and it may shorten the life-span. Some fear they will be poisoned by their own bodies if the fecal matter stays in the body for a certain length of time. Neither of these are true.
Most people have no physical disease related to their constipation. In the majority of cases, it is due to poor dietary habits, not drinking enough fluids and little or no exercise. recovery is determined by how sick the person is when the constipation is caused by an illness; and the person who has constipation caused by anal fissures or hemorrhoids usually recovers quite well.
The copyright of the article Bursting the Dam of Constipation in Adults is owned by Cheryl Weldon and permission to republish in print or online must be granted by the author in writing.
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