Constipation

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What is constipation? - Constipation refers to reduction in the frequency of bowel movement (passing stool). Normally, the frequency of bowel movement is unique to every individual and varies from person to person. While some may move bowel once or twice a day, others may do so once in two days. When there is reduction in this normal frequency for an individual, the person is said to have constipation.

However, generally, when the frequency of bowel movement is less than three times a week, it is regarded as constipation. When, eventually, the individual passes stool, it often comes with difficulty; may be scanty and dry. There is no age restriction to constipation. It is a common complaint across all age groups.

How is stool formed?

The intestine is designed to digest food and absorb the nutrients needed by the body from it. It then moves the indigestible part of the food (roughage), by muscular contraction of its wall, down to the rectum, to be passed out as stool through the anus. During this movement, water is absorbed from the stool so that by the time it appears as the anus, to be passed out, it is well formed as a solid mass.

However, if the stool stays too long inside the large intestine (colon), either taking long before arriving the rectum or staying too long in the rectum before being passed out, too much water is absorbed from it. Consequently, it becomes too hard by the time it comes out through the anus.

Why does constipation occur?

Constipation occurs when the transit time, between the time food is eaten and the time it gets to the rectum, is increased. This results in excess water being absorbed from the food as it forms stool, while moving down the gastrointestinal tract.

The stool then becomes dry and hard by the time it gets to the rectum, making it difficult to pass out. The increased transit time may be due to problem with the tone of the muscles of the intestine or the content of the food eaten.

What are the causes of constipation?

The following are the possible causes of constipation. They all have one thing in common: increased transit time of intestinal contents, thereby allowing excess water to be absorbed from the stool.

  1. Too little fibre in the diet - This leads to less bulky waste to move down the bowel.
  2. Not eating frequently - This makes the available waste scanty.
  3. Not taking adequate liquids - Makes it difficult to move waste down the intestine.
  4. Drugs such as iron supplements, antacids, narcotics, antidepressants etc - Reduce muscle contraction capacity.
  5. Lack of exercise - Reduces the speed with which waste moves down the intestine.
  6. Suppression of the urge to move bowel - Keeps stool for too long in the rectum, leading to absorption of excess water from it.
  7. Diseases of the intestine such as diverticulum (distension of the intestine) - This leads to over-distension of bowel which accommodates large quantity of stool, preventing it from moving down the intestine.
  8. Change of environment such as travelling to a new place - The need to study the new environment usually leads to reduction in the urge to defecate.

What are the symptoms of constipation?

The following are some of the symptoms of constipation:

  1. Passing stool fewer than three times a week (or fewer than normal for the person).
  2. Passing hard and dry stool, often with difficulty.
  3. Feeling of incomplete emptying of the bowel.
  4. Feeling bloated / abdominal distension.
  5. Abdominal pain / cramps.

What are the treatment options for constipation?

Treatments for constipation depend on the identified causes. Options include:

  1. Diet modification - Diet with high fibre contents such as vegetables, fruits, beans, yam, rice, maize etc should form significant part of the meal for such person. Refined or processed foods, such as energy drinks, ice creams, custard, pap  etc should be minimized as they contain less fibre.
  2. Laxatives - These help to increase the bulk of stool, thereby increasing intestinal movement of stool.
  3. Change of medication - This removes the offending drug which prevents adequate intestinal muscular contraction.

What are the complications of constipation?

The following are some of the complications of constipation:

  1. Fecal impaction - In this case, the hard stool tightly packs in the rectum or lower part of the large intestine (colon) so much that straining effort is not enough to expel it. It may require manual evacuation or enema (injection / pumping of water into the rectum through the anus in order to soften the stool inside and provoke defecation). 
  2. Haemorrhoids - These are prominent congested blood vessels around the anal canal. They result from persistent straining that puts pressure on those veins; and may burst open in the process, resulting in bleeding.
  3. Anal fissure - This refers to tear in the skin around the anus, resulting from overstretching of the anal sphincter muscles by hard stool. It may be very painful.
  4. Rectal prolapse - This refers to involuntary pushing out of part of the lining of the intestine through the anal opening.

What are the preventive measures for constipation?

The following steps can help prevent constipation:

  1. Drinking adequate water - Adequacy of water intake can be known by checking urine colour which should be amber (slight yellow). whenever urine is deeply yellow, it indicates inadequate water intake.
  2. Addition of fruits and vegetables to food - These increase the bulk of the intestinal contents and thereby promote intestinal movement. 
  3. Eating balanced diet with adequate fibre - These include beans, yam, rice etc, with fruits and vegetables. They also help increase intestinal contents that promote intestinal movement. 
  4. Regular exercise - Exercise that involves movement can help bowel movement.
  5. Moving bowel when there is urge - It is important to pass stool when there is the urge to do so as delay in bowel movement encourages continuous absorption of water from the stool, making it hard and difficult to pass. 
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