Constipation

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Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

Some people think they are constipated if they do not have a bowel movement every day. However, normal stool elimination may be three times a day or three times a week, depending on the person.

The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.

Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

The two common types of constipation are idiopathic constipation and functional constipation. It is important to note that Irritable bowel syndrome (IBS) with predominant symptoms of constipation is categorized separately.

Idiopathic constipation is defined by the infrequent or difficult passage of the stool for a period of at least three months. It may be caused by abnormal colonic motility that can delay the movement of intestinal contents and impede evacuation. The signs and symptoms associated with chronic idiopathic constipation include abdominal pain or discomfort, bloating, straining, and hard or lumpy stools.

Functional constipation means that the bowel is healthy but not working properly. Functional constipation is often the result of poor dietary habits and lifestyle. It occurs in both children and adults and is most common in women. Colonic inertia, delayed transit, and pelvic floor dysfunction are three types of functional constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower, or sigmoid, colon.

People with IBS having predominantly constipation also have pain and bloating as part of their symptoms.

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through it, the colon absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.

The hard and dry stools of constipation occur when the colon absorbs too much water. This happens because the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly.

Common Causes of Constipation:

Symptoms associated with constipation include infrequent bowel movements, hard stools, straining when passing a motion, cramps, abdominal bloating, flatulence, with a desire to defecate but an inability to pass a stool.

Constipation can cause abdominal pain. The pain may occur only when straining during a bowel movement, although in some people the pain persists between bowel movements. Constipation can cause nausea and impair appetite. Constipation is one of the most common causes of diarrhoea, especially in the elderly in care. Diarrhoea caused by constipation is known as bypass diarrhoea.

There are many treatments for constipation, and the best approach relies on a clear understanding of the underlying cause.

Dietary fiber (bulk-forming laxatives): The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fiber supplements can be useful. There are different sources of fiber and the type of fiber varies from source to source.

Miscellaneous drugs: Several prescribed drugs that are used to treat medical diseases consistently cause (as a side effect) loose stools, even diarrhea. There actually are several small studies that have examined these drugs for the treatment of constipation. These drugs include colchicine, misoprostil (Xytotec), orlistat (Xenical), etc.

Exercise: People who lead sedentary lives are more frequently constipated than people who are active. Nevertheless, limited studies of exercise on bowel habit have shown that exercise has minimal or no effect on the frequency of bowel movements. Thus, exercise can be recommended for its many other health benefits, but not for its effect on constipation.

Biofeedback: Most of the muscles of the pelvis surrounding the anus and rectum are under some degree of voluntary control. Thus, biofeedback training can teach patients with pelvic floor dysfunction how to make their muscles work more normally and improve their ability to defecate.

Surgery: For individuals with problematic constipation that is due to diseases of the colon or laxative abuse, surgery is the ultimate treatment. During surgery, most of the colon, except for the rectum (or the rectum and part of the sigmoid colon), is removed. In patients with colonic inertia, surgery is reserved for those who do not respond to all other therapies. If the surgery is to be done, there must be no disease of the small intestinal muscles. Normal small intestinal muscles are evidenced by normal motility studies of the small intestine itself.

Electrical pacing: Electrical pacing is still in its experimental phases. Electrical pacing may be done using electrodes implanted into the muscular wall of the colon. The electrodes exit the colon and are attached to an electrical stimulator. Alternatively, stimulation of the sacral skin can be used to stimulate nerves going to the colon. These techniques are promising, but much more work lies ahead before their role in treating constipation, if any, has been defined.

Sources:
National Digestive Diseases Information Clearinghouse (NDDIC):
http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/
MedicineNet.com: http://www.medicinenet.com/constipation/page4.htm