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Causes and symptoms of constipation

Is constipation dangerous if it is not chronic? What are the diseases and conditions that can lead to constipation?

Constipation! The idea has been used in movies to get a few laughs, but for those who have this condition, it certainly is not funny.

It is not unusual for me to go two to three weeks without a bowel movement! I have turds as hard as depleted uranium and with the diameter of a 4- year old child's arm. Visits to the toilet have become long and laborious. Sometimes I feel as though I am a prisoner to my bathroom , says a person dealing with this condition.

Constipation is the most common gastrointestinal complaint anywhere in the world. It is a digestive disorder in which bowel movements result in passage of small amounts of hard, dry stool, less than three times a week. Straining hard to defecate and inability to defecate at will is also considered as constipation by some physicians. (Read: Does coffee cause constipation or relieve it? What else to eat or avoid?)

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Do not confuse constipation with chronic constipation. Constipation is a short-term problem that can be resolved with laxatives and other medicines.

What causes constipation?

Normally, as the indigestible food matter passes through the colon, water is absorbed by the colon and waste in the form of solid stool is formed. The colon muscles contract and push the stool toward the rectum. But sometimes your colon muscle contractions can be sluggish or slow, this results in the stool moving through the colon too slowly, so, too much water is absorbed, and the stool becomes hard. It is termed slow transit constipation.

You may also suffer from constipation if you have pelvic floor dysfunction or defecatory disorders.

The third kind of constipation is normal transit constipation. Here you may have the symptoms of constipation but on examination, the colonic transit appears to be normal. Usually, these types of complaints come from patients with psychosocial stress. This category of constipation responds very well to laxatives. (Read: Try this homemade mixture for instant constipation relief)

Risk factors for constipation

Risk factors for constipation include

  • Low socio-economic status
  • Low physical activity
  • Depression
  • Stressful life events
  • Physical and sexual abuse
  • Medications such as analgesics, antihistamines, antipsychotics, antihypertensives, antacids, calcium and iron supplements, and even oral contraceptives. [ 1]

Low dietary fibre intake may also cause constipation in some people but not always. Increasing fibre intake may not always help you reverse constipation. Similarly, a review study published in the World Journal of Gastroenterology suggests that drinking more than 2 litres of water per day is not going to significantly modify your stool consistency and frequency of evacuation. [2] (Read: Aloe vera latex the best remedy for relieving constipation)

Symptoms of constipation

Although each one of us may experience symptoms differently, the most common symptoms are

  • Difficult and painful bowel movements
  • Infrequent bowel movements, usually less than three times a week
  • Bloating
  • Abdominal pain
  • Feeling sluggish

But then your doctor will ask you about any alarm symptoms of constipation you may be experiencing[ 3], such as

  • Unintentional weight loss
  • Abdominal or rectal masses
  • Rectal bleeding
  • Vomiting
  • Severe or lot of abdominal pain
  • Whether you are still passing gas
  • Family history of colon cancer or inflammatory bowel disease (IBD)
  • Abnormal test results, viz., anaemia or iron deficiency
  • If your age is older than 50 years with recent onset of symptoms

If you have one or more of these symptoms, you may need to go for additional investigations to rule out diseases such as colon cancer.

Diseases and conditions that can cause constipation

Chronic constipation is certainly uncomfortable, it is not dangerous according to doctors. However, constipation can indicate a number of conditions, severe and not so severe, but all of them require medical attention. (Read: A vibrating capsule to help cure constipation?)

1. Gastrointestinal disorders

o Diverticulosis. It is a condition in which pouches form in the wall of the colon, which in itself do not cause any painful symptoms. The problems begin if these pouches become inflamed (diverticulitis).

o Hirschsprung disease. Also known as congenital megacolon, it is a disease in which nerves are missing from a part of the bowel causing blockage of large intestine. The disease is congenital, that is, present from birth. Symptoms include severe constipation, bilious vomiting, and abdominal distention. The child may get the symptoms within first few weeks or months of life. [ 4 ]

o Irritable bowel syndrome (IBS). It is a common colon disorder characterized by chronic abdominal pain, discomfort, bloating, diarrhoea and constipation.Actually, it is very difficult to make a separation between the two disorders (chronic constipation and IBS). The only difference is chronic abdominal pain and /or discomfort relieved by defecation, which is typical of IBS. [ 2 ]

o Acquired megacolon. Megacolon is an abnormal widening of the colon. The disorder in children results from faulty toilet training and mental disturbance; the child refuses to try to defecate. Over time, the child s rectum becomes filled with impacted faeces, and the colon enlarges. In adults, the condition may occur because of certain medication, diabetes, thyroid problems, or scleroderma.

o Pelvic floor dysfunction. Bladder, uterus in women, prostate in men, and rectum form the pelvic area. The muscles of these organs control and regulate the bowel and bladder movements. Problems in the functioning of these muscles cause ongoing pain in the pelvic region, painful urination, pain during intercourse if you are a woman, and of course constipation.

o Rectocele (prolapse of the wall between the rectum and vagina) and colon stricture (abnormal narrowing of the colon may be due to scar tissue or to a tumour).

2. Cancer, for example, colorectal cancer, or cancer related causes, such as dehydration and intestinal radiation.

3. Endocrine and metabolic disorders, for example, diabetes, thyroid problems,hormonal changes, hypercalcemia (increased calcium levels in the blood), hypocalcemia (decreased calcium levels in the blood), hypokalemia(decreased potassium levels in the blood), hypomagnesemia (decreased levels of magnesium in the blood), and uraemia (increased levels of urea and other nitrogenous compounds in the blood leading to kidney failure).

4. Neurologic conditions such as dementia, multiple sclerosis, muscular dystrophy, Parkinson disease, stroke, and problems with the spinal cord.

5. Psychological disorders such as depression, anxiety, and eating disorders. Prevalence of mood and anxiety disorders among patients with constipation is higher than in the general population found researchers from University of Teheran, Iran, and they felt it is necessary to have an intervention program for comorbid psychological dysfunctions which affect the course of gastrointestinal disorders .According to them Helping constipated patients manage and express their emotions especially stress management techniques, or helping them resolve their anxiety through experiential psychotherapeutic methods, can reduce the severity of constipation symptoms. [ 5 ]

Sometimes conditions like appendicitis, intestinal parasites, premenstrual syndrome, and pericarditis (swelling and inflammation of the pericardium, the sac surrounding your heart) can have similar symptom as constipation.

Do not ignore the symptoms of chronic constipation. Check with your doctor even if you feel your condition is not dangerous.

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Reference:

  1. Bharucha AE, Pemberton JH, Locke GR. American Gastroenterological Association Technical Review on Constipation. Gastroenterology. 2013;144(1):218-238. doi:10.1053/j.gastro.2012.10.028.
  1. Bellini M, Gambaccini D, Usai-Satta P, et al. Irritable bowel syndrome and chronic constipation: Fact and fiction. World Journal of Gastroenterology : WJG. 2015;21(40):11362-11370. doi:10.3748/wjg.v21.i40.11362.
  1. Schuster BG, Kosar L, Kamrul R. Constipation in older adults: Stepwise approach to keep things moving. Canadian Family Physician. 2015;61(2):152-158.
  1. Pashankar DS. Childhood Constipation: Evaluation and Management. Clinics in Colon and Rectal Surgery. 2005;18(2):120-127. doi:10.1055/s-2005-870894.
  2. Hosseinzadeh ST, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterology and Hepatology From Bed to Bench. 2011;4(3):159-163.


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