Constipation is a very common condition that occurs when bowel movements become difficult or infrequent.
It can be very difficult to pinpoint exactly what a normal bowel movement is because the length of time between bowel movements ranges widely from person to person. However, experts agree that going longer than three days without a bowel movement is too long and could cause problems because the stool becomes harder and more difficult to pass.
In this case, people often decide to use laxatives, medications that help increase the frequency of bowel movements. In most cases, they are extremely useful. It is important to remember, however, that laxatives are not without side effects, some of which can even be life-threatening and require urgent medical intervention.
Diagnostic criteria for constipation
If you have two or more of the following symptoms for at least 3 months, you are considered to suffer from constipation:
- Incomplete evacuation (meaning not passing all stool) more than 25% of the time, or having the sensation of incomplete bowel evacuation.
- Straining during your bowel movements more than 25% of the time spent on the toilet.
- Two or even fewer bowel movements in an average week.
- Hard stools more than 25% of the time.
Incidence: How common is constipation?
This condition is most common in children and older people and affects women more often than men. One in 200 women has severe, continuous constipation, which is considered to be a serious health risk. Pregnancy is a period during which constipation problems usually begin.
More than 6 million people in the UK have problems with chronic constipation. In most cases, constipation isn't the only problem; patients also suffer from hemorrhoids or anal fissures when the condition goes untreated.
Signs and symptoms of constipation
Constipation can be a sign of several different more serious disorders, but in most cases it is simply caused by a low-fiber diet or dehydration. The unfortunate combination of not drinking enough water and lacking fiber would make the stool hard and a lot more difficult to pass through the bowel.
In common constipation, the stool is hard and difficult to pass. When patients strain to pass the stool, they may cause hemorrhoids and anal fissures to appear, which additionally complicate the condition. Besides this, there could be no symptoms whatsoever. Also, in the later stages of the condition, some abdominal symptoms may appear because of abdominal distention. Most patients with chronic constipation report tenderness and cramps in the abdomen, and sometimes loud bowel sounds. Sometimes constipation can turn into one painful, disturbing, and somewhat embarrassing experience.
The most severe case of constipation is a condition called fecal impaction. This complication is accompanied by common symptoms of bowel obstruction such as:
- Vomiting
- Very tender abdomen
- Cramps
- Diffuse abdominal pain
If you suffer from constipation and notice any of these symptoms, see a doctor as soon as possible.
Possible causes of constipation
Common causes of constipation include:
- Inadequate water intake
- Inadequate fiber in the diet
- Resisting the urge to have a bowel movement, making stool harden further
- Overuse of laxatives
- Hypothyroidism
- A disruption of regular diet or routine, as seen in people who frequently travel
- Inadequate activity or exercise or immobility
- Eating large amounts of dairy products
- Stress
- Parkinson's disease or multiple sclerosis
- Antacid medicines containing calcium or aluminum
- Medicines
- Depression
- Eating disorders
- Irritable bowel syndrome
- Pregnancy
- Colon cancer
Constipation: What is the best treatment?
Treatment for constipation also varies from patient to patient, because some of them have a life-long tendency toward constipation while others tend to have only occasional constipation. While mild and intermittent constipation is usually not a cause for concern, long-term constipation is considered to be a serious health issue no matter how long it lasts.
Constipation is also considered serious if accompanied by rectal bleeding, abdominal pain and cramps, nausea and vomiting, or involuntary weight loss. Treatment options for constipation could be divided into two different groups – drug treatment (laxatives) and drug-free treatment.
Drug-free constipation treatment advice
Certain medications, an under-active thyroid, or colon obstruction can cause serious constipation. In almost all other cases, simple lifestyle modifications can help:
- Increasing fiber in the diet: Dietary fibers can significantly improve bowel function by adding bulk and softening the stool. Groceries rich in fiber are vegetables, fruit, whole grain bread, whole grain cereals, prunes, corn, whole beans, oat bran, corn, barley, and many others.
- Increasing fluid intake: A simple fluid intake increase can significantly improve your chances for a quick recovery.
- Regular exercise can also help increase the frequency of your bowel movements.
Laxatives and constipation
Laxatives are medicines that increase the frequency of bowel movements and make your bowel movements easier. There are many types of laxatives, and they come in different forms. Although most OTC (over-the-counter, can be bought without a prescription) laxatives are safe, effective, and well tolerated, they also can cause several unwanted effects.
Types and forms of laxatives
Laxatives come in many forms and, no matter which you choose, every one of them could be as effective as any other:
- Tablets, capsules or granules
- Powders (mixed with water)
- Enema
- Suppositories
- Foods
- Syrups
There are 3 types of laxatives:
1. Bulk forming laxatives: This form works by swelling up inside the bowel, which helps soften the stool and encourages bowels to move and push the stool out. They should be used 2-3 days before the fool effect!
Some of the most commonly used are:
- Celevac®
- Normacol®
- Bran®
- Fybogel®
2. Stimulant laxatives: Like the name says, these work by stimulating bowels and speeding up bowel movement. They can take 8-12 hours to work.
Some of the most commonly used are:
- Co-danthrusate (Normax®)
- Glycerol suppositories
- Senna (Senakot®)
- Syrup of figs
- Bisacodyl®
- Docusate sodium®
3. Osmotic laxatives: These highly effective laxatives work by drawing water into the bowel, making the stool softer and easier to pass. Some of the most commonly used are:
- Phosphate enemas
- Sodium citrate
- Lactulose syrup
- Macrogols
- Magnesium salts
The downside of laxatives
- Using too much laxatives can imbalance important electrolytes in the body. Electrolytes are necessary for proper functioning of nerves and muscles, including the heart muscle. A loss of electrolytes can cause muscle cramps, tremors, spasms, irregular heartbeat, and in some cases cardiac arrest.
- Dehydration is also a problem, because laxatives and enemas remove needed fluid from the body. Dehydration can lead to tremors, weakness, blurry vision, fainting spells, kidney damage, and in some cases even death. It is a condition which requires medical treatment.
- Laxatives can also irritate intestinal nerve endings, which in turn stimulate muscle contractions that move the irritant through the gut and out of the body. However, experiments have shown that, sometimes these nerve endings no longer respond to stimulation. This could be a serious problem because in most cases, patients become laxative–dependent, and without this medical stimulation may not have any bowel movement at all.
- Patients that use laxatives are more prone to infections, because the medications rip away the protective mucus that lines the colon.