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Constipation is defined as infrequent bowel movements, less than 3 a week, or experiencing difficulty when passing stools. With chronic constipation, this situation persists for several weeks or even longer.

Having occasional constipation occurs commonly, but some individuals experience constipation that interferes with their quality of life and this needs to be managed.

Causes

Constipation occurs when stool moves through the digestive tract too slowly, or can't be eliminated properly from the rectum, and this results in the stool becoming dry and hardy.

Causes of constipation include the following problems:

  • Dietary habits such as consuming refined, processed and fatty foods, increased intake of dairy products, not eating enough fibre and not drinking enough water.
  • Medications such as antacids that contain aluminium or calcium, iron supplements, narcotic medications such as codeine and morphine and anti-depressants.
  • Decreased physical activity if choosing to lead a sedentary lifestyle, but also due to surgical procedures where pain limits mobility.
  • Obstructions in the colon or rectum can be caused by anal fissures, bowel strictures causing narrowing, colon or rectal cancer or a rectocele.
  • Problems with the nerves around the colon and rectum as a result of multiple sclerosis, spinal cord injuries, stroke, autonomic neuropathy and Parkinson's disease.
  • Problems with the muscles involved in bowel evacuation such as anismus (the inability to relax the pelvis muscles), dyssynergia or weak pelvic muscles.
  • Conditions that cause hormones imbalances such as diabetes, hyperparathyroidism, hypothyroidism and pregnancy.

Symptoms

Symptoms and signs of constipation include:

  • Having less than 3 bowel movements a week.
  • Producing hard or lumpy stools that can also look like pellets.
  • Sensation of blockage in the rectum preventing passage of stool.
  • Having to strain during bowel movements.
  • Requiring help to empty your bowels by pressing on your abdomen or using a finger to remove stool.
  • It feels as if you can't completely empty the stool from your rectum.

Complications

Constipation may result in the following complications:

  • Haemorrhoids, which are swollen veins of the rectum and anus from straining.
  • Anal fissures, which are tears in the anus caused by large, hard stools.
  • Fecal impaction, which is caused by accumulated hard stools in the colon.
  • Rectal prolapse.

Management

Diet and lifestyle changes

  • Increase your fibre intake through bran products, fruit and vegetables.
  • Avoid processed and fatty foods, as well as reduce intake of dairy products.
  • Increase your water intake, especially during warmer weather.
  • Avoid medications that cause constipation.
  • Increase you physical activity.
  • Don't ignore the call to have a bowel movement.

Laxatives

  • Fiber supplements, that add bulk to your stool such as psyllium and methylcellulose fibre.
  • Stimulants such as bisacodyl and senna to cause your intestines to contract.
  • Osmotics such as oral magnesium help fluids move through the colon. 
  • Stool softeners such as docusate moisten the stool by drawing water from the intestines.
  • Lubricants such as mineral oil allow stool to move through your colon easier.
  • Fleet enemas and suppositories such as glycerin.

Alternative medication

  • Probiotic such as lactobacillus or bifidobacterium may be helpful.
  • Fructooligosaccharide, which is a sugar that occurs naturally in many fruit and vegetables.

Surgical intervention

Surgery is reserved in patients where all the above-mentioned suggestions have failed or in those who are already experiencing complications.

 

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