Constipation is when the affected individual finds it difficult to pass stool through their system. The condition or severity may vary from person to person, but generally, having less than three bowel movements in a week can be termed constipation. The majority of the cases occur due to dietary irregularities, although there may be several other causative factors. It can be managed with modification in diet and other measures. Severe constipation can lead to multiple complications and requires emergency medical attention.
Constipation occurs due to multiple different factors. Some of the most common factors are related to your diet and fluid intake. Eating foods that are less in fiber or drinking less water are major causes. Other habits such as a sedentary lifestyle, less exercise, irregular routine, etc., can also lead to constipation. Many medications may also cause constipation as a side effect. These medications include antidepressants, opioids, antihistamines, diuretics, antacids, etc. This is another reason why constipation has been noticed more in older adults since they usually have a sedentary lifestyle, a less fiber diet, and a greater intake of medications. Anatomical abnormalities of the intestines or other gastrointestinal diseases can also obstruct the normal movement of the bowel. Systemic diseases that may cause constipation include diabetes mellitus, hypothyroidism, hyperthyroidism, celiac disease, chronic kidney disease, systemic sclerosis, cystic fibrosis, etc. Some children or adults may have the habit of withholding their stools or not having bowel movements for extended periods. This can be due to multiple psychological factors and needs to be corrected early. Pregnancy can also cause constipation because the bowel movements are restricted due to the growth of another body within the uterus.
The most common risk factors associated with the development of constipation are dietary insufficiency and dehydration. If you eat food with less fiber content or drink too little water, you may be at risk of developing constipation. People above the age of 60 are particularly at risk because they can’t often exercise, maintain a proper diet, and have other underlying secondary diseases like diabetes, thyroid disease, etc. Intake of certain medications such as opioids, antidepressants, diuretics, etc., may also put you at risk. The presence of pre-existing systemic disorders or abnormalities in the gastrointestinal system may obstruct or slow down normal bowel movement. Pregnancy is another risk factor that may lead to difficulty in defecation.
Constipation affects a large number of people every year around the world. It can occur at any age, although it has been prevalent among older people above 60. Females are more commonly affected than males, which may be related to monthly hormonal changes and pregnancy.
Common signs and symptoms of constipation include difficulty in passing stool, hard or dry feces, decreased frequency of bowel movement, abdominal fullness, bloating, pain in the stomach or anal region, and feeling of incomplete bowel movement. The affected person always has to put extra effort to pass stool which may or may not be accompanied by pain. You may also experience a lack of appetite or nausea/vomiting in such conditions. In severe cases, the stool may contain blood, which is a sign of ruptured vessels in the anus or rectum.
The diagnosis of constipation requires a detailed history of the patient’s dietary and bowel habits. This may be followed by a thorough clinical examination, especially the abdomen and rectal region. The majority of the cases of constipation are diagnosed based on history and examination alone. Suppose your doctor suspects another disease that may be the actual underlying cause; they may require complete blood count (CBC), serum electrolytes level, thyroid function tests, etc., to rule out those diseases. An abdominal x-ray may be done in case of intestinal obstruction. The x-ray will aid in visualizing the size of stool dislodged in the intestines.
Other diseases with abdominal pain and similar symptoms need to be differentiated from constipation. These diseases include irritable bowel syndrome (IBS), cancer of the colon or other parts of the gastrointestinal tract, anal fissure, rectocele, diabetic neuropathy, systemic sclerosis, Parkinson’s disease, etc.
The treatment of the majority of the cases of constipation is done by improving dietary habits, drinking more fluids, and intake of laxatives if required. Affected individuals are suggested to eat higher fiber content such as whole wheat, oatmeal, fruits, vegetables, etc. Fiber supplements are also available in pharmacies to be used as prescribed by your doctor. Exercise, walking, or other physical activities are also beneficial in reducing chronic constipation. In moderate cases, laxatives may be prescribed to stimulate the flow of bowel movement. In cases of severe constipation, which require medical attention, laxatives and enemas are the first options. Enema is the injection of fluid into the rectum to stimulate the bowel movement. Very rare cases may require surgical intervention to relieve symptoms.
Laxatives such as milk of magnesia or polyethylene glycol can loosen the stool to facilitate its movement. Other medicines may include bulk-forming agents such as Citrucel, Metamucil etc., stimulants such as Correctol, Dulcolax, etc., and stool softeners such as Colace, Docusate, etc.
The overall prognosis of constipation is good, and most patients can be treated effectively with lifestyle modifications and prescribed medications. Very rare cases can lead to extensive complications that may disturb the functions of the rest of the organs.
Prevention of constipation requires modifications in diet and lifestyle. Eating a high-fiber diet and drinking plenty of water is the basic preventive method. Exercising or performing other physical activities also regulates regular bowel movements. Avoid sitting or lying down for too long as much as possible. Older people should also be encouraged to move around or walk every once in a while, especially if they have other systemic illnesses. Avoid withholding your stool on purpose and defecate whenever you feel the urge to avoid developing constipation.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 15, 2023.
Constipation - NIDDK (nih.gov)
Constipation - NHS (www.nhs.uk)