Constipation, costiveness, or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest. It may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. The term obstipation is used for severe constipation that prevents passage of both stools and gas. Causes of constipation may be dietary, hormonal, anatomical, a side effect of medications (e.g. some painkillers), or an illness or disorder. Treatments consist of changes in dietary and exercise habits, the use of laxatives, and other medical interventions depending on the underlying cause.
Causes:
The main causes of constipation include:
* Hardening of the feces
Improper mastication (chewing) of food.
Insufficient intake of dietary fiber.
Dehydration from any cause or inadequate fluid intake.
Medication, e.g. diuretics and those containing iron, calcium, aluminum.
Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along.
Hypothyroidism (slow-acting thyroid gland).
Hypokalemia.
Injured anal sphincter (patulous anus).
Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants.
* Severe illness due to other causes
Acute porphyria (a rare inherited condition).
Lead poisoning.
* Dyschezia (usually the result of suppressing defecation).
* Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass
Stenosis (Strictures).
Diverticula.
Tumors, either of the bowel or surrounding tissues.
Retained foreign body or a bezoar.
* Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
Functional constipation.
Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain.
* Smoking cessation (nicotine has a laxative effect).
* Abdominal surgery, other types of surgery, childbirth.
Symptoms:
Following are the major constipation symptoms:
1. Difficulty in elimination of the hard faecal matter.
2. Cramping in a lower abdomen.
3. Mouth ulcer.
4. Bad breath.
5. Nausea.
6. Headache.
7. Coated tongue.
8. Dullness on skin.
Diagnosis:
The diagnosis is essentially made from the patient's description of the symptoms। Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.
During physical examination, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.
X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms।
Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation।
Treatment:
In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.
Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. hyponatremia may occur in some cases especially in diabetics.
In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter.
Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli.
Causes:
The main causes of constipation include:
* Hardening of the feces
Improper mastication (chewing) of food.
Insufficient intake of dietary fiber.
Dehydration from any cause or inadequate fluid intake.
Medication, e.g. diuretics and those containing iron, calcium, aluminum.
Paralysis or slowed transit, where peristaltic action is diminished or absent, so that feces are not moved along.
Hypothyroidism (slow-acting thyroid gland).
Hypokalemia.
Injured anal sphincter (patulous anus).
Medications, such as loperamide, opioids (e.g. codeine & morphine) and certain tricyclic antidepressants.
* Severe illness due to other causes
Acute porphyria (a rare inherited condition).
Lead poisoning.
* Dyschezia (usually the result of suppressing defecation).
* Constriction, where part of the intestine or rectum is narrowed or blocked, not allowing feces to pass
Stenosis (Strictures).
Diverticula.
Tumors, either of the bowel or surrounding tissues.
Retained foreign body or a bezoar.
* Psychosomatic constipation, based on anxiety or unfamiliarity with surroundings.
Functional constipation.
Constipation-predominant irritable bowel syndrome, characterized by a combination of constipation and abdominal discomfort and/or pain.
* Smoking cessation (nicotine has a laxative effect).
* Abdominal surgery, other types of surgery, childbirth.
Symptoms:
Following are the major constipation symptoms:
1. Difficulty in elimination of the hard faecal matter.
2. Cramping in a lower abdomen.
3. Mouth ulcer.
4. Bad breath.
5. Nausea.
6. Headache.
7. Coated tongue.
8. Dullness on skin.
Diagnosis:
The diagnosis is essentially made from the patient's description of the symptoms। Bowel movements that are difficult to pass, very firm, or made up of small rabbit-like pellets qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distention, abdominal pain, or a sense of incomplete emptying.
During physical examination, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not; if so, then suppositories or enemas may be considered. Otherwise, oral medication may be required. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.
X-rays of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms।
Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of content and are vital for normal defaecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction. Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation।
Treatment:
In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.
Lactulose, a non absorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants etc. may be of value. Electrolyte imbalance e.g. hyponatremia may occur in some cases especially in diabetics.
In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often include the breakdown of impacted and hardened fecal matter.
Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli.
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