Constipation: Causes, Risk Factors, Symptoms, Treatment, Prevention and Prognosis

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A man in a toilet who have constipation‬‏

1Overview

Constipation is a common digestive problem experienced by both adults and children. Sometimes, it may become symptoms of various underlying issues, rather than a disease in itself.

People have different bowel movements or habits, depending on how often they pass stools. Some people may pass stools three times a day, some may defecate only once a day and in some people, they may pass stools three times a week.

A person is considered constipated if there are lesser than three bowel movements in a week. During constipation, the bowel may become difficult to pass, painful and the stools may harden.

People may become constipated occasionally while others may experience prolonged or consistent constipation. This can interfere with the ability to perform daily tasks. Moreover, when the constipation is persistent or chronic, it may be one symptom of an underlying disease.

Though most constipation may result from an underlying condition, in some cases, a cause is never found. However, the severity of constipation differs from one person to another. Many individuals only experience constipation for a short time and this may cause significant discomfort and pain that affect the quality of life.

2Causes

Constipation is a common condition that can affect people of all ages. A particular condition does not usually cause most cases of constipation and the exact cause might be hard to identify.

Here are the possible causes of constipation:

Blockage in the large intestine or rectum

When there is an obstruction or blockage in the rectum or colon, this may lead to constipation.

  • Colon cancer and rectal cancer
  • Bowel stricture or narrowed large intestines
  • Bowel obstruction, which can be potentially fatal
  • Anal fissure
  • Rectocele
  • Other abdominal cancers that may put pressure on the colon

Medications

Some medications may have constipation as their side effect. These include:

  • Antidepressants
  • Aluminum antacids
  • Calcium supplements
  • Antiepileptics
  • Antipsychotics
  • Diuretics
  • Iron supplements
  • Opiate painkillers like morphine

Problems with colon and rectal nerves

Some neurological problems can affect the nerves that may cause the colon muscles and the rectal muscles to move through the intestines. These conditions include:

Pregnancy

Constipation occurs more frequently among pregnant women. An estimated two in every five women experience constipation during their pregnancy. The condition occurs during pregnancy because of the increase in progesterone, making it more difficult for the stool to pass through because the muscles can’t contract properly. This leads to decreased peristalsis.

Conditions that affect the hormones

The hormones in the body help keep the fluid and electrolyte balance in the body. Some diseases may alter these hormones, leading to constipation:

Other conditions

Constipation may sometimes be a sign of an underlying condition like:

Constipation in babies and children

Constipation also happens in babies and children. The most common causes of constipation in these age groups include poor diet, poor toilet training and lack of water intake.

Other conditions in babies and children that may alter the bowel habits include anorectal malformation, spinal cord abnormalities, Hirschsprung’s disease, and cystic fibrosis.

3Risk Factors of Constipation

Many factors can increase the risk of developing constipation such as:

  • Having limited privacy when using the toilet leading to the disruption of the bowel movements
  • Not having enough fiber in the diet like those found in fruits, cereals, and vegetables
  • A sudden change in the routine like variations in eating habits
  • Ignoring the feeling of defecation
  • Lack of exercise or sedentary lifestyle
  • Not drinking adequate amounts of water or fluids
  • Fever or high temperature
  • Being overweight and underweight
  • Depression
  • Anxiety
  • Other psychiatric problems like those which were caused by trauma, violence and sexual abuse

Other risk factors:

The other factors include:

  • Women
  • Age
  • Being dehydrated
  • Low fiber diet
  • Sedentary lifestyle

4Symptoms

The common signs and symptoms of constipation include:

  • Having hard and lumpy stools
  • Straining to pass stools
  • Passing fewer than three stools per week
  • Feeling the need to empty the rectum
  • Feeling as though you can’t empty the stool from the rectum

The more serious symptoms include:

  • Constipation is a new experience
  • Stomach pain
  • Unexplained weight loss
  • Still with constipation even with dietary and lifestyle changes
  • Blood or whitish mucus in the stool
  • Can’t pass the stool on your own

The condition may lead to serious complications if left untreated including:

Hemorrhoids These are inflamed veins located around the anus or rectum. A person can have hemorrhoids if you strain during bowel movements.

Torn skin in the anus or anal fissure – A hard or large stool can cause tiny wounds, lacerations or tears in the anus.

Fecal impaction – This condition happens when there is an accumulation of hard stool and it gets stuck in the colon.

Rectal prolapse – Rectal prolapse happens when the rectum sticks out of the anus. This happens when you strain during defecation.

5Treatment

Constipation can be managed through simple changes in the lifestyle and diet. It is safe to try simple measures even when you’re pregnant. In a few days, the symptoms with disappear and you will notice a difference.

Diet and lifestyle changes

Make changes in the diet

  • Drink plenty of water and fluids.
  • Avoid alcohol intake
  • Add oats and wheat in the diet
  • Increase fiber intake from fruits and vegetables

Increase the activity

  • Engage in activities or regular exercise such as walking, jogging and running
  • A daily walk can help pass poo more effectively and regularly
  • Exercise lightly even when you’re pregnant

Do not ignore the urge to defecate

  • Don’t ignore the urge to have a bowel movement.
  • Take your time in the bathroom and let yourself have a bowel movement without any disruptions.

Other measures

  • Add some bulking agents in foods like wheat bran. This will help make the stool softer.
  • Avoid dehydration by drinking adequate amounts of water
  • Follow dosages carefully for medicines, especially if these are linked to constipation
  • Keep a routine when you’re able to spend a comfortable and long time in the toilet. Choose a time when you’re not rushed to use it.

Pelvic Muscle Training

Biofeedback training – This involves using certain devices to help the patient tighten and relax the pelvic floor muscles. This training will help the patient relax the pelvic muscles at the accurate time to aid in the passing of stools.

Medicines

Laxatives – Laxatives are medicines that aid in relieving constipation by making it easier to pass stools.

The common types of laxatives include:

  • Stimulants
  • Fiber supplements
  • Osmotics
  • Lubricants
  • Enemas
  • Suppositories
  • Stool softeners

Treating fecal impaction

Fecal impaction happens when the feces become very hard and dry. They collect in the rectum, leading to a difficulty passing stools. The doctor will prescribe laxatives and in some cases, he may recommend using a suppository or a mini-enema.

Treating constipation in babies and toddlers

In babies and toddlers, just simple changes in the child’s diet and proper toilet training practices may help treat and manage constipation.

  • Make changes in the baby’s diet like giving extra water between normal feeding schedules. However, water should be given to babies who are six months and above.
  • Exercise the baby’s legs in a bicycling motion to help them defecate.
  • Older kids should be offered plenty of water and fluids. They should also be encouraged to eat more fruits to aid in defecation.

6Prevention

Many ways can help prevent constipation, including some changes in the diet and lifestyle.

Fiber – Eating foods rich in fiber is helpful in maintaining a healthy bowel movement. This will also prevent constipation. Fiber-rich foods include fruits and vegetables, whole grain rice, whole wheat bread, oats, and seeds.

Drink fluids – Drinking adequate amounts of water and fluids may help prevent dehydration and eventually, constipation. Also, cut back on fluids that may induce diuretic effects such as sugary drinks, soda, alcohol, and caffeine.

Exercise – Regular exercise can help prevent constipation. Being active may reduce the risk of getting constipation. The recommended amount of time for exercise is about 150 minutes each week.

Healthy toilet habits – Never ignore the urge to defecate because this might lead to constipation. When you feel like defecating, you should have enough time and privacy to pass stools comfortably.

Other measures:

  • Eat fewer foods that contain less fiber like dairy products, meat, and processed foods.
  • Manage stress effectively
  • Create a regular schedule of bowel movements
  • Allow the children to eat solid foods, particularly the foods rich in fiber like fruits and vegetables.

7Prognosis

With appropriate dietary and lifestyle changes, constipation may be treated faster. However, the prognosis of the condition relies on the underlying cause. Moreover, the recurrence of the condition also depends on the patient’s long-term compliance with the treatment and preventive measures.

Constipation is a manageable condition and it can easily be treated with just simple dietary and lifestyle changes. Medicines are usually considered last resort options for doctors. If the condition does not respond to the dietary changes, then the doctor might prescribe medicines such as laxatives.