Constipation is a common condition that affects people of all ages, often characterized by infrequent bowel movements, difficulty in passing stools, or the sensation of incomplete bowel evacuation. It can lead to hard, lumpy, large, or small stools and may cause discomfort and significant distress for some individuals.
Symptoms of Constipation
Common signs and symptoms include:
- Fewer than three bowel movements per week
- Hard, lumpy, or dry stools
- Difficulty or straining when passing stools
- A feeling of incomplete bowel emptying
- Abdominal pain, cramping, and bloating
For some, constipation is a short-term issue that resolves quickly with simple changes. For others, it can become a chronic condition that significantly affects quality of life.
Causes of Constipation
The causes can vary widely, often involving multiple factors. These include:
Dietary Factors:
- Insufficient fiber intake (found in fruits, vegetables, and whole grains)
- Low fluid intake, leading to dehydration
- Changes in eating habits or diet patterns
Lifestyle Factors:
- Sedentary lifestyle or lack of physical activity
- Ignoring the urge to have a bowel movement
- Travel or changes in routine
Medications:
- Certain medications such as painkillers (especially opioids), antacids containing aluminum or calcium, and certain antidepressants can cause constipation.
Emotional and Psychological Factors:
- Anxiety and depression may contribute to bowel irregularities.
Children-Specific Factors:
- Poor dietary habits
- Fear or reluctance to use the toilet, particularly in school settings
- Toilet training challenges
Who Is Affected by Constipation?
- It can affect individuals of all ages, including infants, children, and adults.
- Women are more prone to constipation compared to men, particularly during pregnancy due to hormonal changes.
- Older adults are at higher risk due to decreased mobility, dietary changes, or chronic health conditions.
When to Seek Medical Advice
While constipation is usually manageable through lifestyle changes, certain symptoms warrant medical attention:
- Persistent constipation lasting more than 14 days despite lifestyle adjustments
- Rectal bleeding or blood-streaked stools
- Unexplained weight loss
- Persistent fatigue or symptoms that worsen over time In these cases, it is important to consult a healthcare provider for further evaluation and management.
Treating Constipation
Lifestyle and Dietary Changes:
- Increase Fiber Intake: Incorporate more fruits, vegetables, whole grains, nuts, and seeds into your diet. Aim for a gradual increase to avoid bloating or discomfort.
- Stay Hydrated: Drink plenty of water throughout the day.
- Exercise Regularly: Physical activity can stimulate bowel function.
- Establish a Routine: Give yourself time and privacy to have a bowel movement without feeling rushed.
Pharmacological Treatments:
- If lifestyle changes are insufficient, a pharmacist may recommend an over-the-counter laxative.
- Different types of laxatives include bulk-forming agents, stool softeners, osmotic agents, and stimulant laxatives. A healthcare professional can guide the best option based on individual needs.
Preventing Constipation
Prevention revolves around maintaining a healthy diet and lifestyle:
- Fiber-Rich Diet: Focus on a balanced intake of dietary fiber.
- Adequate Fluid Intake: Aim for the recommended daily water intake.
- Regular Exercise: Engage in activities such as walking, swimming, or yoga.
- Mindful Bowel Habits: Respond to the urge to defecate promptly and ensure comfortable access to restrooms.
Potential Complications
Most people with constipation experience relief without complications, but chronic constipation can lead to:
- Haemorrhoids (Piles): Swollen veins in the rectum or anus due to straining.
- Faecal Impaction: Dry, hardened stools become lodged in the rectum.
- Bowel Incontinence: Leakage of liquid stool around impacted stool in the rectum.
Managing Constipation Holistically: By making consistent lifestyle and dietary changes, individuals can often manage and prevent constipation effectively. However, if symptoms persist or worsen, seeking professional medical advice is recommended to rule out underlying conditions and receive appropriate care.
Symptoms of Constipation
When you are experiencing constipation, bowel movements become difficult and occur less frequently than usual. It’s important to note that “normal” bowel habits can differ from person to person. For example, some adults may need to go to the toilet more than once daily, while others might only go every three or four days. Likewise, some infants pass stools multiple times per day, while others do so only a few times a week.
If you or your child notice a decrease in the frequency of bowel movements, it may indicate constipation. It may also be more challenging to pass stools, leaving you with a feeling of incomplete evacuation. The stools may appear dry, hard, and lumpy or could be unusually large or small.
Common Symptoms of Constipation:
- Stomach ache and cramps
- Feeling bloated
- Nausea (feeling sick)
- Loss of appetite
Constipation in Children
In children, constipation may present as infrequent or irregular bowel movements. In addition to this, children may experience:
- Loss of appetite
- Lack of energy
- Irritability, anger, or unhappiness
- Foul-smelling wind and stools
- Stomach pain and discomfort
- Soiling their clothes
- General feeling of being unwell
If these symptoms persist, it is advisable to consult a healthcare professional for further assessment and to discuss appropriate dietary, lifestyle, or medical interventions. Regular hydration, dietary fiber intake, and exercise are often beneficial for managing and preventing constipation.
Causes of Constipation
Constipation often occurs when stools remain in the colon (large intestine) for an extended period, causing the colon to absorb too much water from the stools, leading them to become hard and dry. While it may be challenging to pinpoint an exact cause, several factors can contribute to constipation:
Common Causes of Constipation:
Diet and Lifestyle Factors:
- Low fiber intake: A diet lacking fruits, vegetables, and cereals can contribute to constipation.
- Changes in routine: Sudden changes in eating habits, traveling, or shifts in daily schedules may disrupt bowel regularity.
- Ignoring the urge to pass stools: Ignoring the body’s signals can lead to prolonged stool retention.
- Limited toilet privacy: A lack of privacy may make it difficult for some to relax during bowel movements.
- Lack of exercise: Physical activity stimulates bowel function; sedentary lifestyles can slow digestion.
- Dehydration: Not drinking enough water can make stools harder and more difficult to pass.
- Stress and anxiety: Mental health factors can impact gut health and contribute to constipation.
- Temperature changes: Having a fever may also lead to changes in bowel movements.
- Weight fluctuations: Being either underweight or overweight can contribute to changes in bowel habits.
Medications: Constipation may sometimes be a side effect of medications, including:
- Aluminium antacids for indigestion
- Antidepressants
- Antiepileptics (for epilepsy)
- Antipsychotics (for mental health conditions)
- Calcium supplements
- Opiate painkillers such as codeine and morphine
- Diuretics (water tablets)
- Iron supplements
- If medication is causing constipation, symptoms often improve upon discontinuation. However, consult a healthcare professional before altering any prescribed medication.
Pregnancy:
- Approximately 40% of pregnant women experience constipation, primarily due to elevated progesterone levels, which relax bowel muscles and slow peristalsis (wave-like muscle contractions that move food through the digestive tract).
- Safe remedies and lifestyle modifications are available for treating constipation during pregnancy.
Underlying Health Conditions (Less Common Causes):
- Irritable bowel syndrome (IBS)
- Diabetes
- Hypercalcemia (excess calcium in the bloodstream)
- Hypothyroidism (underactive thyroid)
- Muscular dystrophy
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injuries
- Anal fissures (small tears in the anus)
- Inflammatory bowel disease (IBD)
- Bowel cancer
Causes of Constipation in Babies and Children
Constipation is common in children and can be influenced by several factors:
Diet:
- Overfeeding and inadequate fluid intake are significant contributors. Babies consuming excessive milk may also experience constipation.
- Ensuring children receive adequate dietary fiber is crucial.
Toilet Training:
- Stressful or pressured toilet training can lead to anxiety around bathroom use.
- Encourage independence while allowing a stress-free environment to foster good toilet habits.
Toilet Anxiety:
- Some children may be afraid to use the toilet, especially outside their home (e.g., at school).
- Painful bowel movements can create fear and lead to withholding stools, which exacerbates the problem.
Underlying Medical Conditions (Rare):
- Hirschsprung’s disease: A condition that affects the colon’s ability to move stools.
- Anorectal malformations: Structural issues with the anus and rectum.
- Spinal cord abnormalities: Conditions like spina bifida and cerebral palsy.
- Cystic fibrosis: This genetic disorder can lead to digestive issues, including constipation.
Managing Constipation
Treatment often involves dietary and lifestyle changes, such as increasing fiber intake, staying hydrated, and regular exercise. In more persistent cases, medical treatments, including laxatives, may be recommended under professional guidance.
Constipation can affect people of all ages but is manageable with appropriate care and intervention. If symptoms persist, it is always recommended to seek medical advice.
Diagnosing Constipation
Constipation is a prevalent condition that can often be managed and diagnosed based on a person’s symptoms and medical history. In most cases, pharmacists and healthcare professionals can confirm a diagnosis without extensive tests, though certain situations may call for further assessment.
Diagnosis Through Symptoms and Medical History
Your pharmacist or healthcare provider will typically start by asking questions about:
- Bowel habits: Frequency of bowel movements, stool consistency, and any changes in your routine.
- Diet and lifestyle: Eating habits, fiber intake, hydration levels, and physical activity.
- Symptoms: Such as difficulty passing stools, straining, hard or lumpy stools, and feelings of incomplete evacuation.
Constipation may be defined by:
- Opening the bowels fewer than three times a week.
- Experiencing straining during bowel movements on more than 25% of occasions.
- Passing hard or pellet-like stools on more than 25% of occasions.
It’s crucial to discuss all symptoms with your pharmacist without feeling embarrassed, as it helps ensure a proper diagnosis.
Physical Examination
If a pharmacist suspects faecal impaction (a condition where hard, dry stools collect in the rectum), they may refer you to your GP for a physical examination.
A physical examination may include:
- Abdominal examination: You will lie on your back while the GP feels your abdomen to check for any signs of stool buildup.
- Rectal examination: This involves a GP using a lubricated, gloved finger to feel for any hard stool in the rectum. This step is more common in adults and rarely performed on children unless necessary. For children, palpating the tummy is often sufficient.
Further Diagnostic Tests
For those experiencing severe or persistent symptoms, additional tests may be recommended, including:
- Blood tests or thyroid tests: To rule out underlying conditions like hypothyroidism or other systemic disorders.
- Abdominal X-ray: Uses radiation to produce images of the abdomen to check for signs of stool buildup.
- Transit study examination: This test involves swallowing special capsules visible on X-rays, allowing doctors to track their movement through the digestive system. The time taken for the capsules to pass through helps assess bowel function.
- Anorectal manometry: This involves inserting a small device with a balloon into the rectum. The device measures the muscle pressure during squeezing, relaxing, and pushing movements. It helps evaluate the functionality of the rectal muscles and nerves.
Additional Tests for Older Adults
Given the increased risk of bowel cancer in older individuals, doctors may conduct tests to rule out cancer:
- Computerised tomography (CT) scan: Provides detailed images of the bowel and surrounding areas.
- Colonoscopy: A procedure using a flexible tube with a camera to visually inspect the colon for abnormalities, including polyps or signs of cancer.
Summary
Diagnosing constipation generally starts with a discussion of symptoms and an assessment of lifestyle factors. While most cases can be managed with simple changes or medications, severe or chronic cases may require further testing to rule out underlying conditions or complications. Proper diagnosis and treatment can significantly improve bowel function and quality of life.
Treating constipation
Treatment for constipation depends on its cause, duration, and severity. While some cases are managed effectively through dietary and lifestyle changes, others may require medication or specific therapies, especially for chronic or severe symptoms. Here is a detailed overview of approaches to relieve and manage constipation:
1. Lifestyle and Dietary Changes
Making changes to your lifestyle and diet is often the first recommended approach to treat constipation. The following tips may help improve bowel regularity:
- Increase Fiber Intake: Consume at least 18-30g of fiber per day from fruits, vegetables, whole grains, and cereals. Adding bulking agents like wheat bran can also help soften stools.
- Stay Hydrated: Drink plenty of water to avoid dehydration, which can exacerbate constipation.
- Exercise Regularly: Engage in daily physical activities like walking or light exercise to stimulate bowel function.
- Toilet Routine: Establish a regular schedule for using the toilet, giving yourself time and privacy. When you feel the urge, do not delay.
- Use Proper Posture: When on the toilet, rest your feet on a small stool to elevate your knees above your hips, which can make passing stools easier.
- Medication Management: If you suspect medication is causing constipation, discuss alternatives with your GP or pharmacist.
2. Laxative Treatment
If lifestyle and dietary changes are insufficient, a pharmacist may recommend laxatives. The types of laxatives include:
- Bulk-Forming Laxatives: These retain fluid in stools, making them softer and easier to pass. Common examples are ispaghula husk, methylcellulose, and sterculia. When using these, drink plenty of fluids, and avoid taking them before bedtime.
- Osmotic Laxatives: If stools remain hard, these laxatives increase the fluid content in the bowels to soften stools. Common examples are lactulose and macrogols.
- Stimulant Laxatives: When soft stools are still difficult to pass, stimulants such as senna, bisacodyl, and sodium picosulphate can stimulate the bowel muscles.
Combining Laxatives: In some cases, a combination of laxatives may be necessary to achieve desired relief. Always follow the advice of your pharmacist or GP.
Duration of Laxative Use: For short-term constipation, stop using laxatives once normal bowel movements resume. Chronic constipation due to medical conditions or medications may require long-term laxative use, which should be gradually reduced under GP supervision.
3. Treating Faecal Impaction
Faecal impaction, characterized by hardened stools in the rectum, may cause overflow diarrhea. Treatment typically involves:
- High-Dose Osmotic Laxatives (e.g., Macrogol): This is followed by stimulant laxatives if needed.
- Suppositories: Medications like bisacodyl are inserted into the rectum to dissolve and soften stools.
- Mini Enemas: Fluid medication (e.g., docusate or sodium citrate) is injected into the rectum.
4. Constipation During Pregnancy and Breastfeeding
Pregnant women experiencing constipation should:
- Increase Fiber and Fluid Intake: Combined with gentle exercise.
- Safe Laxatives: Osmotic laxatives (lactulose and macrogols) are safe, and small doses of stimulant laxatives (e.g., senna) may be used cautiously.
5. Treating Constipation in Babies and Children
- Infants (Not Weaned): Offer extra water between feeds and consider gentle tummy massage or leg movement exercises.
- Weaned Babies: Provide more water, diluted fruit juice, and high-fiber fruits like apples, apricots, and prunes.
- Children: Encourage a balanced diet with whole grains, fruits, and vegetables. Develop a positive toilet routine and reduce mealtime stress.
6. Behavioral and Routine Changes
For children, creating a positive toilet routine and a reward system can encourage successful bowel movements and reduce anxiety.
Preventing Constipation
- Maintain a High-Fiber Diet: Include fruits, vegetables, whole grains, and fiber-rich foods in your daily meals.
- Regular Exercise: Stay active to help stimulate bowel function.
- Stay Hydrated: Drink plenty of water throughout the day.
- Establish Routine Toileting Habits: Listen to your body’s cues and create a comfortable and relaxed environment for bowel movements.
Important Considerations
- See Your GP: If constipation persists despite treatment, is accompanied by rectal bleeding, unexplained weight loss, or severe fatigue, or lasts more than 14 days, seek medical attention.
- Medication Management: If constipation is medication-related, consult your GP before stopping any prescribed treatment.
By following these comprehensive treatment strategies, constipation can often be managed effectively, improving your quality of life.
Complications of Constipation
While constipation itself is a common condition and typically resolves with appropriate treatment, chronic or long-term constipation can lead to complications that may require medical intervention. Here are some potential complications, their symptoms, and treatment options:
1. Rectal Bleeding
- Cause: Straining during bowel movements can lead to rectal bleeding. The pressure exerted while attempting to pass stools may cause tiny tears around the anus (known as anal fissures) or swelling of blood vessels in the rectum and anus, known as haemorrhoids (piles).
- Symptoms: Rectal bleeding can manifest as bright red blood on toilet paper, in the toilet bowl, or on the surface of the stool.
- Additional Symptoms of Haemorrhoids: Apart from bleeding, haemorrhoids may cause itching, swelling, and pain around the anus.
- Management: The symptoms of haemorrhoids often subside within a few days without treatment. To alleviate discomfort, creams and ointments are available over the counter to reduce itching and inflammation.
- When to Seek Help: Consult your pharmacist or GP promptly if you experience rectal bleeding, particularly if it persists or is severe.
2. Faecal Impaction
- What is Faecal Impaction?: Faecal impaction occurs when dry, hard stools become lodged in the rectum and anus, obstructing the normal passage of stools.
- Why It Happens: This complication arises from prolonged constipation, where stools remain in the colon for an extended period, becoming hard and difficult to pass.
- Symptoms of Faecal Impaction:
- Worsened constipation: Difficulty passing stools due to obstruction.
- Swelling of the rectum.
- Loss of sensation around the anus.
- Bowel incontinence: Leakage of loose stool around the impacted mass.
- Bleeding from the anus.
- Rectal prolapse: In severe cases, repeated straining can lead to part of the lower intestine protruding from the anus.
- Treatment:
- Laxative Medications: High doses of laxatives, such as osmotic or stimulant laxatives, may be prescribed to soften and break up the impacted stools.
- Suppositories and Mini Enemas: Medication may be inserted through the anus to soften the impacted stool directly and facilitate its passage.
3. Additional Complications of Chronic Constipation
- Anal Fissures: Tiny tears in the lining of the anus, causing pain and bleeding, particularly during bowel movements. They are often associated with straining and hard stools.
- Haemorrhoids (Piles): Swollen and inflamed veins in the rectum and anus, causing discomfort, itching, swelling, and bleeding.
- Rectal Prolapse: A more serious condition where the rectum partially or completely slips out of its normal position, often requiring surgical intervention.
- Bowel Incontinence: Inability to control bowel movements due to faecal impaction or nerve damage.
Prevention Tips for Complications
- Regular Bowel Habits: Respond promptly to the urge to pass stools to avoid stool retention.
- Dietary Fiber: Ensure adequate intake of fiber-rich foods, such as fruits, vegetables, whole grains, and legumes.
- Hydration: Drink plenty of fluids to prevent dehydration, which can lead to hard stools.
- Exercise: Engage in regular physical activity to promote normal bowel function.
- Avoid Straining: Use proper posture on the toilet (knees above hips) to make passing stools easier.
- Routine Medical Check-Ups: Regularly consult your healthcare provider if you experience persistent constipation to identify and manage potential complications early.
When to Seek Medical Attention
- Persistent or Severe Symptoms: If constipation persists for more than two weeks despite dietary and lifestyle changes, or if you experience severe symptoms such as bleeding, pain, or prolapse, seek medical advice.
- Rectal Bleeding: Any unexplained rectal bleeding should be assessed by a healthcare professional to rule out other serious conditions.
Managing Chronic Constipation
- Follow a Tailored Treatment Plan: For chronic constipation, a combination of dietary changes, lifestyle modifications, and medication may be necessary, often under the guidance of a healthcare professional.
- Gradual Medication Reduction: If taking long-term laxatives, work with your GP to gradually reduce dosages as symptoms improve.
Constipation complications can impact your quality of life, but prompt management and preventive measures can minimize their occurrence and improve overall bowel health.
Preventing constipation
Tips for Preventing Constipation
Preventing constipation is often achievable by adopting a combination of dietary, lifestyle, and behavioral changes. Here are effective strategies you can incorporate into your daily routine to reduce the risk of developing constipation.
1. Increase Your Fiber Intake
One of the most effective ways to prevent constipation is by consuming an adequate amount of dietary fiber. Fiber helps bulk up your stool, making it easier to pass through the digestive tract. The recommended daily intake for fiber is approximately 30 grams for adults.
Here’s how to increase your fiber intake:
- Fruits and Vegetables: Aim to include a variety of fruits and vegetables in your meals. Great sources of fiber include apples, pears, berries, oranges, broccoli, carrots, and leafy greens.
- Whole Grains: Replace refined grains with wholegrain alternatives such as wholemeal bread, wholewheat pasta, and brown rice.
- Legumes: Include lentils, chickpeas, beans, and peas in your diet.
- Nuts, Seeds, and Oats: These are excellent sources of fiber that can be incorporated into snacks, breakfast cereals, or meals.
Important Tip: Increase your fiber intake gradually to avoid side effects such as bloating, gas (flatulence), and stomach cramps. Your body needs time to adjust to the changes.
2. Stay Hydrated
Drinking plenty of fluids is essential for preventing constipation. Water keeps stools soft and supports the smooth movement of waste through the digestive system.
- Daily Water Intake: Aim to drink 6-8 glasses (about 1.5-2 liters) of fluids per day. This amount may vary depending on factors like age, activity level, and climate.
- Limit Caffeine and Alcohol: Both caffeine and alcohol can have dehydrating effects and may exacerbate constipation if consumed in excess.
- Adjust Fluid Intake Based on Activity: Increase your water intake during physical activity or hot weather to compensate for fluid loss.
3. Adopt Healthy Toilet Habits
Paying attention to your body’s signals and establishing healthy toilet habits is crucial for preventing constipation.
- Respond Promptly: Do not ignore the urge to have a bowel movement. Delaying this can lead to stool hardening and make it more difficult to pass later.
- Allow Time and Privacy: Ensure you have adequate time and a comfortable environment to pass stools without feeling rushed.
4. Exercise Regularly
Physical activity promotes healthy bowel movements by stimulating the natural contractions of the intestinal muscles.
- Recommended Activity Levels: Aim for at least 150 minutes of moderate physical activity per week. Activities can include brisk walking, cycling, swimming, jogging, or even yoga.
- Benefits Beyond Bowel Health: Regular exercise not only helps prevent constipation but also boosts mood, energy levels, overall fitness, and mental health.
5. Create a Balanced Diet
- Combine Different Food Groups: Ensure your meals are balanced, including adequate amounts of carbohydrates, proteins, fats, and fiber-rich foods.
- Eat Regular Meals: Maintain consistent meal timings to help regulate digestion and bowel movements.
Additional Tips for Preventing Constipation
- Avoid Highly Processed Foods: Foods low in fiber, such as processed and refined foods, can contribute to constipation.
- Probiotics: Consider including probiotic-rich foods such as yogurt or taking a probiotic supplement to support gut health and regular bowel movements.
- Manage Stress: Stress and anxiety can negatively impact digestion. Practice relaxation techniques like deep breathing, meditation, or yoga to help manage stress levels.
When to Seek Professional Help
- Persistent Constipation: If you experience constipation for more than two weeks despite making lifestyle changes, consult your GP or pharmacist for further evaluation.
- Additional Symptoms: Seek medical advice if you notice symptoms such as rectal bleeding, unexplained weight loss, or persistent fatigue.
By making simple yet effective changes to your diet and lifestyle, you can maintain regular bowel movements and prevent constipation. These habits will not only improve your digestive health but also contribute to your overall well-being.
Diverticular Disease and Diverticulitis
The Declaration of Rights of Man and Citizen
