Family doctor

Overview:

• Constipation is difficulty in passing stools
• Symptoms include less than three bowel motions a week or experiencing pain
• Many people do not have one bowel movement a day, and this is normal
• Constipation may be caused by irritable bowel syndrome, lack of fibre, or disease
• See a doctor if constipation is a sudden development
• Treatment includes eating more fibre and getting more exercise
• The use of laxatives is a last resort
• Always respond to the "call of nature" as soon as possible

How the bowel functions:

In order to understand constipation better, it is important to understand how the bowel works. The digestive tract is one long tube - about 26 feet long in an adult from the mouth to the anus. It has different tasks at different levels.

When you swallow food it goes into the stomach - the first part of the food factory. The stomach is a baggy part of the digestive tract just under the ribs. It is not the whole abdomen as some people think.

After acid and enzymes breakdown the food it moves on to the small intestine. This is the longest part of the digestive tract but is called "small" because it is smaller in diameter to the next part of the digestive tract - the large intestine (also known as the colon) During digestion the small intestine absorbs the nutrients from the food and sends the waste to the colon. The main function of the colon is to absorb water from the waste. As the food residue moves through the colon, water is absorbed back into the body and and the residue becomes firmer and is called "the stool". Bacteria work on the stool and help produce some vitamins used by the body and give the stool its unpleasant smell. Normally, the stool stays in the colon just long enough for most of the water to be absorbed, but stays soft enough to pass out the anus easily. If the stool moves through the colon too slowly, more water is absorbed so that it becomes hard and dry and difficult to pass through the anus.

When exactly is a person constipated?

Constipation means problems with bowel movements. A person who has less than three bowel motions a week or experiences pain and difficulty passing a stool is considered constipated.

It is one of the most common digestive disorders and the rate increases with age. Older adults are five times more likely to have problems with constipation than young people.

Most people have one bowel movement a day. However, many have less than this but that does not mean they are constipated.

Constipation is caused by a number of factors including irritable bowel syndrome, lack of dietary fibre, some medications, psychiatric disorders, haemorrhoids, anal fissures, hormonal disturbances, inactivity, and diseases of the colon such as bowel cancer and diverticulitis in which part of the colon becomes inflamed.

Irritable bowel syndrome is one of the most common causes of constipation because bowel spasms can make it harder for stools to pass through the digestive system.

Bowel cancer can make the bowel passage smaller and lead to a blockage.

Disease like multiple sclerosis and Parkinson's disease can also cause constipation.

Medications that can cause constipation include some narcotics, antidepressants, anticonvulsants, iron tablets, antacids and some heart medication. Abuse of laxatives can also cause the drugs to become ineffective and lead to constipation.

What are the symptoms?

Having less than three bowel motions a week or straining and experiencing pain while passing a stool are the main symptoms.

Some people may have small and hard stools, and feel they have not completely emptied their bowel after passing a stool.

See a doctor if the constipation is a sudden development. A full investigation of the digestive system is recommended in over 30 year olds to exclude serious disease.

Diagnosis of the cause of constipation may involve a barium enema x-ray, a colonoscopy (a flexible tube which examines the whole colon) or sigmoidoscopy (an examination of the lower end of the colon and rectum).

Some children experience constipation by failing to respond to the urge or go, or from extreme psychological distress.

Serious cases of constipation may require medical attention.

Constipation is usually not serious, but in some cases it is the only symptom of cancer.

Straining during a bowel movement can lead to haemorrhoids (piles) or anal fissures.

What is the treatment?

Extra fibre is the initial treatment approach. Studies have proved that a high-fibre diet can lead to more frequent bowel motions that are softer and easier to pass.

People are advised to eat more fruit and vegetables and add extra fibre to their diet such as bran or bulk laxatives like Metamucil.

Liquid enemas inserted into the rectum, such as Microlax, can offer fast relief. It softens the bowel contents, allowing a bowel movement in about 15 minutes.

Laxative tablets should only be used as a last resort and for a short time only.

Regular exercise and drinking more water may also be helpful.

People are also advised to respond quickly to the urge to use the toilet. Some people do not like using toilets away from home and can become constipated.

How can it be prevented?

Eat a high-fibre diet, get plenty of exercise and drink lots of water.

Respond to the urge to go as soon as possible and do not rely on laxatives. Make time to use the toilet.

Getting help?

Your doctor will be able to guide you as to how to prevent and treat the condition, as well as advise if further tests may be needed.