CONSTIPATION
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CONTENTS: -
INTRODUCTION
SIGNS AND SYMPTOMS
CAUSES
RISK FACTORS
TIME FOR MEDICAL ADVICE
DIAGNOSIS
COMPLICATIONS
PREVENTION
TREATMENT
INTRODUCTION:
Constipation is a digestive system related disorder in which a person experiences hard feces, which are difficult to eliminate; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. Obstipation refers to severe Constipation. Causes of Constipation may be Dietary, Hormonal, side effect of medications, an illness or disorder, and anatomical.
TREATMENT is with a change in dietary and exercise habits. The pain can be even worse if you have Haemorrhoids or Anal Fissure. In common Constipation, the stool is hard and difficult to pass. Usually, there is an infrequent urge to void. Straining to pass stool may cause Haemorrhoids and anal fissures. In later stages of Constipation, the abdomen may become distended and diffusely tender and crampy, occasionally with enhanced bowel sounds. Constipation is usually easier to prevent than to treat. Constipation is most common in children and older people, and affects women more than men. One in 200 women have severe, continuous Constipation and it is most common before a period and in pregnancy.
SIGNS AND SYMPTOMS:
You’re likely constipated if you:
• Have abdominal bloating or discomfort
• Pass a hard stool fewer than three times a week
• Strain frequently during bowel movements
• Infrequent bowel movements (typically <3 times per wk)
• Difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools)
• The sensation of incomplete bowel evacuation.
• Types 1 and 2 on the Bristol Stool Chart indicates Constipation
• Constipation is one of the most common digestive complaints. It varies greatly between different people, as each person’s bowel movements differ. Most cases of Constipation are caused by a low fiber diet or dehydration.
Medical authorities accept wide variations in toilet frequency as long as this does not cause any other symptoms. Defecating depends on dietary habits, exercise, fluid intake, and various other factors.
Severe cases (“fecal impaction”) may feature symptoms of bowel obstruction (vomiting, very tender abdomen) and “Paradoxical Diarrhoea”, where soft stool from the small intestine bypasses the impacted matter in the colon. Constipation in children can lead to soiling (Enuresis and Encopresis).
CAUSES:
The main causes of Constipation include:
Hardening of the feces:
> Insufficient intake of dietary fiber
>Dehydration or inadequate water intake
Medicines:
> Diuretics and those containing Iron, Calcium, Aluminium, Loperamide, Opioids (e.g. Codeine & Morphine) and certain Anti-Depressants
Endocrine Dysfunction: ·
> Hypothyroidism (inadequate or slow functioning of the Thyroid gland)
>Hypokalemia (Low Potassium level)
>Acute porphyria (a very rare inherited condition)
Plumbism (Lead poisoning)
Anatomical or Tumours:
>Damaged or injured Anal Valve or Sphincter Constriction, where part of the intestine or Rectum is narrowed or blocked, not allowing feces to pass s,
> tumour either of the bowel or surrounding tissues
> Strictures Paralysis or slowed transit, where peristaltic movement of the intestines is diminished or absent, so that feces are not moved along
> Diverticula Retained foreign body
Psychiatric causes:
Psychosomatic Constipation, based on anxiety or unfamiliarity with surroundings. Malingering or Functional Constipation
RISK FACTORS:
• Not having a bowel movement every day doesn’t necessarily mean the person is constipated.
• Intake of medications like including Sedatives or Narcotics, or receiving Chemotherapy.
• Sedentary life
• Bedridden patient
• During pregnancy women may have bouts of Constipation because of hormonal changes. Later in your pregnancy, pressure on your intestines from your uterus also can cause Constipation.
• Intake of daily diet which low in fiber content
• Drinking inadequate quantity of water (daily)
TIME FOR MEDICAL ADVICE:
You should visit your family Doctor if you experience a recent, unexplained onset of Constipation or change in bowel habits, or any of the following signs or symptoms, which might indicate a more serious health condition:
• Blood in stool
• Intense abdominal pain
• Bowel movements just once or twice a week, despite corrective changes in diet or exercise
• Thin, pencil-like stools
• Unexplained weight loss
• Rectal pain
• Constipation that alternates with Diarrhoea
DIAGNOSIS:
• The DIAGNOSIS of Constipation 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 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.
• Inquiring about dietary habits may reveal a low intake of dietary fiber or inadequate amounts of fluids. Constipation as a result of poor or total loss of movement or physical activity should be considered in the elderly.
• Constipation may arise as a side effect of medications (especially Antidepressants and Opiates).
• During physical examination, Scybala (manually palpable lumps of stool) may be detected when a diagnostician presses on 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, and whether any tumors or abnormalities are present.
• X-rays of the abdomen, may reveal impacted fecal matter in the Colon, and confirm or rule out other causes of similar symptoms.
• Chronic Constipation (symptoms present for more than 3 months at least 3 days per month) associated with abdominal discomfort is often diagnosed as Irritable Bowel Syndrome (IBS) when no obvious cause is found.
A DIAGNOSIS of Constipation generally depends on patient’s Medical history and physical examination. Your Doctor will first want to make sure you don’t have a blockage in your small intestine or Colon (intestinal obstruction), an endocrine condition, such as Hypothyroidism, or an Electrolyte Disturbance, such as excessive Calcium in the blood (Hypocalcaemia). He or she will also want to check your medications in case they may be causing your Constipation.
Diagnostic procedures:
• Stool analysis. In some cases, your Doctor may request a stool sample, to be analyzed for the presence of hidden (occult) blood.
• Barium enema. In this test, the lining of your bowel is coated with a contrast dye (barium) so that your Rectum, colon and sometimes a part of the small intestine can be clearly seen on an X-ray.
• Sigmoidoscopy. In this procedure, your Doctor uses a lighted, flexible tube to examine your sigmoid colon and Rectum.
• Colonoscopy. This diagnostic procedure allows your Doctor to examine the entire colon with a flexible, camera-equipped tube.
• Anorectal manometry. In this procedure, your Doctor inserts a narrow, flexible tube into your Anus and Rectum and then inflates a small balloon at the tip of the tube. This allows your Doctor to measure the coordination of the muscles you use to move your bowel. You may undergo this test if your Doctor suspects pelvic floor dysfunction.
COMPLICATIONS:
• Although Constipation can be extremely harrasing, it usually isn’t serious. If it persists, and especially if straining results, you may develop complications such as Haemorrhoids and cracks or tears in your Anus called abrasions or fissures.
• Very severe or chronic Constipation can sometimes cause a fecal impaction, a mass of hardened stool that you can’t eliminate by a normal bowel movement. An impaction can be dangerous, and you may need to have it manually removed.
• If you use laxatives frequently, you may develop Lazy Bowel Syndrome, a condition in which your bowels become dependent on laxatives to function properly. In fact, laxative use can cause a number of problems, including poor absorption of Vitamins and other nutrients, damage to your intestinal tract and worsening Constipation.
PREVENTION:
• Drink plenty of liquids. The exact amount of water and other fluids you should drink each day varies and depends on your age, sex, health, activity level and other factors. Average adult individual should drink 3 liters of water daily.
• Try fiber supplements: Psyllium Husk can be taken with water or milk after consulting your family Doctor. Check with your Doctor about using stool softeners. If you use fiber supplements, be sure to drink plenty of water or other fluids every day. Otherwise, fiber supplements may cause Constipation or make Constipation worse. Add fiber to your diet slowly to avoid problems with gas
• Limit problem foods: Foods that are high in Fat and Sugar and those that tend to be low in fiber content, such as Ice cream, Cheese and processed foods, may cause or aggravate Constipation.
• Increase physical activity: Engage in regular exercise, such as walking, biking or swimming, on most days.
• Eat fiber regularly: Choose lots of high-fiber foods, including fruits, vegetables, beans and whole-grain cereals and breads. Experiment to see if particular fruits or vegetables have a laxative effect for you. Adding fiber to your diet gradually may help Reduce gas and bloating.
• Don’t rely on stimulant laxatives. These include products such as Correctol and Dulcolax, which cause muscle contractions in the intestines. Habitual use can damage your bowels and make Constipation worse. For occasional relief try saline laxatives, such as milk of magnesia. Saline laxatives draw water into the colon to allow stool to pass easier. Keep in mind that long-term use of laxatives can cause dependency. For constipated children, give them plenty of fluids to drink, but avoid giving them laxatives unless your Doctor says it’s OK.
• Respect nature’s call. The longer you delay going to the toilet once you feel the urge, the more water that’s absorbed from stool and the harder it becomes.
TREATMENT :
Constipation that resists all the above measures requires physical intervention. Manual disimpaction (the physical removal of impacted stool) is done by patients who have lost control of bowels secondary to Spinal injuries. Manual disimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual disimpaction can occasionally be done under sedation or a general anesthetic—this avoids pain and loosens the anal sphincter. In alternative and traditional medicine, Colonic irrigation, enemas, exercise, diet and herbs are used to treat Constipation. Consult a qualified Yoga Trainer.
There are special Asanas for the treatment of Constipation.
HOMOEOPATHIC TREATMENT:
Following is a list of some Homoeopathic medicines to be taken 3 times a day for up to 15 days.
Sulphur 30:
Ineffectual urging accompanied by painful burning sensation, when passed stools are dark, large, hard, and dry, always feeling that there is more to come, person suffers from piles or anal fissure, Constipation alternates with bouts of Diarrhoea, stools are passed every 2-4 days when constipated
Nux Vomica 30:
Great urge to pass stool, but nothing passed, or passing stools and feeling that there is more to come, especially if person is sedentary, elderly, or studying hard, chronic use of laxatives, chilliness, irritability
Natrum Mur. 30:
Rectum feels dry and painful when straining, stools hard and crumbly, and only passed every second day, or at longer intervals during periods. Constipation as a result of abuse of salt (in diet)
Bryonia 200:
Stools large, dry, hard, and burnt-looking, especially in elderly person, dry mouth, head aches and feels congested, abdomen distended, burning feeling in Rectum after passing stool, great thirst and irritability.
Aesculus 30:
Rectum feels dry and hot, as if full of sticks or spikes, sensation of knife being jabbed upwards on attempting to open bowels, sensation of fullness in Rectum, pain in lower back, crawling sensation in Anus, symptoms worse after sleep, in person elderly. Associated with piles.
Opium 30:
No desire to open bowels for days on end, then stools are hard and pill-like, bowels lazy, appetite poor, person drowsy during day but wakeful at night, alert to the slightest sound.
Plumbum 200:
Sharp griping pains, straining produces little pills which are hard, black, and dry, and at the same time bowels feel as if they are being drawn up towards the spine on a piece of string, person habitually constipated.
Alumina 200:
No desire to open bowels until Rectum is completely full, even soft stools are difficult to pass, and may be covered with mucous or soft and clayey, sensation of stools getting caught up under left ribs, where colon starts to descend
Lycopodium 30:
Great flatulence, no desire to open bowels for days on end, hard incomplete stools passed with pain and difficulty, patches of wind in intestines relieved by rubbing, person craves sweet things and feels worse between 4 and 8 pm. Boiling sensation in bowels, splinter-like pains last for hours after passing stools as if something has been torn, also burning and itching.
Silicea 30:
Contraction of anal sphincter not strong enough to expel stool, so stool slides back in again, Anus feels sore, stools scanty, hard and covered with mucous, person chilly and prone to sweating of head.
Platina 30:
For constipation of people who travel frequently from one city to another
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