Constipation

 
Constipation is a common problem particularly in women. Typical symptoms of constipation include infrequent bowel movements from three times a week to less than once a week, hard stools, with diffciculty and pain when passing stools.
Although the cause of constipation is unclear in most people, there are some known causes below:
Causes of constipation
Medications such as calcium, anti-hypertensives, drugs for depression and schizophrenia
Alcohol and caffeine
Pregnancy
Hormone disorders such as thyroid problems
Irritable bowel syndrome
Neurological disorders including spinal problems and Parkinson's disease
Bowel cancer
Mostly chronic constipation does not need any specific tests, however occasionally we need to exclude secondary causes as above or classify the constipation into slow/normal transit constipation or defaecatory disorders. If tests are necessary they include the following:
Investigations for constipation
Blood tests
Colonoscopy
Intestinal transit study requiring an abdominal X-ray
Bowel evacuation studies – this involves assessing whether you can pass stool normally
Treatment for constipation
Exercise and hydration improve bowel movements
Reduce alcohol and caffeine
Train yourself to defecate after meals when colonic activity is highest.
A high fibre diet rich in fruit, vegetables, grain fibre and prunes - a high fibre diet has been shown to improve constipation in normal transit constipation. Cereal fibre resists digestion and retain. Fibre found in citrus fruits and legumes stimulates the growth of colonic flora, thereby increasing fecal mass. Wheat bran is one of the more effective fibre laxatives but may aggravate bloating and abdominal pain in irritable bowel syndrome
Laxatives, which can be divided into the following:
(a)Bulk forming agents such as psyllium husk
(b)Osmotic laxatives which are non-absorbable molecules which retain water and soften the stool such as movicol, lactulose and magnesium salts
(c)Lubricant laxatives, which soften the stool allowing easier passage
(d)Stimulant laxatives, such as senna and bisacodyl, increase the contraction of muscles in the intestine pushing the stool through more quickly
Suppositories can be used for patients with defecation dysfunction
Biofeedback - Biofeedback is a behavioral approach that can be used to correct inappropriate contraction of the pelvic floor muscles and external anal sphincter during defecation in patients with defecatory dysfunction
Prucalopride - this is a new drug used where 2 laxatives fail. It stimulates muscles contraction leading to faster stool transit thereby increasing the number of weekly bowel movements.
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