Constipation is a very common symptom. It affects virtually everyone at some point in their lives. Occasional constipation may result from many factors such as dietary changes or inactivity and will generally respond to simple lifestyle measures.
However, constipation that is chronic or recurrent may indicate a more concerted effort to diagnose and treat. Those suffering persistent constipation should see a physician to plan investigation and treatment.
Many with constipation do not seek help and their symptoms are probably mild or transient. Nevertheless, many do see doctors for constipation and for them it can be very troubling. If constipation goes unnoticed some severe side effects can occur, such as hemorrhoids and damage or tearing of the anus.
Constipation is a symptom, not a disease and affects everyone, although it becomes more common as people age. Women report constipation two to three times more often than men.
Who is at Risk for Constipation?
The following conditions can lead to the symptom of constipation:
- Prolapse of the bladder or rectum
- Hemhorroids
- Immobility or a sedentary lifestyle
- Diverticular disease
- Damage to the nerve supply of the bowel as a result of pelvic injury or a stroke
- Spasms of the colon resulting from irritable bowel syndrome alternately causes constipation and diarrhea, abdominal cramps, gas and bloating
- Varicose veins
- A pelvic floor dysfunction where the (anal) sphincter muscle of the anus tenses rather than relaxes
Symptoms of Constipation
Surprisingly, there is no definition of constipation that applies to all persons. However, some general constipation symptoms are followed as guidelines:
* Less than three bowel movements a week is considered to be a symptom of constipation.
* Passing hard and dry pellet-like stools.
* Straining too much to pass stools.
* Painful bowel movements.
* A feeling of a bloated stomach.
* Uneasiness and sluggishness, and a feeling of incomplete evacuation.
Diagnosis
A physical examination may find local anorectal lesions, such as anal fissures, fistulae, strictures, cancer and thrombosed hemorrhoids and stenosis, abscess, rectal prolapse, bleeding, hernia, fecal retention or abdominal distention.
Treatments for Constipation
Lifestyle and Dietary Changes – Fiber is one of the mainstays in the treatment of constipation. Many types of fiber within the intestine bind to water and keep the water within the intestine. The fiber adds bulk (volume) to the stool and the water softens the stool.
Medications – Overall, the available data indicates that laxatives are safe and effective treatments for constipation. If patients with constipation find that their treatments are becoming less effective, then it is time to consult a doctor about alternatives.
Behavioral Therapy – Most of the muscles of the pelvis surrounding the anus and rectum are under some degree of voluntary control. Thus, biofeedback training can teach patients with pelvic floor dysfunction how to make their muscles work more normally and improve their ability to defecate. During ano-rectal biofeedback training, a pressure-sensing catheter is placed through the anus and into the rectum. Each time a patient contracts the muscles, the muscles generate a pressure that is sensed by the catheter and recorded on a screen. By watching the pressures on the screen and attempting to modify them, patients learn how to relax and contract the muscles more normally.
Surgical Procedures – For severe constipation due to obstructive pelvic organ prolapse, a surgery may be recommended. Constipation due to diseases of the colon are managed by colo-rectal surgeons.
