Constipation
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1- Introduction
2- Pathophysiology
3- Symptoms
4- Treatment
Introduction
Constipation is a common digestive issue characterized by infrequent, difficult, or painful bowel movements. It occurs when stool moves too slowly through the digestive tract or cannot be effectively eliminated from the rectum, leading to hard and dry stools. Factors contributing to constipation include a low-fiber diet, inadequate fluid intake, lack of physical activity, certain medications, and underlying medical conditions.
Pathophysiology
The pathophysiology of constipation involves multiple factors that affect the normal functioning of the gastrointestinal (GI) tract. Normally, stool is propelled through the intestines by coordinated muscular contractions called peristalsis. In constipation, this process is disrupted, leading to slower transit times and prolonged stool retention in the colon. This allows excessive water absorption from the stool, making it hard and difficult to pass. Causes can include dietary factors, such as low fiber intake and inadequate hydration, which reduce stool bulk and moisture. Reduced physical activity and certain medications, like opioids and anticholinergics, can also slow intestinal motility. Structural abnormalities, such as strictures or tumors, can physically obstruct the bowel, while functional disorders like irritable bowel syndrome (IBS) can alter motility patterns. Additionally, dysfunction of the pelvic floor muscles can impede effective defecation. Chronic constipation may also result from neurological conditions, such as Parkinson’s disease or multiple sclerosis, that impair nerve signaling in the GI tract. Understanding these various factors is crucial for diagnosing and effectively managing constipation.
Symptoms
Infrequent Bowel Movements: Typically fewer than three bowel movements per week.
Difficulty Passing Stool: Straining during bowel movements is common, and the stool may be hard and dry.
Feeling of Incomplete Evacuation: Despite passing stool, there may be a sensation that the bowel isn’t completely emptied.
Abdominal Discomfort: Pain or discomfort in the abdomen, often described as cramping or bloating.
Rectal Discomfort: Pain or discomfort in the rectum or anus.
Hard or Small Stools: Stools that are hard, dry, and difficult to pass.
Rectal Bleeding: Due to straining, small amounts of bright red blood may be present on the toilet paper or in the stool.
Nausea and Loss of Appetite: Some people may experience mild nausea or a reduced desire to eat.
Feeling of Fatigue or Malaise: Generalized feelings of discomfort or fatigue, especially if constipation is prolonged or severe.
Treatment
1. Lifestyle and Dietary Changes:
- Increase Fiber Intake: Consuming more fiber-rich foods such as fruits, vegetables, whole grains, and legumes can help add bulk to stool and promote regular bowel movements.
- Stay Hydrated: Drinking an adequate amount of water (about 8 cups per day) helps keep stools soft and easier to pass.
- Regular Exercise: Physical activity, such as walking or jogging, stimulates bowel motility and can help alleviate constipation.
2. Behavioral Techniques:
- Establish Regular Bowel Habits: Try to go to the bathroom at the same time each day, preferably after meals when the colon is most active.
- Don’t Ignore the Urge: Respond promptly to the urge to have a bowel movement, as delaying can lead to harder stools.
3. Over-the-Counter (OTC) Treatments:
- Bulk-forming laxatives: Fiber supplements like psyllium (Metamucil) or methylcellulose (Citrucel) can help soften stool and promote regularity.
- Osmotic laxatives: These draw water into the intestines to soften stool, such as polyethylene glycol (MiraLAX) or lactulose.
- Stool softeners: Docusate sodium (Colace) and other stool softeners help mix water with stool to make it easier to pass.
4. Prescription Medications:
- Laxatives: When OTC options are insufficient, prescription-strength laxatives like stimulant laxatives (e.g., bisacodyl) or prescription osmotic laxatives may be prescribed.
- Prokinetics: Medications that promote intestinal motility, like prucalopride (Resolor), may be used in certain cases.
5. Medical Procedures:
- Manual Removal: In severe cases or for impacted stool, manual removal of stool from the rectum may be necessary.
- Biofeedback: For patients with dyssynergic defecation (difficulty coordinating pelvic floor muscles), biofeedback therapy can help retrain muscle coordination.
6. Addressing Underlying Causes:
- Identify and treat underlying medical conditions: Conditions such as hypothyroidism, diabetes, or neurological disorders that contribute to constipation should be managed appropriately.
7. Surgical Intervention:
- Rarely used: In extreme cases of chronic constipation resistant to other treatments, surgery may be considered to remove part of the colon or rectum.