Constipation is a condition where there is infrequent bowel movements often coupled with hard stools and straining to pass stool. It is a symptom of some underlying condition. Although constipation is a very common symptom and affects a large proportion of people, it can can in some instances be due to very serious conditions. Therefore people with chronic constipation are advised to undergo regular screening for some of these causative conditions. Constipation can affect any person of any age or gender. However, it tends to be a problem for females and the elderly more often.
Constipation is diagnosed when you have:
- less than 3 bowel movements in a week (7 day period), or
- passing hard stools, or
- straining to pass stool.
Many people have all three features simultaneously or it may alternate. Haemorrhoids (piles) is a common complication of chronic constipation. Abdominal bloating, difficulty passing gas and even changes in appetite may accompany constipation.
Patients with constipation-predominant irritable bowel syndrome may also experience abdominal pain and sometimes mucus in the stools. Bleeding when wiping after a bowel movement may be seen with constipation. Often this blood is from bleeding haemorrhoids but should always be evaluated for more serious bowel conditions that may present with constipation.
Bowel habit is largely determined by eating habits and level of physical activity. It is also influenced by fiber and water intake. Bowel habit can vary greatly from one person to another. Some people will pass stool 2 or even 3 times a day and this is normal for them. Other people have a movement less often. Once the digested food mixed with large volumes of water reaches the colon, it is gradually changes from a watery consistency to mush and then soft solids that we see as stool.
When the amount of stool in the colon collects to a point where the colon wall is stretched, stool is then pushed into the rectum. It is at this point that we feel a strong urge to defaecate and have to find a toilet to pass stool. The anal sphincters open and stool is passed out. But in constipation this entire process may be hampered in several ways:
- the stool does not have enough bulk due to insufficient fibre intake,
- the water consumption is too little to maintain a soft solid stool,
- the colon does not start the rhythmic contractions for defaecation until much later than normal,
- the external sphincters do not relax sufficiently to open and allow stool to be passed out.
Although these are some of the problems that may occur, often the cause for constipation is unknown. When no problem can be identified despite rigorous investigations, the condition may then be referred to as functional constipation. It is usually due to the slow movement of stool through the bowels that is not due to any disease. As a result of the lag, the stool becomes hard and drug.
Constipation is a symptom that may occur due to some of these causes:
- Age-related changes
- Any severe or prolonged illness
- Anaesthesia (surgery)
- Hypothyroidism (underactive thyroid)
- Intestinal obstruction
- Irritable bowel syndrome (IBS)
- Medication (side effects)
- Overuse of laxatives
- Parkinson’s disease
- Poor bowel training
- Sedentary lifestyle
- Spinal cord injuries
These are only some of the causes of constipation. There are many other causes as well that has not been listed here.
The first approach to treatment is dietary and lifestyle changes. This involves increasing water and fibre intake, exercising and bowel training. Any underlying condition that is causing constipation needs to be treated in order for the constipation to resolve. Laxatives should only be considered once dietary modification and lifestyle changes have proven to be ineffective. There are several different types of laxatives available on the market. Most are over-the-counter (OTC) preparations. Prescription medication first requires the assessment by a doctor.
Other medication that may be used primarily works by increasing the fluid content within the bowels. Should none of these drugs work, manual intervention may be necessary to present faecal impaction and bowel obstruction. In rare instances severe constipation can stretch the colon and damage the nerves supplying, or even rupture. A doctor may manually attempt to break up the impacted faeces in the rectum but if this fails then surgery may be necessary.
Some of the natural remedies for constipation may include:
- Aloe (herbal)
- Buckthorn (herbal)
- Nettle (herbal)
- Rhubarb (herbal)
- Senna (herbal)
- Slippery elm (herbal)
- Calcarea carbonica (homeopathic)
- Graphites (homeopathic)
- Nat mur tissue salts
- Sepia (homeopathic)
- Silica tissue salts
Many modern OTC pharmaceuticals contain herbal ingredients like senna. It is always advisable when seeking natural treatment options for constipation to first consult with a complementary health practitioner like a homeopath. Professional evaluation and prescription of appropriate homeopathic and herbal remedies may prove to be more effective than trying remedies at random. Furthermore any serious underlying cause of constipation can be identified and treated by a practitioner.