Constipation

Sluggish Bowels

What is Constipation?

Constipation is a symptom and not a disease. By definition, constipation is the passage of hard stools or no stools at all. One-third of all elderly people have a problem with constipation. There are many risk factors for constipation. They include irritable bowel disease (inflammation of the small bowel), enlarged toxic colon (Hirschsprung's disease), low thyroid function (hypothyroidism), drugs, chronic obstructive pulmonary disease (COPD), stroke, paralysis affecting the lower spine, involuntary tremors (Parkinson's disease), colon cancer, tuberculosis, infection of the colon (diverticulitis), pregnancy, and loss of neural innervation to the colon (neurogenic disease).

How is it diagnosed?

Constipation signs and symptoms

People vary widely in bowel activity. Any of the following may be a sign of constipation:

  • Infrequent bowel movements, sometimes accompanied by abdominal swelling.
  • Hard feces.
  • Straining during bowel movements.
  • Pain or bleeding with bowel movements.
  • Sensation of continuing fullness after a bowel movement.
  • History: Individuals will report problems passing stools, complain of hard stools, or not having stools.
  • Physical exam may reveal increased anal canal muscle tone, anal fissures, or sometimes a hard mass can be felt in the upper abdomen (in the transverse colon).
  • Tests: The majority of time, individuals do not need to have any tests run to ascertain they have constipation. It is a condition based on history and physical exam alone. In rare cases, the following tests will be ordered to ascertain the cause of constipation: urinalysis with micro, thyroid gland function tests, radiographic test to reveal the colon (barium enema), and an invasive procedure where a scope is placed through the rectal opening and passed up into the colon (colonoscopy).

How is Constipation treated?

Individuals are advised how to increase their dietary fiber content. In many cases, individuals are also given laxatives or gastrointestinal motility drugs. If individuals are found to have an underlying cause for the constipation such as low thyroid levels or colon cancer, the primary disease is appropriately treated with medication or surgery.

Medications

For occasional constipation, you may use stool softeners, mild non-prescription laxatives or enemas. Don't use laxatives or enemas regularly as this can cause dependency. Avoid harsh laxatives and cathartics, such as Epsom salts. The best laxatives are bulk-formers, such as bran, psyllium, polycarbophil and methylcellulose.

Zelnorm (Tegaserod)

What might complicate it?

Individuals may experience urinary tract infections, urinary stones (bladder calculi), colon cancer, breast disease, and enlarged ureters (urethral dilation).

Predicted outcome

Most individuals can expect to return to normal bowel function. Individuals who continue to have problems with constipation may progress to more severe gastrointestinal symptoms.

Alternatives

Differential diagnoses include irritable bowel disease, Hirschsprung's disease (toxic inflamed colon), colon cancer, and hypothyroidism (low thyroid function).

Activity

Regular exercise and good physical fitness help stimulate the bowel and maintain healthy bowel patterns.

Diet

Drink at least 8 glasses of water each day. Include bulk foods, such as bran and raw fruits and vegetables, in your diet. Avoid refined cereals and breads, pastries and sugar.

Appropriate specialists

Gastroenterologist and general surgeon.

Notify your physician if

  • Constipation persists despite self-care, especially if the constipation represents a change in your normal bowel patterns. (Changes in bowel patterns may be an early sign of cancer).
  • Constipation is accompanied by fever or severe abdominal pain.

Last updated 17 June 2011


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