What is constipation And is it considered to be a medical problem?
There is a wide variety of bowel action that can be regarded as normal. If a bowel action is occurring at less than three day intervals this is regarded as constipation. There should be no need to strain to empty the bowel - straining suggests constipation. Chronic constipation may be associated with haemorrhoids (piles) and prolapse of the rectum. The hard stools may tear the lining of the anus resulting in bleeding and fissures (splits).
What causes constipation?
A number of factors can result in constipation including:
- inadequate fibre intake
- weight reducing diets
- poor abdominal muscle tone
- poor toilet habits (not answering the call to stool) or not allowing the bowel time to work
- progesterone (39) premenstrually and in pregnancy
- anal pain due to haemorrhoids or fissure
- underactive thyroid gland (hypothyroidism)
- high levels of calcium (hypercalcaemia)
- bowel obstruction due to adhesions (scars around the bowel) or a tumour
- medications including:
- 1. iron preparations
- 2. pain killers e.g. codeine containing tablets
- 3. tricycyclic antidepressants
- 4. steroids
- 5. aluminium containing antacids
- 6. progestogens
How can constipation be treated?
Simple measures, such as increasing fluid and fibre intake, may be sufficient. Fibre helps digestion by increasing the amount of water in the bowel content. One gram of fibre will increase the motion weight by 5grams because of the additional water that is retained. The lubrication within the bowel is improved and the peristalsis of the bowel is more effective in moving the contents along. There are two types of fibre: Soluble fibre is broken down in the large bowel whereas insoluble fibre is passed out in the stools. Soluble fibre is found in figs, apricots, tomatoes, oats, barely and rye. Insoluble fibre is found in wheat, rice, pasta, lettuce, spinach, peas, lentils, strawberries and rhubarb. Cereals, particularly bran, are rich in fibre. Soluble fibre has an important role in the stomach and upper intestine. It slows down digestion and absorption allowing the body to deal with nutrients at a relatively steady rate. Insoluble fibre is more important in the large bowel as it bulks up the stool and assists with excretion.
If a healthy diet does not overcome constipation problems, laxatives may be considered. There are laxatives that increase the bulk of the stool, soften the stool or stimulate the bowel action. Bowel stimulants may increase IBS pain. With time, laxatives may become less effective so that stronger agents may be required. It is, therefore, recommended that they be used only when necessary and that every effort to control the bowel by dietary means be explored. Bulking agents may relieve constipation. Fibre supplements such as a tablespoon of natural bran two or three times a day may be adequate. Ispaghula (Fybogel Reckitt and Colman; Regulan Procter and Gamble) are fibre supplements; one or two sachets in water each day is the usual dosage. Lactulose (Duphalac - Solvay) 2 or 3 teaspoonfuls once or twice daily is an osmotic laxative, which increases the fluid in the stool; this is a relatively gentle first choice agent. Bulking agents may relieve symptoms when there is either diarrhoea or constipation. It takes a while for these to help establish a normal bowel pattern so you should not give up too quickly.
Please click on the required question.
- Pelvic Pain. Is this a common problem?
- What are the common causes of pelvic pain in women?
What are the more common gynaecological causes of pelvic pain?
What are the more common non-gynaecological causes of pelvic pain?
What are primary and secondary dysmenorrhoea - painful periods?
What is retrograde menstruation?
How can dysmenorrhoea - painful periods be treated?
What are ovarian cysts?
How do ovarian cysts cause pain?
How are ovarian cysts diagnosed?
How are ovarian cysts treated?
I think I may be pregnant and I have some pelvic pain. What should I do?
What is pelvic inflammatory disease and how can it be treated?
- 3 What are the more common gynaecological causes of pelvic pain?
- 4 What are the more common non-gynaecological causes of pelvic pain?
- 5 What are primary and secondary dysmenorrhoea - painful periods?
- 6 What is retrograde menstruation?
- 7 How can dysmenorrhoea - painful periods be treated?
- 8 What are ovarian cysts?
- 9 How do ovarian cysts cause pain?
- 10 How are ovarian cysts diagnosed?
- 11 How are ovarian cysts treated?
- 12 I think I may be pregnant and I have some pelvic pain. What should I do?
- 13 What is pelvic inflammatory disease and how can it be treated?
FIBROIDS
- What are Fibroids?
I have Fibroids. What difficulties might they cause for me?
How are Fibroids diagnosed?
How could my Fibroids be treated?
I have Fibroids. What difficulties might they cause for me?
How are Fibroids diagnosed?
How could my Fibroids be treated?
- 16 How are fibroids diagnosed?
- 17 How could my fibroids be treated?
ENDOMETRIOSIS
- 18 What is endometriosis?
- 19 How prevalent is endometriosis?
- 20 What causes endometriosis?
- 21 How can my endometriosis be treated?
- 22 How can my doctor determine the cause of my pelvic pain?
- 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- 24 What is laparoscopy?
- 25 What are pelvic adhesions?
- 26 I have chronic pelvic pain. Could this be related to adhesions?
- 27 What is uterine retroversion (retroverted uterus)
- 28 Does a retroverted uterus cause symptoms?
- 29 How is a retroverted uterus treated?
- 30 What is pelvic congestion?
- 31 What causes pain associated with sexual intercourse (dyspareunia)
- 32 How can painful sexual intercourse (dyspareunia) be treated?
- 33 What is a pelvic mass?
IRRITABLE BOWEL SYNDROME - IBS
- 34 What is irritable bowel syndrome?
- 35 How can we find out if I have irritable bowel syndrome?
- 36 Is irritable bowel syndrome (IBS) a common condition?
- 37 What causes IBS?
- 38 What is the pain associated with IBS like?
- 39 Can IBS be mistaken for gynaecological problems?
- 40 How can my IBS be managed?
- 41 What other treatments are available for IBS?
- 42 What can be done to reduce the amount of bowel gas(flatus)
- 43 What is constipation?
- 44 What causes constipation?
- 45 How can constipation be treated?
- 46 How could we summarise the treatments that are available for my pelvic pain?
- 47 Where can I obtain more information?
- 48 Pelvic Pain Support Groups.
- 49 Endometriosis Support Groups.
- 50 IBS Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
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