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.

     


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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - 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.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
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