Bad Constipation

By Dr. Julia Lizy, MBBS (KEMU)

Constipation is a common condition that affects both men and women of all age groups. Severity of constipation varies from person to person.

Some people suffer only sporadically, while others have chronic constipation. 

Symptoms of constipation

1. Hard, lumpy and dry stools
   
   
2. Less than three bowel movements a week
   
   
3. Straining during defecation
   
   
4. A feeling of incomplete evacuation
   
   
5. A swollen abdomen, abdominal pain and vomiting

Causes of bad constipation

There are many causes of constipation.

Most of these are related to a person’s daily routine, including: 

1. Dehydration, usually caused by not drinking enough water, or by drinking diuretics, like coffee, tea and sodas 
   
   
2. Not enough dietary fiber in the diet
   
   
3. A sedentary life style, with too little physical inactivity
   
   
4. Ignoring the urge to have a bowel movement
   
   
5. A change in one’s daily routine, such as traveling
   
   
6. Stress is a contributing factor
   
   
7. Medications such as pain killers, anti-depressants, antacids containing aluminum and excessive use of habit forming laxatives
   
   
8. Pregnancy is a major cause in women
   
   
9. Certain GI tract problems such as colon CA which causes the colon to narrow, resulting in constipation
   
   
10. Certain neurological problems such as Parkinsonism, diabetes and multiple sclerosis
    
    
11. Certain hormonal problems such as hypothyroidism
    
    
12. Anxiety, Depression, eating disorders

Who is affected

Constipation can occur in all age groups. 

It effects almost everyone at one time or another. The following groups of people are more prone to constipation than others: 

1. The elderly
   
   
2. Women, because of pregnancy or menopause 
   
   
3. Those with unhealthy gut flora, usually caused by a course of antibiotics
   
   
4. Those who are chronically dehydrated
   
   
5. Those on a low fiber diet
   
   
6. People who don’t get much exercise
   
   
7. People on certain medications, including narcotics and blood pressure medications

Complications of bad constipation

If constipation is not treated, it can cause many serious complications, including:

1. Hemorrhoids: swollen veins in anal canal which can itch, bleed and be very uncomfortable
   
   
2. Anal fissures: Repeated hard stools can cause tears in the anus
   
   
3. Fecal impaction: sometimes large, hard stool gets stuck in the colon, only allowing liquid stool to seep around it
   
   
4. Bleeding: repeated hard stools and straining to defecate can cause rectal bleeding
   
   
5. Negative psychological effects 

How to prevent bad constipation

For constipation, prevention is better than a cure. Here are some easy steps for preventing bad constipation.

1. Add fiber to the diet: A daily fiber intake of 25 to 35 grams is very helpful for combating bad constipation.
   
   To increase daily fiber intake, eat foods high in fiber, including fruits, vegetables, whole grains, fiber cereals, most types of beans, and nuts. Add them to the diet gradually.
   
   Increasing fiber too quickly can result in gas and bloating.
   
   
2. Stay hydrated: drink 6 to 8 glasses of water a day. Dehydration is a major cause of constipation.
   
   
3. Exercise daily: a daily exercise routine helps to improve abdominal muscle tone.
   
   
4. Do not ignore the urge: Try not to ignore or postpone the urge to have a bowel movement. Habitually doing so can cause the urge to diminish, plus gives stool a longer period to dry out.

Definite treatment of bad constipation

In case of distressing symptoms of constipation, first thing to do is increasing the fluid and fiber intake.

Increasing the amount of fruits, vegetables and grains in the diet or Laxatives which can be used are :

1. Bulking Agents: it includes fiber supplements which add bulk to stools and relieve constipation.
    
2. Osmotic laxatives: these help to loosen stools by drawing water through the bowel wall into the bowel, moistening stool, making it soft, slippery and easy to pass.
   
   These include lactulose, glycol, Milk of Magnesia and Epson Salt. A magnesium supplement gives a lower but effective dose of magnesium for ongoing relief.
   
   
3. Stool softeners: also called emollient laxatives, these make stools wet and soft, making them easier to pass through bowel. Docusate is an example of a stool softener.
   
   
4. Stimulant laxatives: these act on intestinal mucosa and alter the water secretion. They also stimulate peristaltic action of gut. These are habit forming, and not for continued use.
   
   
5. Lubricant laxatives:  these make stools slippery by forming a sticky layer over stool. This layer also helps to prevent stool from drying out. They are effective but are not meant for ongoing use.
   
   
6. Biofeedback Training: this is a relaxation exercise for pelvic floor muscles that may aid in the defecation process and cause stools to pass more easily.

Ongoing relief

Magnesium was mentioned above under Osmotic laxatives.

Many have found that taking 300 mg to 400 mg of daily supplemental magnesium is a long-term solution to bad constipation. Magnesium is found in bananas, grapes, and vegetables such as spinach, cauliflower and capsicum.

It is also found in large amounts in almonds, sunflower seeds and other nuts. However, because of modern farming practices, 80% of Americans don’t get enough magnesium in their diet.

A magnesium supplement can work in two ways.

1. Magnesium is a muscle relaxant which helps a tense bowel to relax, which may help restore the normal peristalsis (the wave-like contractions of the colon). 

2. Magnesium draws water from the bowel wall into lumen. This softens the stool, making it easier for it to pass through the colon. 

Conclusion, bad constipation

Constipation is a problem for many people. It should be given the attention it deserves.

Simple changes in daily routine can help to lessen constipation. 

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