A B C D E F G H I J K L M N O P R S T U V W

CONSTIPATION

What is Constipation ?

Constipation has different meanings to different people. The usual meaning is the passing of small hard faeces (stools, motions) infrequently. Other common symptoms are straining and a feeling that the bowel is not completely empty after a visit to the toilet. In general, unless there is discomfort, or the irregularity is sudden or new, constipation is not a problem: it needs neither investigation nor treatment.

How does Constipation occur ?

Constipation usually occurs because there is not enough fibre in the diet to allow your bowel to work properly. A certain amount of bulk is necessary. The bowel may be affected by drugs, including those used for treating depression, antacids containing aluminium, iron tablets, and some painkillers (especially those with codeine). Many other drugs can more rarely cause constipation. Diseases or conditions that may cause constipation are diverticular disease, irritable bowel syndrome, strokes, pregnancy, an underactive thyroid gland (hypothyroidism), diabetes and depression. Many patients worry that cancer may be the cause of their problem but this is uncommon. It is considered a possibility only if the development of constipation is quite recent. Some people use laxatives too freely. After a few days of taking them, the bowel becomes naturally sluggish again. In this way, taking laxatives can actually cause the problem.

Why does Constipation occur ?

Why some people have the problem and others do not is still a puzzle. Constipation is often the result of a series of factors mentioned above coming together. Inactivity, for example with illness or extended travel, is often a trigger. Pain in the anus, due to a tear in the skin, a fissure or haemorrhoids, may cause constipation because of the fear of passing motions. Constipation is certainly commoner in old age.

Treatment Involved for Constipation

The doctor may want to examine your abdomen. Sometimes an examination of the rectum is necessary and in some people, a sigmoidoscopy (examination of the rectum by a short telescope) may be needed. An assessment of the possible causes of the constipation will be made. This will include an assessment of diet. Taking more fluids and fibre is always a good idea. This means fibrous fruits (e.g. apples, oranges, pears), fresh vegetables and wholewheat bread and breakfast cereals. Fibre supplements such as ispaghula husk may be used in addition. A build-up of exercise, even just walking, is also sensible. Stimulant laxatives such as senna or bisacodyl may work. Once the bowel is working again, stimulant laxatives should be slowly stopped. Lactulose is another laxative which is often helpful: it works by drawing fluid into the bowel. Salts such as magnesium sulphate (Epsom salts) and magnesium hydroxide (milk of magnesia) are also sometimes used. They work in a similar way and are cheaper. Suppositories (to stimulate and lubricate the rectum) and enemas (to add liquid) are needed occasionally.

During Treatment for Constipation

Fibre, especially when taken as bran and bulk laxatives, can lead to bloating of the abdomen, pain and increased wind. These treatments should only be built up slowly to avoid symptoms. It is important never to make a habit of taking laxatives unless it really proves necessary. This should be worked out by discussion with the doctor. Notify the doctor if diarrhoea or severe abdominal pain occurs, or if constipation becomes worse. The diarrhoea produced by chronic over-energetic laxative use can upset the body's mineral balance and lead to other problems.

If Constipation is Left Untreated

Providing any associated illness has been identified and treated there are unlikely to be any ill effects from chronic constipation.

Effects on Family of Constipation

Lack of both exercise and fibre worsen the problem of constipation. Changes in lifestyle can be difficult. They are made much easier by encouragement and support from family and friends.