Understanding and Managing Constipation
Constipation is an uncomfortable and painful condition that can come on in a matter of days mostly if we don’t pay close attention to our diet and fluid intake.
This article below will help you understand the causes of constipation, treatments, the complications of pro-longed constipation and when to see a doctor.
What is constipation and what is normal?
What is normal for some people is not normal for others. Research suggests anywhere from three bowel movements a day to three a week can be normal bowel movements. So, what is not normal is what is not normal for you.
According to the most used definition, constipation is evacuation of faeces less than three times a week. It results in having hard, lumpy dry bowel motions (stools) that are difficult to pass. It can also be the sensation that the bowel has not emptied properly and can be accompanied by a bloated abdomen and abdominal cramps. Constipation can be a common / regular condition or infrequent / occasional. Pro-longed constipation is regarded as chronic constipation and can contribute to poor healthy and sluggishness.
Causes of Constipation
The most common causes of constipation include a change in routine (travellers, shift-workers), not enough fibre in the daily diet, not enough fluids and lack of exercise.
Elderly people, women (pregnant women in particular), immobile people and young children typically suffer from constipation the most due to their circumstances. For the first three it can be due to lack of exercise and mobility or hormone / cramp related. For young children it can be due to a reluctance to eat fruit and vegetables and also not drink enough fluids. In nearly all cases, a lack of water is a contributing factor.
Medications causing constipation
Anaesthetic and codeine-containing analgesics also tend to bring on constipation in many people. If you are constipated post an operation – do not strain – as this can burst internal stitches and create other problems. Go to an Emergency department like BNE straight away.
Other medications that can induce or worsen constipation (in many cases because they serve to reduce the amount of fluid in your body) are:
- Diuretics (Coffee, green and black tea can have a mild diurectic effect)
- Blood pressure medication such as Antihypertensives
- Iron and Folate
- Anti-depressants, anti-psychotics
- Antacids containing Aluminium and calcium
- Medication for people suffering nervous system disorders
What you need to know about that part of the body
Water is a key part of the process. Our body waste is stored in the large intestine (colon or large bowel) which is about 1.5 m long and about 9 cm in diameter. The colon absorbs water from wastes, creating stool. When you don’t have enough water for your body to absorb and for it to stay with the waste is when you can encounter problems. Faecal waste is massaged down the length of the large intestine by waves of muscular contractions (peristalsis).
Before defecating, faecal material stored in the colon moves past the rectosigmoid sphincter into the normally empty rectum by colonic mass movements. With the rectum becoming full it signals a need to defecate sensation. For some, mild straining can produce an increase in intra-abdominal pressure, which results in a relaxation of the pelvic floor, rectoanal inhibition, and internal anal sphincter, along with a voluntary relaxation of the external sphincteric and pubococcygeal muscles.
Conversely, humans can delay defecation by contracting / tightening the external anal sphincter and this will decrease the urge over a few minutes. If the rectum is not emptied there it will stay.
Constipation often happens though with faecal matter queuing up in the colon and not entering the rectum.
Constipation Complications and Straining – 3 issues
In the main you want to avoid excessive straining (and constipation) as this can create a range of more serious conditions and constipation complications, three of these being:
1. Hemorrhoids – swollen and inflamed veins, like varicose veins, in your lower rectum. There are two kinds of hemorrhoids: internal, which occur in the lower rectum, and external, which develop under the skin around the anus. Internal hemorrhoids are usually painless but tend to bleed. External hemorrhoids are the most uncomfortable. Hemorrhoids are usually caused by increased pressure due to pregnancy, being overweight, heavy lifting or straining during bowel movements. They can also add to the constipation problem by restricting the passage way.
2. Rectal Prolapse – when part of the rectal wall loses its attachment to the body, collapses and protrudes out of the anus. It can pop out during a bowel movement. For some it will go back inside naturally. For others it needs to be manually pushed back inside.
3. Fainting and resulting injuries – officially known as “Defecation syncope” – overstraining while trying to do a “number 2”. Constipated people often take a deep breath, hold it, then push and strain. By doing so they lower the volume of blood returning to the heart, which decreases the amount of blood leaving it. This triggers a vasovagal reflex from the body’s vagus nerve. What’s worrying about fainting at any time is where and how you land and the damage you can do to your head, face, teeth and nose.
Using Stool Softeners & Laxatives
Many people resort to using over the counter or supermarket-bought laxatives when they cannot go. This can be dangerous in itself as it’s not managed under medical supervision.
Laxatives should be a rarely used medication and not something you rely on as it can cause serious long-term complications. There are different types of medications from oral to suppositories, from stool softeners to laxatives to bowel stimulants (movement muscle activators). Most work by attracting more water to the stool or by coating it in a gel or oil. They can take anything from 30 minutes to 72 hours to work (orally) and with suppositories can take 2 minutes to 1 hour to work. It is important to note that suppositories often only empty the rectum.
There is still some debate that reliance on laxatives can lead to a lazy bowel, creating a long-term reliance on laxatives and more complications. It is important not to over-treat constipation with laxatives in place of seeking medical advice. Laxatives can also interact with other drugs, vitamins, and supplements that you take.
Serious Ongoing Constipation Complications
Along with the straining complications highlighted above, ongoing complications can include:
- Urinary incontinence – as the constant straining weakens pelvic floor muscles. This makes involuntary passing of urine more likely, especially when sneezing, coughing or laughing.
- Faecal incontinence – an overfull bowel can result in involuntary ‘dribbling’ of diarrhoea.
- Faecal impaction – the lower bowel and rectum become so packed with faeces that the muscles of the bowels can’t push any of it out. Laxatives alone may not help this situation.
- Bowel Obstructions and Twisted Bowels – both of which require hospitalisation, observation and possibly surgery.
Typically, if you have a faecal impaction, chances are you’ve been constipated for a while. And then suddenly, you might have other symptoms, such as:
- Very watery diarrhea or a stool that leaks or explodes at any time or when you cough or laugh.
- Nausea or vomiting
- Back or stomach pain
- Little or no urine or urge to pee
- Swollen belly
- Difficulty breathing
- Very fast heartbeat
- Low blood pressure
If you’ve been constipated and have any of these problems, contact your doctor right away. Many people with faecal impaction are old or have other serious illnesses, so this problem can be life-threatening.
When you have a faecal impaction, you’ll need to have the hard mass of stool removed from your colon or rectum to get better. It won’t go away on its own, and it actually can lead to death, for example with tearing of the intestine wall and infection.
The most common treatment for a faecal impaction is an enema, a fluid that a doctor inserts into your rectum to soften your stool. An enema often makes you have bowel movements, so it’s possible that you’ll be able to push out the mass of stool on your own once it’s been softened by the enema.
Sometimes, if an enema doesn’t do the trick, the stool must be manually removed.
When to see your Doctor immediately or come to BNE
If you or your loved one
- has been constipated for more than 3 days
- has recently had surgery and been constipated for more than 3 days
- has a history of faecal impaction and or any of the symptoms associated with faecal impaction.
- Has a serious side effect from taking a laxative, stool softener or suppository
- Is experiencing severe, stabbing abdominal pain
- Has fainted while on the loo
- Has blood in their stool or vomiting blood (may indicate a more serious condition
- Cannot seem to pass gas even.
The older you get, the more likely you are to be constipated. This is due to a number of factors, including reduced gastric movement that encourages digestion, reduced mobility, and taking more medications that may slow bowel health. Parents also need to be fully aware of the children’s bowel movement. It pays to be extra careful to ensure good bowel health and movement.
Having bowel complications can be very painful and is not something to be embarrassed about. At BNE we have experience with alleviating this pain for patients and just want you to feel well again and for your body to function like normal – because your bowel definitely needs to function. We are here for you so – pardon the pun – don’t just sit on it!
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