Decrease in frequency of bowel movements, difficulty in passing stool, incomplete emptying after bowel movement or hard stool, all these are considered to be constipation in a patient.
If patient has less than three bowel movements in a week, it is considered as severe constipation or chronic constipation.
Symptoms of chronic constipation vary from person to person. Some people have bowel movements three times a day; others have three times a week.
Patient needs to be considered constipated if he/she has two or more of the following symptoms for at least 3 months:
• Straining during a bowel movement.
• Hard stools.
• Incomplete evacuation.
• Two or fewer bowel movements in a week.
It is more prevalent in people who consume junk food. It can occur at any age.
Following factors may contribute to development of chronic constipation. Causative factors vary from person to person.
• Lack of fiber intake in diet.
• Not chewing the food properly.
• Reduced water intake.
• Various medications:
– Iron supplements.
– Antidepressants, tri-cyclic anti-depressants, anticonvulsants and antispasmodics.
– Cigarette smoking withdrawal.
– Abuse of laxatives.
• Severe illness like stroke, paralysis.
• Psychosomatic causes like depression and anxiety neurosis.
• Lead poisoning.
• Intestinal obstruction.
• Connective tissue disorders like lupus and scleroderma.
• Abdominal surgeries.
• Pelvic floor dysfunction.
• Irritable bowel syndrome’ where it alternates with diarrhea.
• Hard stool.
• Infrequent stools, less than three times a week.
• Sensation of incomplete emptying of bowels.
• Bloating of abdomen.
• Straining and difficulty having a bowel movement.
• Cramping pain and distension in abdomen.
• If the cause is intestinal obstruction, then nausea, vomiting may occur along with constipation.
• Coated (furred) tongue, bad breath (halitosis), and bad taste in the mouth.
Diagnosis can be made by a proper clinical history and physical examination.
The presence of characteristic symptoms i.e. hard stools, difficulty in voiding them and feeling of incomplete voiding of stools usually indicate the presence of constipation.
Other tests that your doctor may advice are:
• Examination of stool under microscope.
• Complete blood count.
• Ano-rectal function tests to find out abnormal functioning of the anus or rectum.
• Sigmoidoscopy or colonoscopy.
• Colorectal transit study – shows how well food moves through the colon.
• Barium enema.
• Thyroid function tests to rule out under activity of thyroid.
Treatment aims at the removal of the underlying cause. Along with that, patient needs to follow a healthy diet that includes lot of fiber and fluids.
If the changes in life and diet are not enough to relieve the symptoms of constipation then enema and laxatives may be used. But are not regularly recommended.
Constipation has a good prognosis. It can be cured easily by taking plenty of fluid and fiber in diet. Sometimes laxatives can be used.
• Bowel obstruction.
• Hard, dry, difficult stools.
• Rectum dry.
• Knife-like pains shoot up.
• Severe lumbo-sacral backache.
• Stool followed by fulness in rectum, and intense pain for hours.
• Inactive rectum and bladder.
• Great straining to pass even a soft stool.
• Must strain at stool to urinate.
• No desire for and no ability to pass stool with large accumulation
• Great straining.
• Stool hard, knotty, covered with mucous, or soft, clayey, adhering to parts.
• Chronic constipation, with severe Headache.
• No desire for stool.
• Stool hard, dark, dry as if burnt.
• Distended abdomen rumbling and cutting.
• After stool long-continued burning in rectum.
• Ineffectual desire for stool.
• Tearing and contracting pain, as from piles in rectum and anus after a meal.
• Bright blood with faeces, with constriction and contraction during stool.
• Stool with sensation of “something left behind”.
• Hard, as if burnt.
• Stool every 2, 3 or 4 days.
• Red orifices, acrid excoriating discharges.
Following measures can help you prevent the condition:
• Include more fiber to diet.
• Have 8 hours sleep at night.
• Drink plenty of water.
• Don’t ignore the urge for defecation.
• Regular physical activity is necessary.
• High intake of fiber in diet.
• Salad prior to dinner.
• Dairy products.
• Plenty of water.
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