Constipation symptoms should not be ignored to prevent constipation side effects. Ruling the constipation causes help give right chronic constipation treatment.

Constipation

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Overview

Constipation is a common clinical symptom, rather than a disease. It refers to a reduced number of <a href="https://merisehat.pk/disease/irritable-bowel-syndrome-62">bowel</a> movements, reduced amount of feces, dry feces, and defecation effort. It must be combined with the characteristics of stool.

Infrequent and often painful bowel movements characterize constipation. It results in the passage of hard, dry stool, usually less than 3 times a week.&nbsp;However, normal stool elimination may consist of having&nbsp;a bowel movement three times a day or three times a week, which vary person to person.

Constipation affects approximately four million people in the United States. Constipation is the most common complaint related to the stomach and intestines, due to which annually, 2.5 million people visit the doctor<a href="#accordion">[2]</a>.

The prevalence of constipation varies from 2 to 27%<a href="#accordion">[11]</a>. Its prevalence in Pakistan was found to be 1.61% in 2004<a href="#accordion">[5]</a>. A study was conducted in Pakistan to estimate the number of people suffering from constipation. Out of the 53 constipated patients, 56.6% (30/53) had symptoms of constipation longer than six months. 23.52% of the constipated students had symptoms of constipation longer than 6 months. Out of the 27 constipated attendants, 74.07% (20/27) had symptoms longer than six months. In Pakistan, constipation is fairly common in the age group 18 to 30 years, that is 24.3% of patients<a href="#accordion">[7]</a>. 
&nbsp;

There are three types of constipation:

<h5 dir="ltr"> 
 
1. Chronic Constipation</h5>

Constipation is characterized by infrequent bowel movements or painful passage of stool. It may persist for weeks or longer.&nbsp;

Many people may also experience chronic constipation which affects their daily functioning. Moreover, it can cause excessive straining during bowel movements.

Treatment for chronic constipation depends, in part, on the underlying cause.&nbsp;However, a cause is not always found.

<h5 dir="ltr"> 
2. Functional Constipation</h5>

Functional constipation is the term given to constipation that results due to a dysfunction of the lower intestinal tract, which includes the colon, rectum, and anus.&nbsp;

<h5 dir="ltr"> 
3. Secondary Constipation</h5>

But if there is no problem with the colon, rectum, and anus, it would be &ldquo;secondary constipation&rdquo;. It is due to either an underlying medical condition or the use of certain medications.&nbsp; 
&nbsp;

Signs And Symptoms

If constipation does not go away with self-care or long-term constipation, it is necessary to consult a doctor. You should see a doctor if you have blood in your stool or continual pain in your abdomen. Most common signs and symptoms of chronic constipation are listed below: 
&nbsp;

<ol>
	<li>Passing fewer than three stools a week</li>
	<li>Having lumpy or hard stools</li>
	<li>Straining to have bowel movements</li>
	<li>You may feel like a blockage in the rectum is preventing bowel movement</li>
	<li>You may feel like you are unable to completely empty the bowels</li>
	<li>Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum. 
	&nbsp;</li>
</ol>

Causes

The slow movement of the stool through the digestive tract or its ineffective elimination through the rectum can cause the stool to become dry and hard in constipation. 
&nbsp;

<h5 dir="ltr">Medications</h5>

Some medicines&nbsp;can cause constipation as a side effect. These include:

<ul>
	<li><a href="https://merisehat.pk/disease/heart-burn-58">Heartburn</a> medications like aluminum or calcium antacids</li>
	<li>Certain <a href="https://merisehat.pk/disease/depression">depression</a> medications</li>
	<li>Calcium channel blockers that control blood pressure</li>
	<li>Diuretics&nbsp;(water pills)<a href="http://#accordion">[4]</a></li>
	<li>Medications that can reduce or treat muscle spasms in the digestive tract
	<ol>
		<li>Iron supplements for <a href="https://merisehat.pk/disease/anemia">anemia</a></li>
	</ol>
	</li>
	<li><a href="https://merisehat.pk/disease/epilepsy">Epilepsy</a><a href="https://www.merisehat.pk/disease/epilepsy" target="_blank"> </a>medications</li>
	<li>Painkillers include&nbsp;opioids, such as morphine and codeine<a href="http://#accordion">[4]</a></li>
</ul>

&nbsp;

<h5>Blockages In The Colon Or Rectum</h5>

The movement of the stool can be slowed or stopped by blockages in the rectum or colon. Causes include:

<ul>
	<li>Tiny tears in the skin around the anus (anal fissure)</li>
	<li>A blockage in the intestines (bowel obstruction)</li>
	<li>Colon cancer</li>
	<li>Narrowing of the colon (bowel stricture)</li>
	<li>Other abdominal cancer that presses on the colon</li>
	<li>Rectal cancer</li>
	<li>Rectum bulges through the back wall of the vagina (rectocele)</li>
</ul>

 
&nbsp;

<h5>Dysfunction Of The Nerves Surrounding The Colon And Rectum</h5>

Neurological problems can affect the intestinal muscles that help the stool move through the colon and rectum.&nbsp;Causes include:

<ul>
	<li>Autonomic Neuropathy:&nbsp;Damage to the nerves controlling basic body functions</li>
	<li>Multiple Sclerosis: The body&rsquo;s immune system mistakenly attacks and damages the fatty material, called myelin, around the nerves. Myelin is important for protecting and insulating nerves&nbsp;so that the electrical messages that the brain sends to the rest of the body travel quickly and efficiently.</li>
	<li>Parkinson&#39;s Disease: The disorder affects several regions of the brain, especially an area called the substantia nigra that controls balance and movement. Often the first symptom of Parkinson&#39;s disease is trembling or shaking (tremor) of a limb, especially when the body is at rest.</li>
	<li>Spinal cord injury.</li>
	<li><a href="https://merisehat.pk/disease/stroke">Stroke</a>: Stroke is the second leading cause of disability, after <a href="https://merisehat.pk/disease/dementia">dementia</a>. 
	 
	&nbsp;</li>
</ul>

<h5>Difficulty With The Muscles Involved In Elimination</h5>

Chronic constipation can result from problems with the pelvic muscles responsible for causing bowel movements. These problems may include:

<ul>
	<li>The inability to relax the pelvic muscles to allow for a bowel movement (anismus). Anismus is a functional pooping disorder. It occurs when the muscles and nerves in the pelvic floor fail to coordinate correctly to have a bowel movement (pelvic floor dysfunction)<a href="http://#accordion">[1]</a></li>
	<li>Irregular coordination of the pelvic muscles&nbsp;(dyssynergia).&nbsp;Dyssynergia results from uncoordinated pelvic muscle movements. It is also a feature of ataxia.</li>
	<li>Weakened pelvic muscles.</li>
	<li>Conditions that affect hormones in the body
	&nbsp;
	</li>
</ul>

Hormones help balance fluids in your body.&nbsp;Disorders causing hormonal imbalances can also result in constipation. Examples include:

<ul>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a></li>
	<li>Overactive parathyroid gland (hyperparathyroidism)</li>
	<li>Pregnancy</li>
	<li><a href="https://merisehat.pk/disease/hypothyroidism">Under-active thyroid</a> (hypothyroidism) 
	&nbsp;</li>
</ul>

Diagnosis

Diagnosis of constipation can be determined through family history, medical tests, and physical examination. The tests used for the diagnosis of constipation will depend on the severity and duration of constipation. The doctor will also take into account any weight loss, the patient&#39;s age, whether there is blood in the stool or not, and recent changes in bowel habits.

Diagnosing constipation may include: 
&nbsp;

Medical History:&nbsp;It may include the duration of symptoms, the current frequency of bowel movements, and other information which can help to determine the cause of constipation.

Physical Examination:&nbsp;It can include a digital rectal examination (DRE). This examination helps detect blood, obstruction, tenderness, and caliber of stool, and any enlargement of the rectum.

&nbsp;

Diagnostic tests include:

<ul>
	<li>Abdominal X-ray: An abdominal X-ray is sometimes abbreviated as AXR or KUB<a href="#accordion">[2]</a>.</li>
	<li>Lower GI&nbsp;(Gastrointestinal) Series (Also Called Barium Enema):&nbsp;Lower GI series help examine the lower intestinal tract. The procedure involves a barium enema. Barium is a chalky liquid that coats the organs and helps them become visible on an X-ray. The X-ray can then reveal any obstructions, strictures, or other intestinal tract problems<a href="#accordion">[2]</a>.</li>
	<li>Colonoscopy:&nbsp;&nbsp;This procedure helps doctors identify any blockages, inflammation, bleeding, or abnormal growth in the entire length of the large intestine.&nbsp;The colonoscope allows the doctor to see the lining of the colon and remove tissue for further examination<a href="#accordion">[2]</a>.</li>
	<li>Sigmoidoscopy:&nbsp;The diagnostic procedure can help examine the sigmoid colon. It can identify the causes of diarrhea, abdominal pain, constipation, abnormal growth, and bleeding.&nbsp;A sigmoidoscope is a short, flexible tube with a light at the end. It is inserted through the rectum and blows air into the intestine, inflating it to make the examination easier<a href="#accordion">[2]</a>.</li>
	<li>Colorectal Transit Study:&nbsp;The test helps assess the movement of food through the colon. Capsules containing markers that show up on X-rays are swallowed by the patient. During the test, the patient eats a high-fiber diet, and several abdominal X-rays are conducted to monitor the movement of the capsule, for 3-7 days after the swallowing of capsules.&nbsp;</li>
	<li>Anorectal Function Tests:&nbsp;Constipation caused by dysfunction of the anus or rectum can be diagnosed using these tests<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

Treatment

Your doctor will determine the treatment based on:

<ul>
	<li>Your age, overall health, and medical history</li>
	<li>Extent of the condition</li>
	<li>Your body&rsquo;s tolerance for specific therapeutic interventions</li>
	<li>Expectations for the course of this condition</li>
	<li>Your opinion or preference</li>
</ul>

Constipation is commonly treated with dietary and lifestyle changes. Moreover, these changes can also help relieve the symptoms and prevent the disease&rsquo;s occurrence. Treatment may include: 
&nbsp;

<h5>1. Diet Modifications &nbsp;</h5>

A diet with 20-35 grams of fiber daily helps in the formation of soft and bulky stools. The addition of foods like fresh fruits, beans, bran cereals, whole grains, and vegetables will add fiber to your diet. Foods like meats, ice cream, processed foods, and cheeses should be avoided as they are low in fiber. 
&nbsp;

<ul>
	<li>Food For Patients Suffering From Constipation</li>
</ul>

Your healthcare professional may tell you that you can treat your constipation or prevent it by making changes to what you eat and drink, being more active, or taking over-the-counter medicines.&nbsp;

&nbsp;

<ul>
	<li>Fiber</li>
</ul>

Eat enough fiber and drink plenty of water, juices, or other liquids to help the fiber work well. Depending on age and sex, adults should take 22-34 grams of fiber per day. Older persons may not get enough fiber due to limited intake.&nbsp;To&nbsp;plan meals with a sufficient amount of fiber, talk to a healthcare professional, such as a&nbsp;dietitian. Add a little fiber to your diet slowly so that the body gets used to the change.

Good sources of fiber are:

<ul>
	<li>Whole grains, e.g. whole wheat bread and pasta, bran flake cereals, and oatmeal</li>
	<li>Legumes, which include lentils, kidney beans, chickpeas, and black beans</li>
	<li>Fruits, e.g.&nbsp;oranges, apples with skin, ad berries</li>
	<li>Vegetables, e.g. collard greens and carrots</li>
	<li>Nuts, e.g.&nbsp;almonds, peanuts, and pecans</li>
</ul>

The fiber content of different fiber sources:

<table class="table table-bordered">
	<tbody>
		<tr>
			<td style="text-align:center">Sources</td>
			<td style="text-align:center">Moderate Fiber</td>
			<td style="text-align:center">High Fiber</td>
		</tr>
		<tr>
			<td>Bread</td>
			<td>Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Cereal</td>
			<td>Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Muslix, granola, oat bran</td>
			<td>All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran</td>
		</tr>
		<tr>
			<td>Vegetables</td>
			<td>Beets, broccoli, Brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Fruits</td>
			<td>Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins</td>
			<td>Cooked prunes, dried figs</td>
		</tr>
		<tr>
			<td>Meat Substitutes</td>
			<td>Peanut butter, nuts</td>
			<td>Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix</td>
		</tr>
	</tbody>
</table>

<h5>&nbsp;</h5>

<h5>2. Lifestyle Modifications</h5>

Constipation can be managed with some lifestyle modifications, such as increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements can be helpful. 
&nbsp;

<ul>
	<li>Plenty Of Water</li>
</ul>

Drink plenty of water and liquids, for example, fruits, vegetable juices, or clear soups. This change will make the&nbsp;stools&nbsp;softer and easier to pass.&nbsp;Drinking enough water and other liquids is also helpful to avoid&nbsp;dehydration. Staying hydrated is good for your health, and at the same time, it will help you to avoid constipation. Consult a healthcare professional to decide how much liquid you should drink daily. It will be based on your health, weight, health, where you live, and activity level. 
&nbsp;

<ul dir="ltr">
	<li>Food Items To Be Avoided By&nbsp;Patients&nbsp;</li>
</ul>

Foods rich in fiber can help prevent and relieve constipation. Examples of foods with little or no fiber include:

<ul>
	<li>Chips</li>
	<li>Fast food</li>
	<li>Meat</li>
	<li>Prepared foods, such as some frozen meals and snack foods</li>
	<li>Processed foods, such as hot dogs or some microwavable dinners 
	&nbsp;</li>
</ul>

<h5>3. Medications To Treat Constipation</h5>

&nbsp;

<ul>
	<li>Laxatives</li>
</ul>

After diet and lifestyle changes have failed to cure and control constipation, laxatives will be prescribed. It is a group of drugs that accelerate fecal passage by decreasing fecal consistency. The main mechanisms of action include the enhancement of fluid retention by hydrophilic or osmotic mechanisms. This decreases the net absorption of fluid through effects on the fluid and electrolyte transport (in the small or large intestines), and alteration of motility by inhibiting non-propulsive contractions and stimulating propulsive contractions. Laxatives are placed in one of four categories: stool softeners or surfactant laxatives, osmotic laxatives, bulk-forming laxatives, and stimulant laxatives.

&nbsp;

<ul>
	<li>Eliminating Or Changing Medication</li>
</ul>

&nbsp;

<ul>
	<li>Biofeedback</li>
</ul>

Chronic constipation caused by anorectal dysfunction can be treated via biofeedback. It re-trains the muscles that control bowel movements. 
&nbsp;

Complications of constipation include anal fissures (tears in the skin around the anus), which occur due to the passage of hard stool.&nbsp;Sometimes, straining to pass a hard stool causes rectal prolapse, i.e., the intestinal lining protrudes out of the anal canal. Children and older adults have fecal impaction. It is the packing of hard stool in the intestine and rectum very tightly that the normal pushing action of the colon is unable to expel the stool. 
&nbsp;

The following factors can increase one&rsquo;s risk of chronic constipation:

<ul>
	<li>Being an older adult</li>
	<li>Being a woman</li>
	<li>Being dehydrated</li>
	<li>Eating a diet that&#39;s low in fiber</li>
	<li>Getting little or no physical activity</li>
	<li>Taking certain medications, including sedatives, opioid pain medications, some antidepressants, or medications to lower blood pressure</li>
	<li>Mental health disorders, such as depression and eating disorders 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Constipation can be chronic constipation, functional constipation, or secondary constipation.&nbsp;If there&rsquo;s a problem with the functioning of the lower intestinal tract (colon, rectum, and anus), it is referred to as &ldquo;functional constipation.&rdquo; But if there is no such problem, then constipation is deemed as &ldquo;secondary constipation.</li>
	<li>Constipation is characterized by the passage of hard and dry stools. Moreover, there are infrequent bowel movements.</li>
	<li>Constipation could be a side effect of some medications like heartburn medications e.g. aluminum or calcium antacids, depression medications, calcium channel blockers that control blood pressure and diuretics, etc.</li>
	<li>Other causes of constipation may include, blockages in the colon or rectum, problems with the nerves around the colon and rectum, difficulty with the muscles involved in elimination, conditions that affect hormones in the body, diabetes, an overactive parathyroid gland (hyperparathyroidism), pregnancy, and an under-active thyroid (hypothyroidism).</li>
	<li>Diagnosis of constipation can be done through the patient&rsquo;s medical history and physical examination. Tests used for diagnosis of constipation include&nbsp;abdominal X-ray, and lower GI&nbsp;(gastrointestinal) series (also called&nbsp;barium enema). Moreover, colonoscopy, sigmoidoscopy,&nbsp;colorectal transit study, and anorectal function tests can help diagnose constipation.&nbsp;</li>
	<li>High fiber intake can help to manage constipation.</li>
	<li>Lifestyle modifications like plenty of water intake, regular exercise, and eating high-fiber food can cure constipation.&nbsp;</li>
	<li>If life and diet modifications do not work, then medications like laxatives, eliminating or changing medication, and biofeedback can cure constipation.</li>
	<li>Risk factors include being an older adult, being a woman, dehydration, eating a diet that&#39;s low in fiber,&nbsp;and getting little to no physical activity. 
	&nbsp;</li>
</ul>

[1] Anismus (dyssynergic defecation): Causes, symptoms, treatment. Cleveland Clinic. Accessed May 19, 2023.

[2] Constipation. Constipation | Johns Hopkins Medicine. Accessed May 19, 2023.

[3] Constipation. Constipation | Johns Hopkins Medicine. Accessed May 19, 2023.

[4] Digestive disorders and Digestive Health Center. WebMD. Accessed May 19, 2023.

[5] Cure Research. Statistics by country for constipation.

[6] Dyssynergia. Wikipedia. December 8, 2022. Accessed May 19, 2023.

[7] Khatri P.K.,A.D. Ali, N Alzadjali, G. Bhagia, S.J. Khaliqdina, S.A. 2011. Frequency of functional constipation in 3 different populations and its causative factors. JPMA, 61(11):1149-1152.

[8] Laxative:Laxatives stimulate bowel evacuation and defecation by a number of different methods depending on the drug used. Geriatric Physical Therapy (Third Edition), 2012.

[9] National institute of health, national cancer institute. 10th July2022.

[10] Parkinson disease type 3 - about the disease. Genetic and Rare Diseases Information Center. Accessed May 19, 2023.

[11] Stewart WF, Liberman JN, Sandler RS, Woods MS, Stemhagen A, Chee E, et al. Epidemiology of constipation in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 1999; 94: 3530-40.