Constipation – General Causes and Treatments

Constipation – General Causes and Treatments

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Constipation is denned as a difficult passage of infrequent and excessively dry stools. The normal frequency of the passage of stools varies from person to person. Some pass three stools in a day whereas others do not pass one in three days. It is a personal habit developed over the years and the cause to worry rises only if there is a sudden change of bowel habits e.g. vomiting associated with constipation, or passage of blood with constipated stools.

In infants the frequency of bowel movements/emptying varies. A pattern takes some time to form. An infant can have a normal bowel movement every 4—6 hours for a few weeks and then change to one every two days. Any infant who has distension of the abdomen within a few days of birth and has constipation must be shown to the physician as there are certain congenital disorders which contribute to this condition.

An infant who behaves normally and accepts normal feeds

An infant who behaves normally and accepts normal feeds with no discomfort or vomiting, but comes up with constipated motion is no cause to worry.

At times a total formula feed may be the cause (artificial top feeds).

Faulty bowel habits and children who ignore the call of nature when playing, generally have constipation.

Some people have a fixed notion that unless they empty their bowels daily there is something wrong. Others do not worry if they do not pass a motion for a week. Still others get into the habit of taking laxatives which worsen the situation. All these cases respond to proper psychotherapy—education on what is normal and abnormal and the effects of misuse of purgatives.

• Dietary factors—low fibre diets with inadequate water or fluid intake.

• Pregnancy—pregnant women have a tendency to constipation which is partially hormonal.

• Physical inactivity—sedentary workers, and those who take no exercise, patients who have been confined to bed for a long duration due to illness etc. develop constipation.

• When the call of nature is ignored due to, say, pending housework, or an interesting programme on TV a bad bowel habit is formed.

• Congenital defects in the structural development of the large intestine, rectum and anus.

• Diseases of the large intestine where there is inflammation or cancerous growth.

• Haemorrhoids and fissure in the anus, when because of the bleeding and pain during defecation the patient tries not to go to the toilet and sets up a vicious cycle.

• Cerebral disorders, where the nerve supply to the intestines is affected.

• Medicines —misuse of purgatives, antacids, post anaesthetic, antihypertensives, iron salts, anti-Parkinsonism drugs, opium derivatives etc.

• Trauma and post operative surgical complications.

A sudden change in bowel habits e.g. vomiting with constipation or blood with stools etc. must be investigated before treatment.

Constipation due to faulty habits, physical inactivity, etc. can be treated safely with:

• A regular time fixed to visit and sit in the toilet for a minimum time even if there is no urge.

• Proper fluid intake—a glass of lukewarm water in the morning and a brisk walk helps start peristaltic activity. Six to eight glass of water must be had in a day.

• Proper diet—plenty of fresh fruit and vegetables and high fibre foods. Often constipation may occur because of not eating properly.

1. Isogel (psyllium hydrophilic mucilloid) is a fibre occurring naturally as the husk of the said seed. 1-2 teaspoonfuls of Isogel with a glass of water after meals with adequate fluid intake increases the bulk of the faeces and is one of the least harmful ways of treating constipation especially in habitually constipated people and the elderly.

2. Milk of Magnesia at bedtime is a mild to moderate laxative.

It should not be given to patients with renal dysfunction as it leads to the accumulation of magnesium and toxicity causing a fall in blood pressure and respiratory paralysis.

3. Liquid paraffin helps lubricate the intestinal contents for an easy passage through the rectum and anus, but it interferes with absorption of fat soluble Vitamins A & D and in pregnancy with the absorption of Vitamin K, causing a blood clotting temporary disorder.

4. Laxatives in tablet form are also available.

6. Enemas should only be a temporary measure if there is no underlying cause of constipation. They interfere with the bowel reflex and hence a wrong habit may be set up.

7. Moderate physical exercise increases abdominal muscle tone and is helpful in treatment of chronic constipation.

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