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Definition of Constipation
The definition is probably the most difficult issue around constipation! There are
so many different attempts in medical publications and even in lay dictionaries
which make one wonder why doctors cannot agree on what exactly the term
means.
The fact of the matter is that bowel habits rely a lot on factors which have to do
with the life style or are even cultural.
Although all the definitions of constipation involve a low frequency of bowel
movements, the exact lower limit where constipation starts is uncertain.
Opening one’s bowels every two days is considered normal in Britain whereas it
would be considered as constipation in India.
However, opening of the bowels once a week or less is considered pathological
and needs assistance with medical means.
The factor of straining is also important. The straining expresses the effort
required by the individual to achieve a bowel movement. The doctor relies on the
patient’s description to assess the presence of straining. This is very inaccurate.
The patient does not have any measure of comparison and very often excessive
straining is taken as normal just because it has been present for many years. In
those cases the patient denies straining and it is only through the radiological
and other findings which are consequences of chronic straining that it is
confirmed.
The quality of the stools has also been used in the attempt to define
constipation and it is generally accepted that patients with constipation produce
small quantities of hard stools. Although this is generally true there are quite a
few cases where it is not –actually there are patients with constipation who
experience diarrhoea from overflow of a packed colon.
The main questions through which the physician will assess the presence of
constipation are:
a) How many times a week do you open your bowels?
b) Do you have to strain in the toilet in order to achieve a bowel movement?
c) What are your stools like?
Unfortunately the answers are sometimes not straight forward and further
investigations have to be conducted.
Often the patient realises that they have been constipated only after their bowel
function gets normalised as the result of laxatives etc.
Diet and Water
Diet is the most important factor. Fibre is not digested by the intestines and
provides bulk of stools. Bulky contents of the colon travel at higher speed and
are usually evacuated within 30 hours. The main source of fibre are fruits and
vegetables and five serving of those a day are recommended currently in the
UK. Fibre supplements such as bran, muesli etc. can also be helpful.
However fibre does not work unless adequate water is also taken. This is
because the primary function of the colon is water absorption and in case of
dehydration the fiber in the colon can actually turn into a hard mass which
aggravates constipation.
Factors predisposing to constipation
- Low fibre content in diet
- Poor water intake
- Endocrine disorders
- Hypothyroidism
Hypoparathyroidism
Diabetes
Hypopituitarism
- Electrolyte disorders
- Hypokalemia
- Hypercalcemia
- Amyloidosis
- Pregnancy
- Brain disorders (CVA, Parkinson’s etc)
- Spinal injuries –diseases
Medication predisposing to constipation
- Anticholinergics
- Antidepressants
- Opiates
- Iron
- Antihypertensives
- Drugs acting on central nervous system
Forms of constipation
- Idiopathic
- Slow transit constipation
- Obstructive Defaecation Syndrome (ODS)
- Anismus
Methods of investigating constipation
- Colonoscopy
- Barium enema
- Colonic Transit Study
- Defaecation proctogram
- Anorectal physiology/ Manometry
Constipation