Understanding Constipation: Causes, Symptoms, and Relief

What is constipation?

It is defined as a change in bowel habit (acute or chronic) in which there is a decrease in the number of stools (less than 3 times a week) with generally dry and hard stools and difficulty in expulsion or a sensation of incomplete evacuation. The normal frequency of bowel movements is considered between 3 times a day and 3 times a week.

How is it produced?

Constipation is considered a symptom that occurs as a result of various factors and causes. Among them are an inadequate diet (low in fiber), a sedentary lifestyle, the absence of regular habits to go to the toilet, the abuse of laxatives, anatomical defects, changes in schedules, habits and travel, diseases of the digestive system, systemic diseases, drugs, tumors and cancers of the digestive system. It is generally a functional disorder, that is, there is no organic cause that causes it, but there is a sum of factors that give rise to this alteration in the normal intestinal rhythm.

Symptoms

The more frequent complaints in people with constipation include abdominal pain or discomfort, bloating, a feeling of fullness, bloating (gas) and a feeling of incomplete evacuation. Difficulty expelling stool and straining can cause or aggravate hemorrhoid problems or anal fissures. Dirty tongue (coated) and bad breath may also appear.

The alarm symptoms that must be taken into account when faced with a constipation problem, since they can translate into a serious illness and for which it is advisable to consult a doctor include: weight loss, blood in the stool, pain every time you have a bowel movement or appearance of constipation as a new symptom (before it did not exist).

Diagnosis

It will be based on questioning the patient where it is important to influence lifestyle habits, diet, physical activity, family history, drug use, symptoms when defecating (for example, rectal bleeding or emission of red blood), weight loss and other factors related to constipation.

The physical examination is done to look for signs of organic disease. The diagnosis should be completed with:

• Thyroid hormones (constipation is common in hypothyroidism).
• Detection of blood in stool.
• Abdominal imaging tests to rule out underlying diseases that justify the symptom:
• X-ray abdomen.
• Sigmoidoscopy: allows the examination of the final part of the colon and rectum.
• Colonoscopy: to rule out organic disease (such as a tumor).

In some selected cases, more complex studies studying anal sphincter function such as anorectal manometry may be required.

Treatment

Treatment is based on following a series of dietary hygiene recommendations, treating the underlying disease or the cause if possible (for example, withdrawing the drug that causes it) and pharmacological measures.

The fundamental bases of the treatment are the dietary hygiene measures, it is recommended:

• Follow an adequate diet rich in fiber. Eat fruit with skin if possible and undercooked or raw vegetables, bread and whole grains. Two to 4 servings of fruit and 3 to 5 servings of vegetables are recommended daily. Wheat fiber is the one that produces the greatest increase in fecal weight.
• Drink plenty of fluids (about a liter and a half to two) a day to facilitate the formation and elimination of feces.
• Perform physical exercise on a regular basisJust walking is good exercise. A sedentary lifestyle favors constipation.
• Establish a regular daily time to go to the bathroom to "educate" the body.
• Be orderly and regular in meal times, eat slowly and chew well.
• Avoid abuse of laxatives, especially irritating laxatives.
• Avoid the consumption of drugs that cause constipation.

Pharmacotherapy:

The regular and continuous use of laxatives is not advisable. This treatment should be reserved for special and short-term situations, when the above conservative measures are not effective. There are different types of laxatives (lubricating, osmotic, irritant or stimulant, and bulking or bulk forming). Irritants or stimulants have great rapidity of effect but are highly inadvisable as regular use. The volume or mass formers (indigestible fibers of the diet, such as wheat bran), can be taken longer than the rest, they add water and volume to the stool facilitating its elimination. They are usually taken in gradual doses until the desired effect is achieved. It includes oat bran and plantago ovata among others. At the beginning of the consumption of laxatives, discomfort such as bloating, abdominal pain or gas may appear that usually disappear with time.

Prevention

Following the dietary hygiene recommendations described in the treatment is the best way to prevent constipation.

Dra. Eva Ormaechea Alegre Intensive Medicine Specialist Advance Medical consultant