What Is Constipation? What Causes Constipation?

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Main Category: GastroIntestinal / Gastroenterology
Also Included In: Irritable-Bowel Syndrome;  Pain / Anesthetics
Article Date: 16 May 2009 - 13:00 PDT

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The word constipation comes from the Latin constipare meaning "to press, crowd together", and from 1400 A.D. Latin Constipationem. According to Medilexicon's medical dictionary, constipation is "A condition in which bowel movements are infrequent or incomplete". Constipation is also known as costiveness, and irregularity.

Constipation is a condition of the digestive system. The sufferer has hard feces that are difficult to expel. In most cases, this occurs because the colon has absorbed too much of the water from the food that is in the colon. The slower the food moves through your digestive tract, the more water the colon will absorb from food. Consequently, the feces become dry and hard. Defecation (emptying the bowels) can become very painful, and in some serious cases there may be symptoms of bowel obstruction. When the constipation is very severe; when the constipation prevents the passage of feces and gas, it is called obstipation.

What causes constipation?

Constipation happens when the colon absorbs too much water, or if the muscles in the colon are contracting slowly or poorly so that the stool moves too slowly and loses more water.

Here are the most common causes of constipation:

• The sufferer's diet is lacking in adequate quantities of fiber
  
  It is well known that people whose diets include a good quantity of fiber are significantly less likely to suffer from constipation. Foods low in fiber are high fat foods, such as cheese, meats, and eggs. If you consume them, make sure you are also eating enough fruits, vegetables, and whole grains - which are rich in fiber.
  
  There are two main types of fiber, soluble and insoluble. Soluble dissolves in water, while insoluble doesn't. Fiber cannot be digested. However, soluble fiber is transformed as it passes through the digestive tract, where it is fermented by bacteria. Soluble fiber absorbs water, and becomes gelatinous as it does so. Insoluble fiber passes through the gut without changing its form.
  
  Quite simply, fiber promotes bowel movements and prevents constipation. Studies have indicated, however, that fiber is not that useful in dealing with constipation, it is better at preventing it.


• The sufferer is too physically inactive. This is especially the case if the person is elderly
  
  
  We know that if somebody has had to lie down in bed for a long time, perhaps for several days or weeks, his/her risk of having constipation is significantly increased. Experts are not sure why. Some say that physical activity keeps our metabolism high, making most things in our bodies happen more rapidly. Elderly people tend to have a more sedentary life, compared to younger, people, and are therefore at higher risk of constipation. Physically active people are much less likely to become constipated than inactive people.


• Some drugs
  
  It is common for people to forget that there are a lot of medications that can cause constipation. The most common ones are:
  
  -- Narcotic (opioid) pain drugs, such as codeine (Tylenol#3), oxycodone (Percocet), and hydromorphone (Dilaudid)
  
  -- Antidepressants, such as amitriptyline (Elavil) and imipramine (Tofranil)
  
  
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  -- Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol) Iron supplements
  
  -- Calcium channel blocking drugs such as diltiazem (Cardizem) and nifedipine (Procardia)
  
  -- Aluminum-containing antacids such as Amphojel and Basaljel
  
  -- Diuretics such as chlorothiazide (Diuril)


• Milk
  
  Some people become constipated when they consume mild and dairy products.


• IBS (irritable bowel syndrome)
  
  People who suffer from IBS get constipation much more frequently, compared to the rest of the population.


• Pregnancy
  
  Pregnancy brings about hormonal changes which can make a woman more susceptible to constipation. Also, the uterus may compress the intestine, slowing down the passage of the food.


• Aging
  
  As we get older our metabolism slows down, resulting in less intestinal activity. The muscles in the digestive tract do not work as well as they used to.


• A change in routine, such as when travelling
  
  When we travel our normal routine changes. This can have an effect on our digestive system, which sometimes results in constipation. Meals are eaten at different times, we might go to bed, get up, and go to the toilet at different times. All these changes may raise the risk of constipation.


• Overuse of laxatives
  
  We all think we should go to the toilet at least once a day - this is a myth. To make sure that happens many people self-medicate with laxatives products they buy at the pharmacy. Laxatives are effective; they do help bowel movements. The problem is that if we keep taking them we gradually have to up the dose for the same effect. Laxatives can be habit-forming. When we become dependent on them there is a significant risk of constipation when we stop taking them.


• Not going to the toilet when you feel the urge to
  
  There can be many reasons for this. Perhaps we are not at home and would prefer to wait till we get back. It is surprising how many people never open their bowels in the toilets at work or at school. Others may be too busy to go, while some people don't because of emotional stress. Children often stop going if they are being toilet trained and find the whole training program nerve-racking. Sometimes children are too busy playing and put off going to the toilet. However, if you ignore the urge to have a bowel movement, that urge can gradually go away until you no longer feel the need to go. The longer you delay it, the drier and harder the stool will become.


• Not drinking enough water (dehydration)
  
  Experts say that if you already have constipation, drinking more liquids might not relieve it. However, if you regularly drink plenty of water you are less likely to become constipated. If you tend to suffer regularly from constipation you should seriously consider increasing your consumption of water. Many sodas and drinks containing caffeine may cause dehydration and worsen your constipation. Alcohol also dehydrates the body and should be avoided if you are constipated, or very susceptible to constipation.


• Problems with the colon, or rectum
  
  Tumors can compress or restrict the passages and cause constipation. Also scar tissue (adhesions), diverticulosis, and abnormal narrowing of the colon or rectum (colorectal stricture). People with Hirschsprung disease are susceptible to constipation (a birth defect in which some nerve cells are absent in the large intestine. The intestine does move stool through, consequently the intestine becomes blocked, causing the abdomen to enlarge).


• Some diseases and conditions
  
  Diseases that tend to slow down the movement of the feces through the colon, rectum, or anus are more likely to cause constipation. They include the following:
  
  
  • Neurological disorders
    MS (Multiple Sclerosis), Parkinson's Disease, Stroke, Spinal Cord Injuries, Chronic Idiopathic Intestinal Pseudo-Obstruction
  
  
  • Endocrine and metabolic conditions
    Uremia, Diabetes, Hypercalcemia, Poor Glycemic Control, Hypothyroidism
  
  
  • Systemic diseases (Diseases that affect a number of organs and tissues, or affects the body as a whole)
    Lupus, scleroderma, and amyloidosis
  
  
  • Cancer
    Mainly due to the medications for pain, and chemotherapy. Also if a tumor blocks or squeezes the digestive system.

What is the treatment for constipation?

It is important to remember that the necessity to defecate at least once a day is a myth. Constipation happens when you want to go but are unable to evacuate the feces. In the majority of cases, constipation resolves itself without any treatment or risk to health.

The treatment of recurring constipation can include lifestyle changes. Doing more exercise, eating more fiber, and drinking more water. Some studies contradict the high fiber advice; a study published in the American Journal of Gastroenterology found that the role of dietary fiber to treat chronic constipation is exaggerated. A low fiber diet has been proven not to be the cause of constipation and the success of fiber intake as treatment is modest.

Usually, laxatives will successfully treat most cases of constipation - but should be used with care and only when really necessary. In more difficult cases the person may need a prescription medication. Some people have responded well to biofeedback.

It is important to try to find out what has caused the constipation is in the first place - there could be an underlying illness or condition. Some people with recurring constipation use a daily diary where they record their bowel movements, stool characteristics, and other factors which may help both the doctor and patient devise the best treatment.

Some gastroenterologists comment that there are people who do not allocate enough time for their defecation. Set aside enough time to allow your toilet visit to be unstressed and uninterrupted, and do not ignore an urge to have a bowel movement.

Over-the-Counter laxatives

Only use these laxatives as a last resort. They can be habit forming, as was mentioned above:

• Stimulants - they make the muscles in your intestines contract rhythmically. These include Correctol, Dulcolax and Senokot.


• Lubricants - they help the stool move down the colon more easily. These include mineral oil and Fleet.


• Stool softeners - they rehydrate (moisten) the stool. These include Colace and Surfak.


• Fiber supplements - these are perhaps the safest laxatives. They are also called bulk laxatives. These include FiberCon, Metamucil, Konsyl, Serutan and Citrucel. Make sure you have plenty of water when you take them.


• Osmotics - they facilitate the movement of fluids through the colon. These include Cephulac, Sorbitol, and Miralax.


• Saline laxatives - they draw water into the colon. These include milk of magnesia.


• Choride channel activators - these require a prescription. These include lubiprostone (Amitiza).

.
• 5-HT-4 agonists - they increase the secretion of fluid in the intestines, and also speed up the rate at which food passes through the colon. These include Prucalopride.


• Relistor was approved by the FDA in April, 2008 for the treatment of opioid-induced constipation. Opioids are commonly prescribed on a continuous basis for patients with late-stage, advanced illness to help alleviate pain.

If your doctor identifies an underlying disorder that may be causing your constipation he/she will treat that disorder.

If you have pelvic floor dysfunction, you may be treated with biofeedback. It is a retraining technique that helps you learn how to coordinate the muscles appropriately so that you have a successful bowel movement.

If the constipation does not respond to any treatment, as a last resort it might be recommendable to remove part of the colon. When this happens the troublesome segment(s) of the anal sphincter or rectum are removed.

How common is constipation?

• Among children
  
  According to research carried out at Nationwide Children's Hospital, Columbus, Ohio, the burden of illness in children suffering from constipation, and the costs associated with this condition, are roughly of the same magnitude as those for asthma and attention deficit-hyperactivity disorder (ADHD). According to researchers at the University of Iowa, constipation is the most common cause of children's abdominal pain.


• Adults and people in general
  
  According to a presentation by Boehringer Ingelheim, data show that 12% of people worldwide suffer from self-defined constipation. The figure varies depending on the region; people in the Americas and Asia Pacific suffer twice as much as their European counterparts, where the incidence of constipation is lowest (Americas and Asia Pacific mean 17.3% -v- European mean 8.75%).
  
  According to a study carried out by the University of Iowa, chronic constipation affects 15% to 20% of the U.S. population.

Further reading

All About Opioids and Opioid-Induced Constipation (OIC) Includes the following sections:

• About Opioids
• Causes of Oipioid-Induced Constipation
• Palliative Care Facts
• Symptoms of Oipioid-Induced Constipation
• Treatment for Oipioid-Induced Constipation
• Glossary of Terms
• Resources

Written by Christian Nordqvist


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