The slower the food moves through the digestive tract, the more water the colon will absorb from it. Consequently, the feces become dry and hard.
When this happens, emptying the bowels can become very painful.
This article will cover the main causes of constipation and how it can be treated and prevented.
Here are some key points about constipation. More detail and supporting information is in the main article.
- Constipation generally occurs because too much water is absorbed from food
- Causes of constipation include physical inactivity, certain medications, and aging
- Some cases of constipation can be relieved by lifestyle changes
- Laxatives should only be used as a last resort
A diet that contains a good quantity of fiber helps prevent constipation.
The main symptoms of constipation are increased difficulty and straining when passing stools.
Passing fewer stools than usual can be a sign of constipation.
Other symptoms include:
- stomach ache
- stomach cramps
- feeling bloated and nauseous
- losing appetite
Constipation happens when the colon absorbs too much water. This can occur if the muscles in the colon are contracting slowly or poorly, causing the stool to move too slowly and lose more water.
These are the most common causes of constipation:
1) Lack of fiber in the diet
People whose diets include a good quantity of fiber are significantly less likely to suffer from constipation.
It is important to consume foods rich in fiber such as fruits, vegetables, and whole grains.
Fiber promotes bowel movements and prevents constipation.
Foods that are low in fiber include high-fat foods, such as cheese, meat, and eggs.
2) Physical inactivity
Constipation can occur if someone becomes too physically inactive. This is especially the case in older adults.
For individuals who have been bedridden for a long time, perhaps for several days or weeks, their risk of having constipation is significantly increased. Experts are not sure why. Some believe that physical activity keeps the metabolism high, making the processes in the body happen more rapidly.
Older adults tend to have a more sedentary life compared with younger people and are therefore at higher risk of constipation. Physically active people are much less likely to become constipated than inactive people.
The most common medications to cause constipation are:
- narcotic (opioid) pain drugs including codeine (Tylenol), oxycodone (Percocet), and hydromorphone (Dilaudid)
- antidepressants including amitriptyline (Elavil) and imipramine (Tofranil)
- anticonvulsants including phenytoin (Dilantin) and carbamazepine (Tegretol) iron supplements
- calcium channel blocking drugs including diltiazem (Cardizem) and nifedipine (Procardia)
- aluminum-containing antacids including Amphojel and Basaljel
- diuretics including chlorothiazide (Diuril)
Some people become constipated when they consume milk and dairy products.
5) Irritable bowel syndrome
People who suffer from irritable bowel syndrome (IBS) get constipation much more frequently, compared with the rest of the population.
Pregnancy brings about hormonal changes that can make a woman more susceptible to constipation. Also, the uterus may compress the intestine, slowing down the passage of food.
As a person gets older, the metabolism slows down, resulting in less intestinal activity. The muscles in the digestive tract do not work as well as they used to.
8) Changes in routine
When a person travels, their normal routine changes. This can affect the digestive system, which sometimes results in constipation. Meals are eaten at different times, or a person might go to bed, get up, and go to the toilet at different times. All these changes can raise the risk of constipation.
9) Overuse of laxatives
Some people believe a person should go to the toilet at least once a day - this is not true. However, to make sure this happens, some people self-medicate with laxatives.
Laxatives are effective at helping bowel movements. However, using them regularly allows the body to get used to their action and gradually the dose needs to increase to get the same effect.
Laxatives can be habit-forming. When a person becomes dependent on them, there is a significant risk of constipation when they are stopped.
10) Not going to the toilet when needed
If individuals ignore the urge to have a bowel movement, the urge can gradually go away until the individual no longer feels the need to go. The longer it is delayed, the drier and harder the stool will become.
11) Not drinking enough water
If constipation is already present, drinking more liquids might not relieve it. However, regularly drinking plenty of water reduces the risk of constipation.
Many sodas and drinks contain caffeine which can cause dehydration and worsen constipation. Alcohol also dehydrates the body and should be avoided by individuals who are constipated or very susceptible to constipation.
12) Problems with the colon or rectum
Tumors can compress or restrict the passages and cause constipation. Also, scar tissue, diverticulosis, and abnormal narrowing of the colon or rectum, known as colorectal stricture.
People with Hirschsprung disease are susceptible to constipation (a birth defect in which some nerve cells are absent in the large intestine).
13) Some diseases and conditions
Diseases that tend to slow down the movement of feces through the colon, rectum, or anus can cause constipation.
These include the following:
- Neurological disorders: Multiple Sclerosis (MS), Parkinson's disease, stroke, spinal cord injuries, and chronic idiopathic intestinal pseudo-obstruction can lead to constipation.
- Endocrine and metabolic conditions: Uremia, diabetes, hypercalcemia, poor glycemic control, and hypothyroidism.
- Systemic diseases: These are diseases that affect a number of organs and tissues, or affect the body as a whole, they include lupus, scleroderma, amyloidosis.
- Cancer: Constipation occurs in people with cancer, mainly due to pain medications and chemotherapy. Also, if a tumor blocks or squeezes the digestive system.
In the majority of cases, constipation resolves itself without any treatment or risk to health.
The treatment of recurring constipation can include lifestyle changes such as doing more exercise, eating more fiber, and drinking more water.
Usually, laxatives will successfully treat most cases of constipation - but should be used with care and only when necessary. In more difficult cases, the person may need a prescription medication.
It is important to understand the cause of constipation - 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 that 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.
Only use these laxatives as a last resort:
- Stimulants: These make the muscles in the intestines contract rhythmically. These include Correctol, Dulcolax, and Senokot.
- Lubricants: These help the stool move down the colon more easily. These include mineral oil and Fleet.
- Stool softeners: These moisten the stool. Stool softeners include Colace and Surfak.
- Fiber supplements: These are perhaps the safest laxatives. They are also called bulk laxatives. They include FiberCon, Metamucil, Konsyl, Serutan, and Citrucel and should be taken with plenty of water.
- Osmotics: These facilitate the movement of fluids through the colon. These include Cephulac, Sorbitol, and Miralax.
- Saline laxatives: These draw water into the colon and include milk of magnesia.
- Chloride channel activators: These require a prescription and include lubiprostone (Amitiza).
- 5-HT-4 agonists: They increase the secretion of fluid in the intestines and speed up the rate at which food passes through the colon. They include Prucalopride.
If the constipation does not respond to any treatment, as a last resort, surgery to remove part of the colon may be undertaken. In the procedure, the segment of the anal sphincter or rectum that causes the constipation is removed.
There are a few ways to ease the symptoms of constipation without using medication.
- Increasing fiber intake: People with constipation should eat between 18 and 30 grams (g) of fiber every day. Fresh fruits and vegetables and fortified cereals have high fiber content.
- Drinking water: Consuming lots of water can help to rehydrate the body.
- Bulking agents: Adding these to your diet can help soften stools and make them easier to pass. Examples of bulking agents include wheat bran.
- Regular exercise: This can help to make bodily processes more regular, including the passing of stools.
- Routine: Having a place and time of day where you can put aside time to visit the bathroom without forcing a stool.
- Avoiding holding in stools: Responding to your body's natural urges to pass stools when they happen is key to reducing the impact of constipation.
- Elevate your feet: Place your feet short platform, such as a step, and make sure the knees are above hip-level while passing stools. This can reduce constipation.
- Homeopathic remedies: While their effectiveness is disputed by evidence, treatments for constipation offered by homeopathic doctors involve a range of herbs. These include calcarea carbonica, nux vomica, silica, bryonia, and lycopodium.
Speak with your doctor about the best course of action if symptoms are not responding to natural or home remedies.
Constipation on its own can be uncomfortable but not life-threatening. However, severe constipation can develop into more serious conditions, including:
- rectal bleeding after continually straining to pass stools
- anal fissure, or a small tear around the anus
- hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum
- faecal impaction, in which dried stools collect in the anus and rectum, leading to an obstruction in the path stool would take to leave the body
Dealing with constipation before it becomes one of these conditions can prevent further discomfort.