Constipation is a condition wherein a person finds it difficult to empty their bowel or has decreased stool frequency (<3/week). Reduced liquid & fiber intake and/or reduced physical activity are common predisposing factors. Drugs like diuretics, morphine, iron supplements can lead to constipation. Transit of contents in the large intestine is getting affected in some conditions like diabetes. Evacuation is affected in another group of conditions which are clubbed together as ‘Obstructive defecation syndrome’ (ODS). Typically, patients affected by these diseases have incoordination muscles around the anus which leads to excessive straining. Part of the rectum (distal-most part of the large intestine) can come out of the anal canal which is called ‘rectal prolapse’. Rectal prolapse is often neglected as piles and is curable by surgery. Sometimes patients use their fingers to evacuate the stool. Repeated trauma by using finger evacuation can cause ulcers in the rectum, which is called as ‘solitary rectal ulcer syndrome’ (SRUS). The blockage of the intestine due to various diseases like tumors, adhesions, strictures, and volvulus (twist) can also cause constipation.
CT scan and/or colonoscopy are done if there is a clinical suspicion of a structural cause. Some special tests like defecography (visualizing the act of passing stool using image technology like MRI/ x-ray), anorectal manometry and colonic transit study (following the movement of colonic content using x-ray/nuclear scan) may be ordered in some cases.
We need to identify and correct the reason for constipation. Diabetes should be controlled. Biofeedback (a technique you can use to learn to control some of your body's functions) can be offered in selected patients with ODS (Obstructive defecation syndrome). Some patients require surgery like those with tumors, slow transit constipation not responding to medications, strictures and in selected patients with ODS (Obstructive defecation syndrome).
Consuming food rich in fiber, drinking plenty of water and exercising regularly, can prevent constipation. Constipation normally rectifies itself in a couple of days without any medication and if it doesn’t, a gastroenterologist must be consulted, who will prescribe one of the following medications to help with the condition.
Fiber supplements:
The most recommended and safest options are fiber supplements. Also known as bulk-forming agents, they are to be taken with a lot of water.
Lubricants:
Doctors prescribe lubricants to ensure that the stool passes smoothly through the colon.
Stimulants:
Stimulants help the muscles of the intestines to contract rhythmically.
Stool Softeners:
When the stool is moist, it’s easier to pass. Stool softeners help with this.
Osmotic agents:
Osmotic agents draw water into the colon to hydrate the stools. Once hydrated, the stool softens, aiding easy movement.
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