Constipation

Chronic constipation is defined as the presence of two or more of the following symptoms for at least 3 months:

  1. Decrease in frequency of defaecation ( 2 bowel movements per week)
  2. Passage of hard stools more than 25% of the time
  3. Straining at stools more than 25% of the time
  4. Incomplete evacuation more than 25% of the time

The normal stool frequency in Indians is 1 per day, as compared to 3 per week for Western men.

Causes:

The causes of constipation can be divided into mechanical (lumen-obstructing) or functional (muscle abnormality)

Factors which affect bowel movement can be divided into general, colonic, defaecatory mechanism and behavioural.

General factors

Age and sex: In the elderly, constipation usually means increased straining at stools rather than a true decrease in frequency of defaecation. Also, there is a decline in the inhibitory nerve-mediated responses similar to Hirschprung’s disease. Constipation is more frequent in women than in men.

Diet: A fibre-deficient diet is usually associated with constipation.

Consistency of stools: Small, hard stools are difficult to pass.

Colonic factors:

Anatomic: Narrowing of the colonic lumen due to a mass (malignancy), stricture (tuberculosis, ischaemia) or inflammation (diverticulitis) leads to constipation. In these cases, constipation is usually progressive and may be associated with bleeding per rectum.

Motor function: The frequency and duration of high-pressure peristaltic colonic waves are reduced in some patients with constipation, resulting in overall slow transit of colonic contents.

Defaecatory function:In normal subjects, passage of a stool is associated with reflex relaxation of the internal anal sphincter and of the striated muscles forming the puborectalis (which maintains the anorectal angle), and voluntary relaxation of the external anal sphincter. Aganglionosis of the colon, as in Hirschsprung’s disease, leads to failure of relaxation of the internal sphincter on rectal distention. In certain people the striated muscles of the pelvic floor contract, rather than relax, on straining; this phenomenon, called anal dyssynergia or anismus, is common among patients who complain of difficulty in defaecation.

Psychological and behavioural factors:Personality affects stool size and consistency. Heavier stools tend to be produced by people who are more socially outgoing, more energetic and optimistic, and less anxious.

Treatments:

The treatment of constipation can be divided into dietary adjustment, behavioural therapy, drug therapy and surgery.

Dietary adjustment:

supplementation is the first-line therapy for constipation. Wheat bran is the most effective supplement, followed by fruits, vegetables, oats, mucilages, corn and cellulose. Patients with gas bloat as a primary symptom, those with obstructive lesions and faecal impaction experience worsening of symptoms, and should not receive fibre supplementation.

Behavioural modification:

Habit training is aimed at achieving regular defaecation and prevention of buildup of stool and soiling. The patient is asked to attempt defaecation after meals as the colonic motility is most active during these times. Once post-prandial defaecation occurs on a regular basis, the laxative is gradually withdrawn.

Pharmacological treatment

Laxatives are useful for short-term therapy of constipation. Most laxatives lose their effect over time. Hence Homeocare International offers a permanent, individualistic and safe cure.