Constipation is a common problem in adults of all ages, though it tends to occur more often in women and in the elderly.
Symptoms of Constipation
People with constipation typically have:
- hard, dry stools that are difficult or even painful to pass
- three or fewer bowel motions per week
- a feeling of incomplete evacuation after a bowel motion.
Some people may also suffer abdominal bloating and pain or, in chronic cases, faecal impaction (blockage of the bowel by a solid bulk of stool).
Causes of Constipation
- The most common cause of constipation is a diet low in fibre. Hard, dry stools can also occur in people who are dehydrated because of insufficient fluid intake or due to conditions such as vomiting, infection or malnutrition.
- Certain drugs can cause constipation as a side-effect, including the opiate analgesics codeine and morphine, tricyclic antidepressants and diuretics.
- In occasional cases, constipation is a symptom of a medical problem such as hypothyroidism, hypokalaemia (reduced potassium in the blood) or porphyria (a rare metabolic disorder). In these conditions, stools move very slowly through the bowel because the normal muscular action of the intestine is disrupted.
- Obstruction of the bowel by a tumour can cause constipation.
- Constipation can be a feature of irritable bowel syndrome.
- In the elderly, reduced mobility, poor access to toilet facilities and illnesses such as Parkinson’s disease may contribute to constipation.
Treatments for Constipation
People with concerns about their bowel habit should never feel too embarrassed to seek a doctor’s advice. This is especially important when a recent change has been noticed. After taking a detailed account of the problem, the doctor will be able to decide whether any further investigations are needed. These may include a test to measure the speed of stool transit through the gut, an X-ray of the abdomen, or an examination of a small sample of tissue from the rectum.
- For constipation with no underlying medical cause, the usual treatment is increased fluid intake and dietary fibre in the form of whole grains, fresh fruit and vegetables.
- Bulking agents such as methylcellulose increase the volume of stools and help them retain water, easing their passage along the bowel.
- Stool softeners also speed stool transit, by promoting absorption of water and fats.
- Biofeedback methods may help when constipation is caused by problems with the pelvic floor muscles.
- Laxatives relieve constipation by stimulating the muscles that move the stools along the gut. They should be employed with caution, however, as users can become psychologically dependent on them. Prolonged laxative abuse may lead to kidney failure and other health problems.
Preventing Constipation
The best way to avoid constipation, or prevent further episodes, is to drink plenty of water and eat a diet rich in high-fibre foods such as oatmeal, pulses, potatoes, apples and broccoli. Drinking prune juice may also help maintain a regular bowel habit, with few of the adverse effects of over-the-counter laxatives.
References
Copeland PM. Renal Failure Associated with Laxative Abuse. Psychother Psychosom 1994; 62(3/4): 200–2.
Kamm MA. Constipation. Medicine 2003; 31(2): 52–5.
Kumar V et al. Laxative Use and Abuse in the Older Adult: Part I. Clin Geriatr 2007; 15(4): 37–42.
Disclaimer
The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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