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    Chronic Constipation

     Overview
    Causes
    Symptoms

    Diagnosis
    Treatment
     Where To Seek Treatment


    Contributed by Singapore General Hospital

    Overview

    Constipation means different things to different people. Most commonly, it refers to infrequent bowel movements, but some interpret it as a decrease in the amount of stool. Others describe constipation as difficulty in passing motion, a sense of incomplete evacuation, or the need for medication to help pass motion.

    There is no defined "normal" frequency of bowel movement. It varies from three times a day to three times a week; some people may go a week or more without experiencing discomfort or harmful effects. Bowel habits are affected by diet. The average Singaporean diet includes 12 to 20 grams of fibre per day, and is below the recommended 25 to 30 grams of fiber. Exercise is also beneficial to proper function of the colon.

    About 80 percent of people suffer from constipation at some time during their lives, and brief periods of constipation are normal. Not passing motion does not result in poisons remaining inside your body. Widespread beliefs, such as the assumption that everyone should have a movement at least once each day, have led to overuse and abuse of laxatives.

    Eating foods high in fibre, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fibre per day recommended for proper bowel function.

    Causes

    Several factors may act together and cause constipation. These include inadequate fibre and water intake, a sedentary lifestyle, and environmental changes. Constipation may be aggravated by travel, pregnancy, or change in diet. In some people, repeatedly ignoring the urge to pass motion may result in constipation.

    More serious causes of constipation include growths or areas of narrowing in the colon, so it is wise to seek the advice of a doctor when constipation persists. Uncommonly, constipation may be due to a nervous or endocrine disorders, including thyroid disease, multiple sclerosis, Parkinson's disease, stroke, and spinal cord injuries.

    Can medication cause constipation?

    Yes, many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and aluminum containing antacids can cause or worsen constipation. Do check with your doctor if you have constipation after being started on a new medication.
     

    Symptoms

    Most of the time, the cause of constipation is not serious. But, in rare cases, chronic constipation may be a sign of an obstruction or abnormality in the colon. You should seek medical advice if there is a persistent change in your bowel habit for more than 3 weeks - this may either be an increase or decrease in frequency, size of stool or an increased difficulty in passing. The important factor is the change - if you have been passing one time every three days and now pass one time a day, this is not normal. If blood appears in the stool, consult your doctor right away. Your doctor can evaluate you to determine the cause of your constipation and rule out any underlying disorder.

    Your doctor may ask you questions like these:

    How long have you had symptoms?
    Have you any medical problems, and if yes, what medications are you on?
    What is your diet like?
    What is your daily activity like?
    How often do you need use laxatives or enemas?

    Diagnosis

    There are many possible causes of constipation. It is important to find the cause and treat them specifically. Repeatedly taking laxatives may help but it does not treat the cause.

    Your doctor will want to check for any anatomic causes, such as growths or areas of narrowing in the colon. Examination of the anus and rectum is usually the first step, since it is relatively simple and may show the cause of the problem. Examination of the intestine with either a colonoscopy or barium x-ray study may also be required. This is to look for conditions such as such as polyps, cancers, or diverticular disease, which may cause constipation. If this is found, then the underlying condition can be treated.

    Other test may be needed to identify specific problems with the movement of your intestines. A "marker studies" in which the patient swallows a capsule containing markers that show up on x-rays taken several days later, provide clues to disorders in the movement of the intestines. Other physiologic tests check the function of the anus and rectum. These include testing the reflexes of anal muscles that control bowel movements using a small plastic catheter, or x-ray testing to evaluate function of the anus and rectum during defecation.

    In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific.

    Treatment

    Most patients with constipation are successfully treated by a few simple steps. Eat well balanced, regularly scheduled meals to promote normal bowel function. If you have not been consuming much roughage, take additional fibre in your diet. Ensure that you drink enough fluids to help keep the stools soft. Try to drink at least 8 to 10 glasses of liquid each day in the form of juice, milk, coffee, tea, soup, water or other fluids. An increase in activity will also help the bowel move.

    High fibre diet, in addition to relief of constipation, may help to lower cholesterol levels, reduce the risk of developing colon polyps and colon cancer, and help prevent symptomatic hemorrhoids.

    Fibre supplements takes time (up to weeks) for the full effect to take place. However, they are not harmful to the body. Laxatives stimulate the colon to work more rapidly. Continuous use of laxatives can cause the colon to stretch and weaken and, eventually the colon may not work right without them. Thus, laxatives, enemas or suppositories, although it provides rapid relief, is harmful in the long term, and you should avoid long term usage unless recommended and monitored by your doctor.

    A change in lifestyle may also help. Having a specific time each day to have a bowel movement may be helpful. In some cases, bio-feedback may help to retrain poorly functioning anal sphincter muscles.

    In rare circumstances are surgical procedures necessary to treat constipation. Your doctor can discuss these options with you in greater detail to determine the best treatment for you.


    Need indepth information ?

    Access our Conditions & Treatments sections for related topics on Colonoscopy, Colorectal Cancer and Polyps.

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