Constipation

• What is Constipation
• Statistics on Constipation
• Risk Factors for Constipation
• Progression of Constipation
• Symptoms of Constipation
• Clinical Examination of Constipation
• How is Constipation Diagnosed?
• Prognosis of Constipation
• How is Constipation Treated?
• Constipation References

What is Constipation

Constipation (irregularity of bowels; lack of regular bowel movements), is a common symptom, but often, constipation remains unrecognized until the patient develops sequelae such as anorectal disorders or diverticular disease.
Several definitions of constipation have been proposed based upon passing stools frequency (often less than 3 times weekly) in different population groups. However, it is more useful to approach constipation operationally, as a change in the bowel habit or defecatory behavior that acutely or chronically results in symptoms or diseases that are resolved by relieving the constipation.
Constipation symptoms:

• infrequent or hard stools
• difficulty passing stools
• discomfort passing stools.
• constipation pain during the passage of a bowel movement
• inability to pass a bowel movement after straining or pushing for more than 10 minutes
• no bowel movements after more than 3 days.

Infants who are still exclusively breastfed may go 7 days without passing stools. Stools are hard due to the lack of water. Constipation may be associated with several disorders.
Constipation is a symptom rather than a disease in itself.

Statistics on Constipation

Self-reported constipation is one of the most common gastro disorders. About 2% of the population describe constant or frequent intermittent episodes of constipation. Constipation is thought to be more common in women than men.
Internationally, prevalence of self-reported constipation varies substantially because of differences among ethnic groups in what is perceived as constipation.

Risk Factors for Constipation

The causes of constipation are numerous. Constipation is most often caused by a diet low in fibre, a distinct lack of physical activity, not consuming enough water daily, or delaying toilet habits when the urge to defecate first occurs. Stress and travel can also contribute to constipation or other changes in bowel habits.
Other times, diseases of the bowel (such as irritable bowel syndrome), pregnancy, certain medical conditions (like an underactive thyroid or cystic fibrosis), mental health problems, neurological diseases, or medications may be the reason for your constipation. More serious causes, like colon cancer, are much less common.
Constipation in children often occurs if they hold back bowel movements when they aren’t ready for toilet training or are afraid of it.

How is Constipation Diagnosed?

• General questions about history, including diet and recent bowel movements.
• Barium enema.
• Blood tests.

Prognosis of Constipation

With appropriate dietary management, prognosis in most patients is excellent but depends on the underlying cause of the symptom. Recurrence depends on the patient’s long-term compliance to therapy.

How is Constipation Treated?

After serious illnesses have been ruled out, medical care of the patient who is acutely constipated involves a combination of enemas and laxatives, preceded by manual disimpaction of stools if necessary. This then is followed by elective evaluation of the causes of the constipation.
Avoiding constipation altogether is easier than treating it, but involves the same lifestyle measures:

• Eat more fibre (at least 30g per day is recommended for adults. See foods below).
• Drink plenty of fluids each day (at least 8 glasses of water per day).
• Exercise regularly.
• Go to the bathroom when you have the urge. Don’t wait.

High fibre foods to manage constipation

• Wholemeal/wholegrain bread
• Wholegrain cereals
• Pulses (e.g. baked beans, lentils, split peas)
• Fruit
• Nuts and seeds
• Vegetables (cooked vegetables often contain more fibre than salad vegetables)

Article kindly reviewed by:
The DAA WA Oncology Interest Group
and
Food4Health (Helen Baker Dietitian-APD)

Constipation References

1. Basson M. Constipation [online]. Omaha, NE: WebMD eMedicine; 2004 [cited 8 June 2004]. Available from: URL link
2. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. Book
3. Lennard-Jones JE. Clinical management of constipation. Pharmacology. 1993;47(Suppl 1):216-23. Abstract
4. Longmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (6th edition). Oxford: Oxford University Press; 2004. Book
5. Constipation [online]. Bethesda, MD: Medline Plus; 2004 [cited 8 June 2004]. Available from: URL link