Constipation
Dr. Widjaja Luman
Consultant Gastroenterologist and General Physician
B Sc (St. Andrews), MB ChB (Man), MRCP (UK), M.D. (Edin),
CCST (UK), FRCP (Edin)
(Ahli penyakit pencernaan dan hepar)
Constipation is a common symptom and it affects people of all ages. It occurs when a person has difficulty emptying the large bowel. This can be described as reduced frequency of bowel movement (less than three times per week) or the stool consistency is hard and lumpy, and there is a need to strain for stool evacuation. Other accompanying symptoms include abdominal cramp and bloating.
What causes constipation
Constipation in adults has many possible causes. The most common causes include:
- not eating enough fibre – such as fruit, vegetables and cereals
- not drinking enough fluids
- not moving enough and spending long periods sitting or lying in bed
- being less active and not exercising
- often ignoring the urge to go to the toilet
- changing your diet or daily routine
- a side effect of medicine
- stress, anxiety or depression
- Constipation is also common during pregnancy and for 6 weeks after giving birth.
People who become physically inactive often suffer from constipation. Some medications can cause constipation. These include opiod group of painkillers (codeine, oxycodone and morphine), Tricyclic antidepressants, Calcium channel blockers (nifedipine), iron and calcium supplements. Laxatives can help with bowel movements, but regular use of certain laxatives paradoxically may cause constipation as it allows the body to get used to their action. This is a common problem caused by long term consumption of stimulant laxative. Dependence of stimulant laxative causes constipation when the medication is discontinued.
Constipation is commonly caused by change in routine such as travelling. The reason is not clear but it could be due to change in diet or simply change of routine.
Constipation in the elderly group is common. It could be due to slower bowel motility with aging but the cause is often multifactorial: lack of fibre in diet due to poor dentition, physical inactivity and side effects of medication.
Many adults with chronic constipation (more than 3 months) do not have problems mentioned above. They may suffer from slow transit constipation due to slow contraction in their bowel. The slower the food moves through the digestive tract, the more water the colon will absorb from the gut content and the harder the feces will become
In much rarer cases, constipation is caused by blockage in the large bowel caused by cancerous tumors in the large bowel, inguinal hernia, scar tissue or colonic diverticular disease with abnormal narrowing of the colon.
Other medical conditons that cause constipation are
- neurological condition such as Parkinson disease, multiple sclerosis
- hypothyroidism, diabetes mellitus, hypercalcaemia (high calcium level)
How you can treat constipation yourself
Simple changes to your diet and lifestyle can help to treat constipation. You may notice symptom improvement within a few days. Occasionally it may take few weeks before you notice improvement.
For making stool softer, you can:
- Increase fluid intake
- increase the fibre in your diet by adding more fruits and vegetable to your diet
- increase physical activity such as daily walk or jog.
Fiber promotes regular bowel movements, especially when it is combined with proper hydration.
Laxatives can improve symptom in the short term but long term use is discouraged due to side effects of dependence.
When should I seek medical consultation
- Constipation has not improved with life style and dietary changes
- You are troubled by severe or worsening abdominal pain or bloating
- You notice blood in your stool or weight loss
- You feel very tired all the time
Your doctor may order investigation to exclude colon cancer and other medical conditions mentioned above. Secondly, your doctor can prescribe you stronger medications.
Can constipation lead to serious complication?
Long-term constipation can lead to faecal impaction. This is where hard faeces has built up in your rectum. The main symptom is diarrhoea after a long bout of constipation and this is often described as overflow diarrhoea.
Faecal impaction may be treated with:
- stronger laxatives
- a suppository – medicine you place through your anus
- a mini enema – where fluid is passed through your anus into your bowel
- a doctor manually removing some of the impacted faeces
Other complications are anal fissure, which is a small tear around the anus, and bleeding or swollen piles.