Definition of Constipation

Constipation (from Latin constipare = to press together) is having a bowel movement with difficulty or less than three times a week.

Symptoms of Constipation

Absence of daily stools is not already a constipation. Constipation is usually accompanied with:

  • Straining or pain during passing the stool, feeling of incomplete bowel emptying
  • Hard and dry stool

Bloating and excessive gas, coated tongue, bad taste, offensive breath, headache, fatigue, poor appetite and weight loss are other common problems in constipation.

Causes of Constipation

There are four main causes of constipation:

1. Inappropriate Diet

Do your meals consist mainly from low-fiber foods, like potatoes, meat, white bread, pasta, pastries, cheese and sweets? Do you skip meals or have no regular meal schedule? Do you drink a lot of carbonated drinks or coffee, or you do not drink enough? Are you overweight? These are main dietary causes of constipation. 

2. Inactivity

Sedentary life style and depression may aggravate constipation.

3. Stress

It is not stress itself but not being able to cope with stress that may result in anxiousness and constipation. Changing the job, problems in relationships, travel, excessive excitement or emotions, like fear may all aggravate constipation. Combination of stress and certain foods may cause irritable bowel syndrome(IBS) in sensitive people. 

4. Diseases, Medications

Constipation in many acute diseases results from pain, inactivity, especially bed rest, stress, changed diet or avoiding food, and medications.

Certain gastrointestinal and neurological disorders can directly cause constipation.

Constipation in Infants, Children, Adults and Elderly  

Causes of constipation may vary a lot among age groups:

  • Infant constipation is mainly caused by congenital disorders , formula feeding or introduction of solid foods
  • In children, psychological factorsare important; celiac disease is also not rare
  • In adolescents, irritable bowel syndrome and Crohn’s disease are common
  • In adults, constipation is mainly caused by inappropriate diet and stress
  • In old people, inactivity, chronic diseases, medications and dehydration are main causes
  • Certain diseases and medications may cause constipation in all age groups

Types of Constipation

Understanding possible mechanisms of constipation can help you get rid of it.

Atonic constipation results from reduced muscle tone of the colon, abdominal wall or pelvic floor. Causes include:

  • Habits, like sedentary life style, irregular meals, low-fiber diet, postponing bowel movement, overuse of laxatives resulting in a lazy colon that does not react to stimuli, like eating and presence of the stool in the rectum. Affected person simply does not feel the urge to defecate even when his colon is full of stool.
  • Loosen rectal muscles in old people
  • Weak pelvic floor muscles in women after giving birth
  • Damage of intestinal nerves in poorly controlled diabetes or congenital disorders, like Hirschsprung’s disease.

Spastic constipation results from colonic spasms triggered by stress, certain foods or medications and is known as constipation-dominant irritable bowel syndrome (C-IBS). Symptoms include constipation, abdominal cramps, bloating and occasional diarrhea. Certain neurological disorders can also cause spastic constipation.

Obstructive constipation results from obstruction of passage of the stool, caused by congenital disorders, like cystic fibrosis (in children), tumors, scars (adhesions- surgical scars formed outside of the intestine, or strictures – scars within the intestine, mostly caused by inflammation, like in Crohn’s disease), or damaged pelvic nerves (injuries, neurological diseases) that prevent relaxation of anal muscles.

How to Relieve Constipation

1. Eat Properly

Try to have a regular meal schedule and do not skip the meals. Eat enough fibers (vegetables, cereals, wholemeal bread) to maintain bulk and soft stool. Drink enough fluid (plain or mineral water, tea) – have a glass with water on the reach of the hand; if you can drink it with ease, it means you needed it. A good sign of proper body hydration is having at least 200 mL of urine every morning. What and how much to eat? – eat what makes your digestion smooth, does not cause excessive gas, is tasty, and gives you energy for life.

2. Be Active

Be active to achieve a joy in your life. Activity may include physical work, study, being active among friends or in public, care about others, sport, and so on. Only activities you find them meaningfull may bring you constipation relief.

The role of physical exercise in constipation is debatable. Vigorous sport strain may cause more stress then relief and may aggravate constipation.

During, and after the meal, the blood flow is redirected from skeletal muscles toward the gut to provide oxygen and nutrients necessary for peristalsis. This means, less blood (and hence oxygen and nutrients) will be available for muscles, so the time after a meal is a rest time and not a time for exercising. Taking enough time for sleep and rest is necessary to relax and maintain smooth bowel movements.

3. Fight Against Bad Mood and Depression

Stress, like preparing for an exam, changing a job, death in the family, may cause transient constipation, but try to continue with regular life and eating habits, if possible. There is a time for sorrow, but long-term depression slows down peristalsis. If you feel depressed, fight against depression and find if there is anything good you can do for others.

4. Maintain Regular Bowel Evacuation Habit

Natural squatting position during bowel movement provides the largest abdominal pressure and optimal angle between rectum and anus to push out the stool. Instead of squat WC,  you can use about a feet (20-30 cm) high footstool when sitting on usual “English” WC. Stepping on toes does not; during bowel movement feet must be in a horizontal position.

Kegel exercises strengthen pelvic floor muscles that are often weakened in women after delivery.

5. Treat Eventual Diseases

If nothing of above helps, consider to have tests, like stool test for parasites or colonoscopy that may reveal diverticulosis, Crohn’s disease, polyps or other disorders.

When to Visit a Doctor?

In case of severe abdominal pain or distension, vomiting, rectal bleeding, raised temperature or general bad feeling, immediately visit a doctor, because of possible serious underlying process, like appendicitis. Constipation itself is not dangerous for health, but if despite appropriate food, symptoms of acute constipation persist for more than a week, an examination is recommended to find a cause.

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