There are several variants within primary constipation:
- Constipation with normal colonic transit, in other words, the time the intestinal material takes to pass through the large intestine is normal. It is the most common type and is associated with pain. It is often known as irritable bowel syndrome.
- Constipation with slow colonic transit caused by an alteration to colon motility, in other words, the movements of the intestine. In general, this has more severe symptoms and does not respond as well to treatment.
- Constipation with expulsion difficulty, caused by an alteration in defecation or an anatomical abnormality of the pelvis, the rectum or the anal canal such as rectocele, enterocele or rectal prolapse.
- Constipation associated with complex pan-intestinal pathologies (intestinal myopathies and neuropathies), which, despite being rare, can continually cause treatment to fail.
Secondary constipation due to taking certain medication, above all opioids for pain, and due to neurological, metabolic, or infectious diseases (Chagas) or cancer, amongst others.
The most frequent symptom is difficulty evacuating the bowels.
If there is an alteration in rectal evacuation, symptoms may be:
- difficulty defecating
- hard or lumpy stools
- a feeling of not having completely emptied the bowel
- lack of evacuating reflex
- feeling of obstruction
Who is affected by constipation?
This is a very common condition in adults and children and affects 10-30% of the world population. 69% of patients say that it affects their performance at work or school, and 40% of patients with constipation have consulted a doctor at some time for this reason. In Spain, between 2005 and 2006, twenty-three million units of laxatives where prescribed in a year.
In general, there are no routine tests on patients with chronic constipation as long as there are no causes for concern such as fever, weight loss or rectal bleeding. On the other hand, if constipation has started recently with no apparent cause, or does not respond well to treatment, it must be investigated via different tests such as:
- anorectal mamometry
- colonic transit time
- lower gastrointestinal series
Constipation must be treated in a personalized way and the causes of it starting or worsening must be analysed. Dietary and hygiene habits and any medication being taken must also be looked into.
The lack of response to this treatment should be assessed by specialists.
There are several ways to prevent constipation:
- Avoid a sedentary lifestyle and do moderate exercise.
- Increase fluid and fibre intake.
- Do not avoid defecation when you need to, and adopt a suitable position to do so.
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