Constipation

Constipation is a disorder of the bowel habits characterised by emptying the bowels less often or hard stools that are difficult to expel. It affects women more than men, and in most cases there is pain or abdominal discomfort. This condition has very important repercussions on the patient’s personal life, health and social life.

In most cases, the cause of constipation is unknown, with no organic or anatomical injury to explain it, and is defined as functional or primary constipation. In other cases, constipation is the result of certain illnesses or medications, known as secondary constipation.

Description

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.

Symptoms

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.

Diagnosis

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:

fibrocolonoscopy
anorectal mamometry
colonic transit time
defecography
lower gastrointestinal series
scan
MRI

Typical treatment

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.

Prevention

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.