Constipation: causes, symptoms, remedies

What is that

Constipation or constipation is one of the most frequent reasons for seeking help from a doctor: in fact, 5 to 10 percent of adults and 20 percent of the elderly suffer from it chronically .

It generally affects women more frequently and those in situations of particular stress or in a state of depression , compromising, in the most serious cases, even the quality of life and daily activities of the subject.

Constipation is defined as a difficult and infrequent evacuation caused by the association of a slowdown in intestinal transit at the colorectal level and by the formation of excessively hard stools usually during states of dehydration.

Although the optimal defecation frequency varies from person to person, it should generally be at least three times a week.

Cause

Constipation, depending on the duration, is divided into acute or chronic constipation.

The acute form is transitory in nature and can appear in particular situations, for example after surgery, a trip, antibiotic therapy or during pregnancy, going to resolve spontaneously within a few days.

Instead, we speak of chronic constipation if the difficulty in evacuating correctly lasts for more than 6 months and the causes are to be found in real alterations of intestinal and/or anorectal motility or in other pathologies such as diverticulitis, chronic intestinal inflammation, tumor forms.

Then there are some chronic diseases that primarily affect other anatomical sites, but which are often accompanied by constipation such as:

• Parkinson ‘s disease or other neurodegenerative diseases of the nervous system
• diabetes _
• hypothyroidism . _

Among the more general and common causes we also find:

• a diet based on refined foods and therefore low in fiber
• the sedentary lifestyle
• poor hydration
• the lack of regularity in daily habits due to the frenetic rhythms typical of modern society, which acts negatively through a constant slowing down of intestinal activity (peristalsis). In fact, anxieties and neuroses often have, among their consequences, also alterations in the functions of the intestine
• the presence of hemorrhoids or anal fissures. In subjects who suffer from it, the experience of defecation could be seen as a moment of worsening of the pre-existing symptoms and therefore be delayed, more or less voluntarily, with the consequent appearance of constipation
• intestinal motility disorders, such as the so-called “lazy intestine”, or when you have an inert colon that tends to contract more slowly
• pelvic floor dysfunction
• irritable bowel syndrome , which combines constipation with abdominal pain
• the assumption of some medicines, which can favor constipation, including, paradoxically, laxatives when used incorrectly and for too long periods of time. To these are added anesthetics, analgesics, antacids , anticholinergics, antidepressants, hormonal therapies and iron supplements , the latter administered more frequently to anemic subjects or pregnant women.

Constipation in children

Constipation is very frequent in children and is generally due to the reduced intake of foods rich in fibre, especially vegetables.

Children can also hold their stool for a long time for various reasons, for example by refusing to go to the bathroom outside the home, during emotional stress or school difficulties.

In these cases, fecal obstructions may occur that do not resolve spontaneously.

Constipation in the elderly

Older people suffer from constipation much more than young adults.

In old age, the causes are to be found in an incorrect and unbalanced diet often dictated by a lack of interest in food or financial hardship, in the lack of introduction of liquids, in the lack of physical movement, in the assumption of many medicines.

Furthermore, a sometimes inadequate set of teeth leads to the ingestion above all of soft, highly processed and low-fibre foods.

Most common symptoms

The most common symptoms of constipation include:

• reduction in the number of evacuations (less than three per week)
• heaviness, bloating and abdominal pain
• faecal material of considerable consistency and with a “ball” appearance (goats)
• excessive and prolonged straining during defecation
• feeling of constipation or anal blockage
• feeling of incomplete emptying.

Read also Nature that helps the stomach and intestines.

Complications

Apart from the subjective discomfort, constipation, especially in the elderly, can trigger numerous disorders such as the formation of fecal impactions , i.e. abdominal masses due to the accumulation of faeces in the colon which can cause intestinal obstruction and, in the most serious cases, even real rectal ischemia due to lack of blood supply.

Continuous efforts can also lead to an increase in blood pressure, as well as irritation and small injuries to the anal sphincter, the so-called fistulas and anal fissures.

If the difficulty in evacuating continues , prolapse of the anal mucosa and the appearance of local infections and blood in the stool can occur .

The diagnosis

To make the diagnosis, the doctor is essentially based on the clinical history, on the symptoms reported by the patient (anamnesis) and on any diagnostic tests chosen according to the different needs.

Among the most common investigations to be carried out in case of suspected constipation we find:

The cure

In most cases and especially for forms of acute constipation, simple changes in diet, hydration and lifestyle are sufficient to resolve the disorder or alleviate the symptoms.

Among the most useful precautions to adopt before resorting to drugs to facilitate the proper functioning of the intestine we find:

• never repress the urge to go to the bathroom
• regularity in meal times
• dedicate the right time for intestinal functions
• have a hearty breakfast based on fibers (fruit and whole grains) to promote the natural morning reflex of emptying
• ensure proper hydration by drinking about two liters of water a day to make the stools softer
• increase the dietary intake of vegetable fibers (fruit, vegetables, whole grains such as bran, wheat) bearing in mind that the optimal quantity is 20 grams per day against the 12-15 normally taken.
• practice regular physical activity to facilitate intestinal motility

If all these suggestions are not sufficient to regulate the intestine, it is necessary to intervene with enemas and/or undertake a pharmacological therapy based mainly on products with a laxative action.

There are various types of laxatives namely:

• mass laxatives: they are in fact fiber supplements which, by drawing water into the intestine, soften the faecal mass and facilitate its elimination
• contact laxatives or stimulants: they are powerful activators of intestinal motility which can in some cases cause the onset of episodes of colic or abdominal cramps
• emollient laxatives: they lubricate the stool and help its expulsion; among the best known in this subgroup we find glycerin, mainly formulated in suppositories
• osmotic laxatives: based precisely on the principle of osmosis, they are able to modify the distribution of water in the faeces by recalling liquids from the intestine; to this category belong for example lactulose or macrogol, among the most recommended even in pregnancy
• saline laxatives: similarly to mass laxatives they draw water into the colon, but exploiting the electrolyte balance; they are among the most used in endoscopic preparations
• prokinetic laxatives: they stimulate contractions and intestinal motility by acting on the muscles
• serotonergic agents: promote the release of the neurotransmitter acetylcholine at the level of the enteric nervous system by promoting peristaltic contractions.

When resorting to laxatives, it is important to use them correctly and, above all, for a limited period of time. Excessive use is in fact the cause of the “paradoxical” effect, which causes a worsening of the condition of constipation which justified its intake.

There are also many phytotherapeutic remedies , the most used are based on frangola , cascara , cassia , fucus .

When to see your doctor

In reality, constipation is not a real disease, but a symptom of various pathologies; it is therefore important to understand what the cause is, analyzing lifestyle habits and any new onset clinical signs (blood in stools, colic, etc.).

The doctor should be consulted if constipation persists despite increasing fiber intake, changing lifestyle habits and taking laxatives for 2-3 days. Furthermore, medical consultation is recommended when constipation occurs quickly and is associated with weight loss and/or abdominal pain.

Before resorting to diagnostic and/or invasive tests such as CT or MRI, colonoscopy, manometry, etc. a visit to a specialized gastroenterologist is always recommended, who will evaluate their actual need.