A known Zoology lecturer namely Ms Pramila came to me in agony last week and told me Doctor that “my father aged around 65 years complaints sharp gas pains in the abdomen and bloating and whenever went to the washroom he did not come out of it for 45 minutes to one hour. The other members of the family were so tiresome to get time to go to the toilet and even I failed to go on time to the college as there was only one restroom in our house. When I asked my father the reason for the delay, he said that hard pellet stools occur with slow transit that too with great difficulty on excessive straining. Many times, he said that he uses his figures to remove the hard stony pellet stools from the anus which is the opening of the rectum to the outside of the body, which is the last few inches of the large intestine closest to the anus. He often complaints of incomplete evacuation of the stool. What is this problem doctor to my father?
Ms Pramila, this problem is called broadly constipation. It is a common condition that occurs when it’s difficult or uncomfortable to have a bowel movement. It can be characterized by having hard, dry, or lumpy stools, having fewer than three bowel movements a week, and having a feeling that not all stool has passed. Constipation can be caused by several factors, including not drinking enough fluids, and not eating enough fiber diet. A fiber diet is a diet that contains the recommended amount or more of dietary fiber. Dietary fiber is a carbohydrate found in plants that the body can’t digest or absorb. It’s also known as “bulk” or “roughage”. Good sources of dietary fiber include whole grains, nuts and seeds, and fruit and vegetables. Additionally, those who do not do exercise regularly; taking certain medications, such as pain relievers, antidepressants, antacids, iron pills etc., may develop constipation, which is not serious if lasts for a short period.
Sometimes blockages in the colon or rectum, or damage or changes to tissues in the colon or rectum, in many cases, can also manifest as constipation. However, when constipation is not controlled with self-care and long-term constipation, one should consult a specialist or a gastroenterologist. In addition to constipation if there is bleeding from the rectum, blood in the stool, and continuous pain in the abdomen. Broadly constipation is an uncomfortable or infrequent bowel movements that result in the passage of small amounts of hard, dry stool, usually fewer than three times a week.
According to Harrisons’ principles of Internal medicine Patients with more troublesome constipation may not respond to fiber alone and may be helped by a bowel-training regimen: taking an osmotic laxative (lactulose, sorbitol, polyethylene glycol) and evacuating with enema or glycerin suppository as needed. After breakfast, a distraction-free 15-20 min on the toilet without straining is encouraged. Excessive straining may lead to the development of hemorrhoids which are otherwise called piles, are swollen veins in the anus and lower rectum. Those few who do not benefit from the simple measures narrated above may require long-term treatment with potent laxatives. The latest agents that induce secretion (e.g. liposome, a chloride channel activator) are also available.
Investigation severe constipation
A small minority (probably less than 5 percent) of patients have severe or “intractable” constipation. These are the patients most likely to be seen by gastroenterologists or in referral centers. Further observation of the patient may occasionally reveal a previously unrecognized cause, such as an evacuation disorder, laxative abuse, or malingering which is the act of intentionally faking physical or mental illness or symptoms to gain a secondary advantage. This advantage can be financial, emotional, or to avoid responsibility, and also psychological disorders. In these patients, evaluations of the physiologic function of the colon and pelvic floor the pelvic floor is a group of muscles and ligaments that support the bladder, uterus (womb), and bowel and of psychological status aid in the rational choice of treatment. Even among these highly selected patients with severe constipation, a cause can be identified in only about two-thirds of tertiary referral patients.
Prevention of constipation:
According to naturopathy, half cup of aloe vera jelly if taken on an empty stomach, the anthraquinones help to produce water and fluid in the large intestines that help to have easy motion. Basil seeds are soaked in water the whole night and to take on an empty stomach, eat plenty of vegetables, in which the magnesium would help a better motion, some people use ayurvedic powders, and flaxseeds also help in digestion and relieving constipation. One can try the self-care steps to relieve constipation by eating more fresh fruits, leafy vegetables, and whole grains, drinking plenty of water and other liquids, get enough exercise; some may need to avoid alcohol and caffeine.
Treatment
After the cause of constipation is identified a treatment decision can be made. Slow-transit constipation requires aggressive medical or surgical treatment. Pelvic floor dysfunction usually responds to biofeedback management. However, only 60% of patients with severe constipation are found to have such a physiologic disorder (half with colonic transit delay and half with evacuation disorder). Patients with spinal cord injuries or other neurologic disorders require a dedicated bowel regimen that often includes rectal stimulation, enema therapy, and carefully timed laxative therapy.
Patients with slow-transit constipation are treated with many medications bulk, osmotic, prokinetic, secretory, and stimulant laxatives including fiber, psyllium, a leafy-stemmed Eurasian plantain, the seeds of which are used as a laxative, milk of magnesia, lactulose a synthetic sugar used to treat constipation, polyethylene glycol (colonic lavage solution), and latest molecules e.g. lubiprostone, and bisacodyl is a stimulant laxative used to temporarily relieve occasional constipation. If a three to six-months trail of medical therapy fails and patients continue to have documented slow-transit constipation unassociated with obstructed defecation, the patients should be considered for laparoscopic surgery basing on the cause at a specialized hospital under the care of a surgical gastroenterologist.