Constipation

To define and to know what is constipation, you should have two or more of the following for at least 12 weeks

(Infrequent passage of stools (<3/week –

Straining >25% of time –

Passage of hard stools –

Incomplete evacuation and sensation of ano-rectal blockage –

Constipation affects more than 1 in 5 of the population –

If you have constipation you may complain of headache, malaise, nausea and a bad taste in the mouth.  You may also complain of abdominal bloating and/or discomfort (undistinguishable from the irritable bowel syndrome) as well as local and perianal pain

Why you may have constipation? Many causes of constipation, which include the following

General:  pregnancy, inadequate liquid and fiber intake, immobility

Metabolic/ endocrine: diabetes mellitus, hypocalcaemia, hypothyroidism

Functional: e.g. irritable bowel syndrome

Drugs: e.g. Opiates, iron, some antidepressants and others

Neurological: Spinal cord lesion and Parkinson’s disease

Psychological: Depression, Anorexia nervosa and Repressed urge to defecate

Gastrointestinal disease: Intestinal obstruction and pseudo-obstruction, Colonic disease e.g. carcinoma, diverticular disease.  Painful anal condition e.g. anal fissure

Defecatory disorders: e.g. Rectal prolapse

The history of a change in bowel habit associated with other symptoms (e.g. rectal bleeding) is very important for assessment of constipation

Some gastrointestinal causes can be excluded

Treatment

Any underlying cause should be treated –

Increase fiber content of the diet and you can approach the bulking agents –

Drink plenty of water –

Exercise –

Never ignore the need to pass stools –

Eating regular healthy meal –

If conservative treatment does not help, laxatives may be needed –

 Behavioral therapy, biofeedback training and psychotherapy can be useful in some patients

Surgery in some cases –

Dr. Kameela Al Majed♦ General Surgeon♦

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