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


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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