Constipation, The unspoken discomfort

By Dr. D.G.A. Abeyguanratne

Constipation is a common problem, particularly so in elderly patients. I have hardly seen an elderly patient who does not mention it. This may be the reason why most drug companies make so much money selling aperients to ordinary people. Usually the aperients are sold over the counter and do not need a prescription from a doctor to buy them.

What is constipation?

Medically constipation is defined as a bowel movement of less than three times a week, passing with difficulty and subjective sensation of passing hard pellet-like stools with straining and a sensation of incomplete evacuation.

However, constipation means different things to different people. For example, some people think their bowels should open daily, and if not think they are constipated. In some cases even if bowels are opened daily and if they have to strain a little, they think they are constipated.

For another person passing hard, pellet-like faeces irregularly is constipation. Another person may think having to manipulate the rectum to open the bowels is constipation.

According to some, the best definition is the person’s perception, that his / her normal bowel motion is replaced by abnormal hard stools.

Most in the medical profession think at least two of the following criteria should be fulfilled before one labels a person as constipated.

  • Straining
  • Hard pellet-like stools
  • Feeling of incomplete evacuation
  • Feeling of obstruction and blockage
  • Manual manipulation to open bowels
  • Less than 3 bowel openings per week

What is a normal bowel action?

Normal bowel action is taken as three bowel openings per day to three bowel openings per week. According to American and British physicians, the usual amount of faeces passed per person per day is about 100 to 200 grams, of which 60 to 85 % is water. This may be dependent on the food consumed. We Sri Lankans produce about 10 times more faeces and this would be again due to our food habits.

What should we do to avoid constipation?

A little exercise daily is very important to avoid constipation. If you are very lazy and do not walk even a little distance per day, your bowels will also be lazy and probably not open as regularly as you want. Therefore it is important to get the minimum exercise for your body to function. This could be done by simply walking for 30 minutes a day, 4-5 times a week. If you are doing a bit of gardening, it will help as well.

Your diet which should be healthy for obvious reasons must contain a lot of fibre if you are to avoid constipation. Most of the vegetables, green leaves, and fruits, can supply enough fibre in your diet. The other important thing is to make sure that you do not become dehydrated. To avoid dehydration we need to drink at least two litres of water a day. This is absolutely essential as we live in a tropical country.

What should we do when constipated?

If you have the above symptoms and signs of constipation, you should seek advice from your general practitioner or the family physician.

At your consultation he or she will obtain a thorough history and examine you, before coming to a diagnosis.

It is important that you explain the duration of your problem and whether you have undergone any surgical procedures.

It is important that you mention if you have had a spontaneous bowel opening and whether you have any faecal soiling.

Very important symptoms like rectal bleeding, loss of weight, recent onset of abdominal pain, fever and any other bowel diseases must be divulged to the doctor. It is important to mention any current medication you are on as well as the use of any herbal remedies. If you have any psychological problems they should also be mentioned.

Also do not forget to tell your Doctor whether there is a family history of cancer of the large bowel, as well as any past history of thyroid disease, diabetes and renal impairment. The doctor may proceed to carry out certain basic tests and request some special tests before confirming the diagnosis. At certain times you may be referred to a physician, surgeon or a specialist radiologist before a diagnosis is made.

What is the treatment?

Treatment, of course, depends on the diagnosis. Your doctor or the specialist will initiate the treatment. If it is simple constipation your general practitioner will help and if there are no major problems, will start a short course of laxatives.

It is very important to confirm that the patient is actually constipated before laxatives are prescribed, as they have many side effects and abuse of them can lead to further problems. The resulting problems can be more dangerous.

It is thus important to find the exact cause of constipation before embarking on treatment to avoid major problems. Your family doctor will point you in the right direction.

(The writer is a Family Physician)

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