It is estimated that 99% of the Western population defecates between three times a day and three times a week, with the primary focus of physicians being on the frequency and quantity of defecation.
Constipation itself is not considered a disease but rather an indicator of a specific clinical condition.
When is a person considered constipated?
A person is considered constipated under the following conditions:
Defecation occurs less than three times a week for at least 12 weeks in a year.
Defecation requires significant effort.
Defecation feels incomplete.
The stool is hard.
There is a sensation of blockage requiring manual assistance to defecate.
People who use laxatives regularly due to constipation or for body cleansing purposes are not considered constipated patients.
Symptoms of Constipation
The most bothersome symptoms for patients include:
Straining during defecation.
Hard stool.
The feeling of incomplete evacuation.
Low frequency of defecation.
Causes and Risk Factors of Constipation
Constipation is generally attributed to either an organic disease or a functional disorder of the gastrointestinal system.
Organic Causes of Constipation
Childhood Diseases:
Hirschsprung's disease: Congenital colon enlargement caused by damage to the gastrointestinal nerves.
Cystic fibrosis: A hereditary disease affecting exocrine glands, causing constipation.
Metabolic Disorders:
Diabetes.
Hypothyroidism.
Hypopituitarism.
Elevated or reduced levels of calcium, potassium, or sodium.
Kidney diseases.
Hormone-secreting tumors.
Central and Peripheral Nervous System Diseases:
Parkinson's disease.
Stroke.
Dementia.
Brain tumors.
Brain or spinal cord injuries.
Diseases of the Large Intestine:
Tumors.
Rectal inflammation.
Intestinal volvulus.
Diverticular disease.
Anal fissures.
Medications:
Many medications can cause constipation, including:
Antihypertensives.
Antidepressants.
Pain relievers.
Diuretics.
Functional Causes of Constipation
Colonic Inertia:
A decline in the motor function of the large intestine, leading to decreased bowel movements.
Often due to nerve damage in the pelvic region or the colon's nervous system.
Rarely, the condition involves damage to the colon's muscles.
Defecatory Disorders:
These include difficulties in defecation and a sensation of incomplete evacuation due to:
Dyssynergic defecation: Inappropriate contraction of pelvic floor muscles and anal sphincters during defecation.
Pelvic floor muscle relaxation.
Rectocele: A pocket formed due to damage in the barrier between the vagina and rectum.
Prolapse of pelvic organs onto the rectum during defecation.
Mixed Constipation:
A combination of colonic functional decline and defecation disorders.
Risk Factors
Constipation is more prevalent among women than men and becomes more common with age.
Complications of Constipation
Anal fissures.
Hemorrhoids.
Fecal impaction.
Rectal prolapse.
Diagnosis of Constipation
Diagnosis is based exclusively on the patient’s complaints.
If constipation persists for more than three months, the possibility of organic diseases must be ruled out. Key diagnostic tests include:
Blood tests.
Imaging with contrast enema.
Endoscopy.
Anorectal manometry.
Defecography.
Colon transit time study.
Electromyography of the anal sphincter and pelvic floor muscles, including balloon insertion into the rectum to evaluate muscle elasticity and pain sensitivity.
Treatment of Constipation
For organic constipation, the primary underlying issue must be addressed.
In most cases, non-specific treatment is applied, including:
Dietary Changes:
Dietary fibers play a critical role in treating constipation.
The recommended intake is 20-30 grams daily.
Fiber increases the weight, volume, water content, and bacterial activity in the stool, reducing intestinal transit time.
It is recommended to consume fiber-rich whole grains and fruits.
Laxatives:
Administered if dietary changes fail to resolve the issue.
Surgical Procedures:
Reserved for severe cases where conservative treatments fail.
Partial colectomy: Performed for severe colonic inertia.
Colostomy: Facilitates regular defecation. Although not curative, it is reversible.
Past surgical methods for anal sphincter relaxation are no longer practiced due to poor outcomes.
Other Therapies:
Behavioral and psychological therapies.
Biofeedback.
Hypnotherapy to ensure calmness and better bowel control.
Complementary Medicine:
Homeopathy and physical therapies such as Paula exercises for anal muscles.
Prevention of Constipation
The following measures are essential for preventing constipation:
Consuming a fiber-rich, healthy diet.
Regular physical activity.
Drinking plenty of fluids.
Reducing intake of processed foods.
Avoiding neglect of the urge to defecate.
Managing stress and anxiety.