Constipation

Cause

Constipation is often caused by an unhealthy and low-fiber diet. Poor exercise, irregular life, stress and psychological factors may play a role. Constipation can also occur when using some medications or as a result of a disease.
Other causes of constipation are:

• Drinking too little.
• Ignoring urge.
• Misuse of pelvic floor muscles.
• Irritable bowel syndrome.

In some cases, the cause of constipation is unknown.

Symptoms

We speak of constipation when a person has stool for less than three times a week. Characteristic for constipation is hard, dry stool. It often takes a lot of effort to get rid of the stool and it only succeeds by pressing hard. Abdominal pain and a hard, swollen abdomen are also common. As a result of constipation, a person can suffer from hemorrhoids, breaks and fissures. Also, overflow diarrhea (paradoxical diarrhea) can occur. This is the leakage of some loose stools along the hard stool, when the intestine is very full. This causes poo sweeps in underwear and unpleasant smells.

Diagnosis

The diagnosis of constipation is made by the general practitioner, based on the symptoms. The general practitioner can physically examine the patient. Optionally, the doctor can perform an internal examination through the anus (rectal examination). If necessary, the patient is referred to a gastroenterologist and hepatologist or internist for further investigation.

Treatment

In case of constipation, the general practitioner initially gives advice on lifestyle and diet. If this is not effective, the doctor may prescribe various types of medicines:

• Bulking agents. These have the same properties as dietary fiber: they absorb moisture. They ensure smooth relief and proper bowel function.
• Humectants. These drugs retain moisture in the intestine, making the stool softer.
• Laxatives. These drugs activate bowel movements by a chemical stimulation of the intestinal wall. This gives them a strong laxative effect.
• Enema. In exceptional cases, an enema with lukewarm water is prescribed to dissolve the clogging. A fluid is injected through the anus into the rectum. This fluid makes hard stools softer.

Constipation can result from misuse of the pelvic floor muscles. There are special pelvic floor centers or clinics that specialize in these problems. There are also pelvic floor physical therapists who can teach patients to use pelvic floor muscles the right way. Good posture on the toilet and good use of pelvic floor muscles can reduce and prevent symptoms.

Prognosis

In infants with constipation, who are treated early and appropriately, the prognosis is good. After six months of treatment, the majority is symptom-free and the treatment with laxative medication can be stopped. In older children, the duration of treatment varies. Sometimes it only takes a few months, sometimes years. Because children don’t always grow over the condition, it's important to start treatment in time. Then the chance that the symtoms definitively disappear is the greatest. In adults, it usually succeeds to normalize bowel movements with lifestyle changes and laxatives, but chronic medication is often necessary.

Considerations

• Dietary fiber is essential for healthy digestion and proper stool. Fibers act like a sponge and retain moisture, so that the stool remains soft. Fibers also stimulate bowel movement.
• It’s advisable to drink at least two liters a day, while using a high-fiber diet. When drinking too little, the fibers cannot perform their sponge function and they work counterproductive.
• Regular exercise stimulates bowel movement and prevents constipation. Exercising ensures that the intestine gets going.
• When there is urge, go immediately to the toilet. By keeping the stool, it further thickens. This may cause constipation.
• Don’t skip breakfast. Breakfast is very important. A high-fiber breakfast ensures that the functioning of the intestine gets going and continues going.
• Quit smoking. For overall health it’s wise not to smoke.
• Caffeine has a stimulating effect on the bowels. A cup of coffee can thus stimulate the intestines. Contrary to what is often asserted, coffee is not desiccant.

Facts

• The term ‘constipation’ is derived from the Latin word constipatio (thickening).
• Constipation is very common, one out of three people is sometimes affected.
• Women suffer on average twice as often from constipation as men. The condition is also common during pregnancy.
• Constipation occurs at any age.
• There need not be spoken of constipation if a person doesn’t produce stool every day. Some people have stools only three to four times a week and feel fine with it.