Constipation is a situation that occurs when the patient evacuates heavily and infrequently, usually less than 3 times a week and need to make great efforts to that feces able to pass.
Constipation can be acute when it is an isolated event and short-term, or chronic, when it is persistent and lasts for months or even years. Almost everyone has had at least one episode of acute constipation during their lifetime, and one in six people suffer from chronic constipation.
In this article we make a review of chronic constipation, addressing their definitions, causes, symptoms and treatment options.
Simply put, we can say that belly prison is a difficulty to evacuate, which causes a person to be several days without being able to go to the bathroom. But not always the frequency of bowel movements alone is a reliable parameter to say that someone has constipation.
Classically, we considered normal for an individual evacuation at frequencies ranging from three times daily to 3 times per week. Thus, following that logic, constipation be diagnosed whenever someone defecasse less than 3 times per week.
However, a definition as simplistic as well does not work universally. One reason is that the frequency of bowel movements is generally underestimated by the patient. If the individual does not make a personal diary recounting their bowel movements, hardly he can properly set the number of times that defecates during the week.
Another problem is the interpretation that each one gives the term constipation. Studies of patients who complain of constipation have shown that up to 60% of those who classify themselves as constipated can evacuate daily or almost daily. These individuals, in most cases, complain actually stress defecation and / or feeling of incomplete defecation. A small volume of evacuation and feces into pellets may also be a fuller's belly signal.
In view of this, it becomes easy to understand why an exact definition of the term constipation is not as simple as it sounds. Constipation can have different meaning for different people. For many, constipation simply means infrequent bowel movements or in short supply. For others, constipation means hard stools, difficulty to pass the stool (often with pain and anal bleeding) or a feeling of incomplete emptying after a bowel movement.
To standardize the term, a group formed by various international experts developed criteria for the diagnosis of constipation, which became known as Rome III criteria for constipation.
Therefore, the diagnosis of constipation should be based on the presence for at least three months, the 3 following criteria:
Criterion 1: At least 1 in 4 evacuations must present two of the following:
Effort to get defecate.
Feces "balls" or hardened.
Feeling of incomplete evacuation.
Sensation of obstruction or blockage in the passage of stool.
Need for manual or digital maneuvers to facilitate a bowel movement.
Less than three bowel movements per week.
Criterion 2: Need the use of laxatives to have loose stools.
Criterion 3: absence of criteria for irritable bowel syndrome.
Constipation occurs when the intestinal transit is slowed, causing the stool remains longer than needed in the intestine, which makes resected and hard. In general, in patients with intestinal complaints of constipation, intestinal transit shows up normal during passage of stool in the small intestine, but it becomes slow to reach the colon or anorectal region.
The causes for this slowing of intestinal transit are diverse, ranging from simple situations as little water intake and low fiber diet, even more serious cases, such as tumors of the intestines or neurological diseases. In most instances, the constipation is not a sign of a serious disease and is very common not be a clearly identifiable cause. These cases of chronic constipation without apparent cause are classified as idiopathic or functional constipation.
Among the possible causes of constipation, one may cite:
Insufficient fluid intake.
Improper diet with high intake of animal protein and carbohydrates and low intake of fiber (very common cause of constipation).
Changes in the individual's daily routine, for instance, travel.
Sedentary lifestyle.
Immobility, as in the case of people who are restricted to bed.
Excessive dairy consumption.
Pregnancy.
Emotional stress.
Often not evacuate in time you get the urge. This can occur in people with hemorrhoids or anal fissure, since, as the evacuation is painful, the individual ends up holding the stool afraid of pain.
Abuse of laxatives, in the long run may weaken the intestinal muscles.
Changes in the pelvic muscles.
Pseudo-constipation, which is the case of the patient who refers constipation, but in fact, does not meet criteria for this diagnosis.
Antihypertensives, particularly from the class of calcium channel inhibitors.
Constipation in young, healthy women do not usually have a serious cause behind and, in most cases, does not require a very profound medical research. On the other hand, the constipation in the elderly should be evaluated more carefully, because it may be the first sign of a colon tumor or rectum. The elderly are also often treated with multiple drugs, may be one of them the source of your constipation.
Symptoms of constipation are those used in the Rome III criteria. This therefore means that you may have constipation even without stay several days without a bowel movement.
Have rigid stool or into balls, have to do a lot of strength to get defecate, feel that there is a blockage in the rectal region that prevents the evacuation, feeling unable to completely empty your rectum and need to use their hands or fingers to facilitate the exit of the stool are all signs of constipation. Evacuate least 3 times a week is also a strong indicator of constipation, but alone is not sufficient to make the diagnosis.
It is worth remarking that if an individual be 1, 2 or even 3 days without a bowel movement, but once you do, the stools are well shaped, soft, moist and not demanding any effort to leave, that does not mean he has constipation. It's just a different evacuation standard, which is perfectly normal.
There is a very myth propagated in the media that says normal is to evacuate every day; not evacuate daily causes the body to absorb impurities and toxins from feces, causing diseases, skin disorders and premature aging. That does not exist. The result of this false propaganda is an unnecessary consumption, and sometimes exaggerated, laxatives by individuals who have a perfectly acceptable motility. Worse, even the constant use of laxatives for long periods can lead to constipation. In short, a patient who has constipation (or have lightly) is led to believe that has severe constipation, it starts to make use of a medication that does not need and in the long run, end up developing or exacerbating the problem he wanted to avoid from the outset.
Constipation can cause basically two types of complications. The first, which is derived from the effort and the difficulty of passing the stool, is the development of lesions in the anal area, ranging from hemorrhoids, anal fissure to the prolapsed rectum. The second problem is the impaction of stool in the rectum. If the stool become too hard and dry and form a large volume, they create what we call fecal impaction, staying impacted in the rectum, with no possibility of being eliminated without mechanical help, either finger or through an enema.
The use of the Rome III criteria is sufficient for the diagnosis of constipation in most cases. However, the doctor needs to be aware of some signs that may indicate that constipation is a symptom of some other disease, such as metabolic disorders or intestinal tumor. In these cases, do not just diagnose constipation, you need to identify the cause.
In healthy young people, mostly women, and no other complaints or findings on physical examination, no need to make any major investigation. In general, simple measures such as nutritional education, increased fiber intake, consume more water and exercising help control constipation. On the other hand, in persons older than 50 years, presence of involuntary weight loss, anemia, bleeding, stool, sudden onset of constipation, diarrhea alternating with constipation etc., usually a sign that something may be behind of constipation.
For the investigation of constipation, in addition to digital rectal examination, the doctor may order a colonoscopy or sigmoidoscopy, which are tests that allow the visualization of the inside of the colon and rectum, looking for lesions that could be the source of constipation.
The evaluation of the anal sphincter muscle operation can be made through the anorectal manometry. In this procedure, the doctor inserts a thin flexible tube into the rectum and then inflating a small balloon at the tip of the tube. This allows assess the coordination of the muscles around the anus at the time of evacuation, in order to clarify whether the difficulty to defecate is due to some weakness or incoordination of the muscles.
The traffic study in the colon is a procedure done to assess the speed of intestinal transit. In this study, the patient swallows a capsule containing 24 markers that are dispersed throughout the intestines and can be identified by abdominal films. The patient after 6 days is an X-ray of the abdomen to see how many markers are still present and how many have already been eliminated. The identification of at least 5 markers present in the colon after 6 days signal is a slowing of intestinal transit.
Initial treatment of constipation should always be with diet changes, including increased consumption of fiber, fruits and vegetables. Granola, cereals enriched with fiber, wheat bran, papaya, kiwi and plum are foods that can help a lot in constipation. Meat and carbohydrates can have the opposite effect. Another essential point is to increase the consumption of water. At least 1.5 liter of water should be taken throughout the day.
One way to relieve constipation, which is often overlooked is the physical exercise. Regular physical activity improves the functioning of the intestinal and abdominal muscles, and stimulate the motility of the colon itself.
Among the natural laxatives, psyllium, calcium polycarbophil, and methylcellulose are the most suitable. This fiber products are capable of absorbing large amounts of water, which form a large stool and humid, ideal to be expelled at the time of defecation.
It is also important to explain to the patient that it should always evacuate the mood strikes. Staying holding feces increases the time that they are in the intestine, a fact that favors the absorption of water from the stool, making it increasingly hard and dried.
Laxatives for constipation
If the above measures are not effective, the use of laxatives may be indicated. It is worth remembering, however, that the abuse of long-term laxatives can perpetuate constipation, making the resolution of the most difficult problem. The laxatives are to be used occasionally, in times of greatest need. If you need to resort to laxatives on a regular basis, it is best to seek help from a gastroenterologist instead of being self-medicating continuously.
Laxatives Among the options are the most used lactulose, sorbitol, mineral oil, Bisacodyl (Dulcolax purging or lactose) and senna. In more resistant cases, glycerin or bisacodyl suppositories or enemas may be attempted.
If nothing goes way, manual disimpaction is the next step. Often, the patient fecaloma forms a cake so large and hard, it is physically impossible for the same to be deleted without being fragmented mechanically before.
