Intestinal Constipation

Constipation means too hard and small, or infrequently eliminated stools under excessive straining upon defecation.

The patient should consult the physician evacuating is twice per week (less than once every 3-4 days) or when it is too hard to defecate. The research conceived constipation as reducing the liquid contents of the faeces, i.e., less than 70% water by total weight.

Intestinal constipation
Intestinal constipation


Intestinal lesions become visible by imaging methods of investigation (Rx or similar, endoscopy, microscopy), are known as organic diseases, and changes in peristalsis (bowel movements leading food through the intestine), usually called functional changes.

Constipation can be classified into:
  • Simple, clinically short term, with recent casual and triggering as dietary change, postoperative febrile pictures, medication. Chronic idiopathic long evolution, with no known organic cause, which can show changes in motility (peristalsis).
  • Organic, with structural change, with rapid evolution or chronic.

How does it develop?

Examples of causes of constipation are:
  • Certain drugs used in various purposes: antidepressants, cough suppressants, opioid analgesics (codeine, morphine), antiparkinsonian drugs, antihypertensives, antacids containing aluminum, calcium preparations.
  • Lifestyle: Low dietary fiber, low fluid intake, inactivity, movement limitations of the body (sequelae, rheumatism, old age).
  • Changes that alter hormones or modify the recovery and disposal of substances: hypothyroidism, diabetes, chronic renal failure.
  • Psychiatric situations: depression, dementia, post-sexual abuse.
  • Structural abnormalities of the colon, the anorectal and perineal: megacolon, anal fissure, haemorrhoid complications, rectal prolapse.
  • Narrowing of the large intestine: cicatricial complications of diverticulitis, inflammation as an undesirable effect of radiotherapy, malignant tumors of the rectum and the final portion of the large intestine.
  • Neurological and muscular disorders: spinal cord injuries, multiple sclerosis, Parkinson's disease, perineal relaxation failure in the effort to expel stool.
  • Slow colonic transit: idiopathic (cause not identified), false chronic intestinal obstruction.

This situation occurs in 1-20% of the population, in most cases from 65 years of age. Constipation from birth suggests organic problem, endemic areas of Chagas disease (trypanosomiasis), its dominant megacolon after the second decade of life. In adolescence constipation can result from illicit drug use and abuse of opioids or psychotropic drugs.

How does it feel?

Feeling of constipation
Feeling of constipation
It varies from one person to another, as in the same individual. Adults with megacolon - dilation of the large intestine by rarefaction of nerve endings from the intestine to the muscles themselves - complain about the difficulty evacuation since childhood.

Women may show non-painful constipation since early adolescence, curiously, those, who report abdominal pain, do so from the end period of the development. Patients may have days without emptying bowels or have the feeling that it is incomplete, complain of pain during evacuation, straining, need for manual extraction of feces, bleeding is also observed.

A recent change in bowel function makes it more likely to identificate constipation, while the long-term suggests a staff. There may be bloating or visible abdominal pain, particularly in the lower abdomen, accompanied by localized or diffuse abdominal pain, passage of mucus, blood and stools alternating with harsh.

Fever is rare, sudden and painful accompanying tables, which is also valid for the coexistence of nausea and vomiting. Complaints of restlessness, malaise, appetite and mood changes are common, as well as a headache. The rectal distention by inflating a cuff can cause nausea and headache.

How does the doctor make the diagnosis?

Patients should be asked about their evacuation habit evacuation over time, including part of the day, the time it takes to alleviate the number of bowel movements (per day? week?), and the possible use of laxatives for long periods , years maybe. Also of medical aid it is important to understand the characteristics of faeces (consistency, volume, color, odor), the presence of pathological products, such as mucus, pus and blood. Thus, it is to be clarified, as much as possible about what the individual feels and notes, including changes in body weight.

The doctor finds something important or difficult to diagnose on physical examination. If possible, rectal colonoscopy should be carried on, since over 50% of colon tumors are the scope of this simple methodology.

Basic complementary tests may indicate anemia or inflammation. Specific blood tests may suggest colon cancer, although they are more useful for the evolutionary control of post-treatment.

The Rx input of the large intestine with rectal barium (barium enema) is very useful, particularly when the hospital does not have the Colonoscopy (endoscopy of the colon via anal, allowing the collection of material for microscopic examination and removal of polyps - "mole" for example), and is preferred today for detection of organic morphological changes of the intestinal lumen.

Studies of contractile function and pelvic colon can be obtained by radiological 72-hour monitoring the rate of displacement of the patient swallowed radiopaque markers, anorectal pressure measurements (manometry) by electromyography and defecography (radiography accompanying changes in the shape and rectal and perineal contractions during the evacuation).

How is it treated?

Constipation food
Constipation food
Whenever possible the dose or type of medicine that contributes to the appearance or worsening of constipation should be modified in order to minimize side effects. It should be corrected to the maximum, not to damage endocrine, metabolic, neurological, and proctologic systems.

Encourage intake of fiber-forming and moistening medicines (the granola and wheat bran are very popular and efficient), suggesting the use of natural foods with laxative properties (papaya and plum are widely used), advise the use of more of the various classes of laxatives, (always sparingly) and prescribe prokinetics (peristaltic stimulants via the blood, swallowed or injected). The use of suppositories or enemas has an important action. Surgical methods can be used, but their use is rare, except in case of obstructive painful lesions in the anal.

It is worth mentioning the fecal impaction - accumulation of hardened and very dry feces in the rectum and sigmoid - which occurs mainly in elderly patients, and in case of psychiatric and neurological disorders. Enemas and suppositories can help, but often a manual disimpaction under some sedation or anesthesia is required. It should be noted medical care to prevent damage to the anal sphincter during these maneuvers.

Special care should be taken regarding the use of laxatives without medical advice. These products, often sold under the label "natural" or available in pharmacies without a prescription, can cause damage and have irritating effect on the mucosa of the intestine and the neuromotor system. In addition, people with heart or kidney problems may experience worsening of their disease by acute excessive loss of fluids and minerals eliminated with feces.

Unlike these drugs, food or fiber-containing compounds may be used freely, it is recommended to seek medical attention if more "powerful" treatment is needed.

How is it prevented?

  • Education and diet and habits to evacuate stool regularly with a soft consistency.
  • Regular ingestion of concentrated fiber.
  • Treatment or control of underlying local or systemic diseases, as well as review of medications, especially those of continuous use.

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