Constipation - Symptoms, Causes, Side Effects, Treatment

Constipation refers to a condition in which a person’s bowel movements are painful or infrequent. It is prevalent and does not require medical intervention in the majority of cases. Treatment of constipation ranges from minor lifestyle changes to surgical intervention in severe cases.

Signs and Symptoms

Can classify constipation as either acute or chronic, with chronic constipation frequently lasting longer than three months. Symptoms may differ from person to person. Following are some of the most commonly identified symptoms of constipation:

• Pain in abdomen
• Less than three bowel movements in a week
• Painful and difficult motions
• Hard, dry or lumpy stools
• Feeling uneasy or bloated
• A feeling of incomplete emptying of bowels.

Causes 

Lifestyle habits, medical conditions, medicines, and pregnancy can be possible causes of constipation.

Lifestyle Habits that can cause constipation are:

• Drinking less water
• Not exercising enough
• Having a lot of milk or cheese products
• Not eating food rich in fibre
• Controlling the urge to pass stool
• Irregular sleep timings
• Stress
• Changes in everyday routine, including travelling or eating.

Medical Conditions that can lead to constipation include:

• Irritable bowel syndrome (IBS) (bloating, abdominal pain, and either diarrhoea or constipation or alternating diarrhoea and constipation).
• Endocrine system disorders such as diabetes, hypothyroidism, and hypopituitarism
• An anal fissure is a medical disorder in which there is a tear in the anus lining. Fearing pain, a person may resist the urge to use the washroom.
• A tumour of the rectum can also cause pain while passing stools.
• Obstruction of the rectum or anus can also lead to constipation. Examples include rectal prolapse or haemorrhoids/piles.
• Structural defects in the digestive tract such as a fistula (an abnormal connection between organs), malrotation (congenital abnormality in which the intestinal tract doesn’t form or rotate correctly), imperforate anus (abnormally located or absent anus), etc., can block the passage of stool.

Medications that can cause constipation are:

• Antacids having aluminium or calcium
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen
• Narcotics (pain-relieving medicines) containing oxycodone, codeine, and hydromorphone
• Medicines to control blood pressure like beta-blockers and calcium channel blockers
• Antipsychotic and antidepressant medications

Many other drugs can also cause constipation. It is recommended to clear your concerns with a doctor before taking any medication.

When to See a Doctor?

Seek medical help if constipation is accompanied by:

• Fever
• Bloody stools
• Unexplained weight loss
• Bleeding rectum
• Vomiting
• Constant abdominal pain
• Pain in the lower back.

What Investigations May Be Done?

To find the exact cause of constipation, the doctor may ask for various tests and procedures. These include:

• Laboratory tests: Hypothyroidism, diabetes, and anaemia can all be detected through blood and urine tests. Inflammation, infection, and cancer are all checked for in a stool sample.
• Endoscopy: It is a procedure that examines the inside of your anus, rectum, and colon for evidence of disorders in the lower digestive tract. Two types of endoscopies can be used for this: flexible sigmoidoscopy and colonoscopy. In addition, a tiny sample of your tissue may be collected (biopsy) to screen for cancer or other issues.
• Imaging tests: To eliminate other causes of constipation, a CT (Computed Tomography) scan or MRI (Magnetic Resonance Imaging) may be ordered by the doctor.
• Colorectal transit studies: A small amount of radioactive substance is consumed during these tests, followed by tracking its passage through the intestine. 
• Other tests to check bowel function: Certain tests (defecography, anorectal manometry, balloon expulsion test) can be conducted to determine how well the anus and rectum can hold and release stool.

How To Proceed?

Lifestyle changes:

You can treat mild to moderate cases of constipation at home in most situations. The following tips can help provide relief from constipation:

• Drink plenty of water.
• Avoid coffee, alcohol, and tea as they can cause dehydration.
• Eat fruits, vegetables, and high-fibre food items.
• Exercise regularly.
• Examine your toilet-sitting manner. It might be easier to have a bowel movement if you squat, raise your feet, or lean back.
• Avoid taking your phone to the restroom.

Medications: If lifestyle and diet changes fail to solve your constipation problem, the doctor may recommend taking laxatives. Laxatives are drugs that help to soften your stool.

Surgery: The doctor may recommend surgery if there is a structural problem with your colon or correct an abdominal hernia. You may also need surgery if cancer has been detected in your rectum, anus, or colon.

Signs and Symptoms

1. Constipation can be classified as either acute or chronic, with chronic constipation frequently lasting longer than three months.[2]. Symptoms may differ from person to person. Following are some of the most commonly identified symptoms of constipation:
2. Pain in the abdomen
3. Less than three bowel movements in a week
4. Painful and difficult motions
5. Dry, hard, or lumpy stools
6. Feeling uneasy or bloated
7. A feeling of incomplete emptying of bowels.

1)Blood tests- Your doctor will look for a systemic condition such as low thyroid (hypothyroidism) or high calcium levels.

2)X-ray-. An X-ray can help your doctor determine whether our intestines are blocked and whether there is stool present throughout the colon.

3)Examination of the rectum and lower, or sigmoid, colon (sigmoidoscopy).- In this procedure, your doctor inserts a lighted, flexible tube into your anus to examine your rectum and the lower portion of your colon.

4)Examination of the rectum and entire colon (colonoscopy). -This diagnostic procedure allows your doctor to examine the entire colon with a flexible, camera-equipped tube.

5)Evaluation of anal sphincter muscle function (anorectal manometry)-. In this procedure, your doctor inserts a narrow, flexible tube into your anus and rectum and then inflates a small balloon at the tip of the tube. The device is then pulled back through the sphincter muscle. This procedure allows your doctor to measure the coordination of the muscles you use to move your bowels.

6)Evaluation of anal sphincter muscle speed (balloon expulsion test).- Often used along with anorectal manometry, this test measures the amount of time it takes for you to push out a balloon that has been filled with water and placed in your rectum.

7)Evaluation of how well food moves through the colon (colonic transit study). -In this procedure, you may swallow a capsule that contains either a radiopaque marker or a wireless recording device. The progress of the capsule through your colon will be recorded over 24 to 48 hours and will be visible on X-rays.

8)In some cases, you may eat radiocarbon-activated food and a special camera will record its progress (scintigraphy). Your doctor will look for signs of intestinal muscle dysfunction and how well food moves through your colon.

An X-ray of the rectum during defecation (defecography). During this procedure, your doctor inserts a soft paste made of barium into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination.

MRI defecography. During this procedure, as in barium defecography, a doctor will insert contrast gel into your rectum. You then pass the gel. The MRI scanner can visualize and assess the function of the defecation muscles. This test also can diagnose problems that can cause constipation, such as rectocele or rectal prolapse.

1. Lifestyle changes:
2. You can treat mild to moderate cases of constipation at home in most situations. The following tips can help provide relief from constipation:
3. Drink plenty of water.
4. Avoid coffee, alcohol, and tea as they can cause dehydration.
5. Eat fruits, vegetables, and high-fibre food items.
6. Exercise regularly.
7. Avoid taking your phone to the restroom.
8. Examine your toilet-sitting manner. It might be easier to have a bowel movement if you can practice simple postures on the toilet seat as listed below:
9. Try to bend forward while sitting on the toilet and place your hands on your thighs.
10. Bend your knees and keep it higher than your hips, use a footstool if the toilet seat is tall.
11. Always rest your feet on the ground or a footstool.
12. Breathe through your mouth to avoid straining and contracting pelvic muscles.
13. Move your tummy forward in a bulging manner as you are on the abdomen.
14. Practice these steps at least thrice and if it doesn’t work, get up and walk about for a bit.

Consuming hot beverages or warm water may help. 

Medications: If lifestyle and diet changes fail to solve your constipation problem, the doctor may recommend taking laxatives. Laxatives are drugs that help to soften your stool.

1) You will not pain 

2) The chances of developing Hernia  decreases

1. Bleeding from the rectum
2. Blood in your stool
3. persistent abdominal pain
4. pain in the lower back
5. a feeling that gas is trapped
6. vomiting
7. fever
8. unexplained weight loss
9. a sudden change in bowel movements