Constipation: Causes, Symptoms and Treatment

Introduction

Constipation is a clinical condition in which a person has uncomfortable or infrequent bowel movements and/or passage of hard stools. Generally, a person is considered to be constipated when bowel movements result in passage of small amounts of hard, dry stool, usually fewer than three times a week.

Causes of Constipation

  1. Inadequate fibre in diet (simple constipation)
  2. Drugs e.g. antidepressants, narcotic analgesics, etc
  3. Diseases of the anus, rectum and colon e.g. fissures, haemorrhoids, cancer
  4. Irritable bowel syndrome
  5. Metabolic diseases e.g. hypothyroidism, hypercalcaemia

Symptoms of Constipation

  • Dry, hard and/or lumpy stools
  • Abdominal bloating
  • Excessive flatulence.
  • Fewer than three bowel movements a week.
  • Difficult or painful defecation
  • A possible stomach ache or cramps.
  • A feeling of incomplete bowels emptying after a movement.

Complications of Constipation

  • Megacolon
  • Anal fissures/tears
  • Haemorrhoids
  • Rectal bleeding

Diagnosis

  • Stool examination including microscopy.
  • Proctoscopy/sigmoidoscopy.
  • Barium enema
  • Serum hormonal levels e.g. thyroxine, triiodotyronine, thyroid stimulating hormone to exclude hypothyroidism

Treatment objectives of Constipation

  • Identify and eliminate cause(s)
  • Evacuate hard faecal matter

Where to use of laxatives in Constipation

This means situations where straining will exacerbate pre-existing medical/surgical conditions. The conditions are:

  1. Angina
  2. Risk of rectal bleeding
  3. Increased risk of anal tear

When to use laxatives apart from as noted above include

  • In drug-induced constipation
  • To clear the alimentary tract before surgery or radiological procedures

Non-drug treatment of Constipation

  • Avoid precipitants
  •  Eat high fibre diet (including fruits and vegetables).
  • Take adequate fluid
  • Megacolon: Saline enema
  • Surgical: resection of large bowel
Read Also:   Giardiasis: Causes, Symptoms and Treatment Guideline

Drug treatment

Stimulant laxatives

Senna 7.5 mg tablet (as sennoside B)

Adult: 2-4 tablets at night

Child:

6-12years: 1-2 tablet stat at night (or in the morning if preferred)

12-18 years: 2-4 tablets at night

Or:

Bisacodyl tablets 10 mg orally at night; bisacodyl suppositories 10 mg per rectum at night

Caution

Laxatives should generally be avoided. Most times these drugs are needed for only a few days

In children, laxatives should be prescribed by a healthcare professional experienced in the management of constipation in children.

References

  1. John Hopkins Medicine: Constipation
  2. Cleveland Clinic: Constipation

 

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