Constipation

Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. Bowel habits vary, but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.

Description

Constipation is one of the most common medical complaints in the United States. Constipation can occur at any age, and is more common among individuals who resist the urge to move their bowels at their body's signal. This often happens when children start school or enter daycare and feel shy about asking permission to use the bathroom.

Constipation is more common in women than in men and is especially apt to occur during pregnancy. Age alone does not increase the frequency of constipation, but elderly people (especially women) are more likely to suffer from constipation.

Although this condition is rarely serious, it can lead to:

• bowel obstruction
• chronic constipation
• hemorrhoids (a mass of dilated veins in swollen tissue around the anus)
• hernia (a protrusion of an organ through a tear in the muscle wall)
• spastic colitis (irritable bowel syndrome, a condition characterized by alternating periods of diarrhea and constipation)
• laxative dependency

Chronic constipation may be a symptom of colorectal cancer, depression, diabetes, diverticulosis (small pouches in the muscles of the large intestine), lead poisoning, or Parkinson's disease.

In someone who is elderly or disabled, constipation may be a symptom of bowel impaction, a more serious condition in which feces are trapped in the lower part of the large intestine. A doctor should be called if an elderly or disabled person is constipated for a week or more or if a child seems to be constipated.

A doctor should be notified whenever constipation occurs after starting a new prescription, vitamin, or mineral supplement or is accompanied by blood in the stools, changes in bowel patterns, or fever and abdominal pain.

Causes and symptoms

Constipation usually results from not getting enough exercise, not drinking enough water, or from a diet that does not include an adequate amount of fiber-rich foods like beans, bran cereals, fruits, raw vegetables, rice, and whole-grain breads.

Other causes of constipation include anal fissure (a tear or crack in the lining of the anus); chronic kidney failure; colon or rectal cancer; depression; hypercalcemia (abnormally high levels of calcium in the blood); hypothyroidism (underactive thyroid gland); illness requiring complete bed rest; irritable bowel syndrome; and stress.

Constipation can also be a side effect of:

• aluminum salts in antacids
• antihistamines
• antipsychotic drugs
• aspirin
• belladonna (Atopa belladonna, source of atropine, a medication used to relieve spasms and dilate the pupils of the eye)
• beta blockers (medications used to stabilize irregular heartbeat, lower high blood pressure, reduce chest pain)
• blood pressure medications
• calcium channel blockers (medication prescribed to treat high blood pressure, chest pain, some types of irregular heartbeat and stroke, and some non-cardiac diseases)
• diuretics (drugs that promote the formation and secretion of urine)
• iron or calcium supplements
• narcotics (potentially addictive drugs that relieve pain and cause mood changes)
• tricyclic antidepressants (medications prescribed to treat chronic pain, depression, headaches, and other illnesses)

An adult who is constipated may feel bloated, have a headache, swollen abdomen, or pass rock-like feces; or strain, bleed, or feel pain during bowel movements. A constipated baby may strain, cry, draw the legs toward the abdomen, or arch the back when having a bowel movement.

Diagnosis

Everyone becomes constipated once in a while, but a doctor should be notified if significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber and fluid intake.

The patient's observations and medical history help a primary care physician diagnose constipation. The doctor uses his fingers to see if there is a hardened mass in the abdomen, and may perform a rectal examination. Other diagnostic procedures include a barium enema, which reveals blockage inside the intestine; laboratory analysis of blood and stool samples for internal bleeding or other symptoms of systemic disease; and a sigmoidoscopy (examination of the sigmoid area of the colon with a flexible tube equipped with a magnifying lens).

Physical and psychological assessments and a detailed history of bowel habits are especially important when an elderly person complains of constipation.

Treatment

If changes in diet and activity fail to relieve occasional constipation, an over-the-counter laxative may be used for a few days. Preparations that soften stools or add bulk (bran, psyllium) work more slowly but are safer than Epsom salts and other harsh laxatives or herbal laxatives containing senna (Cassia senna) or buckthorn (Rhamnus purshianna), which can harm the nerves and lining of the colon.

A woman who is pregnant should never use a laxative. Neither should anyone who is experiencing abdominal pain, nausea, or vomiting.

A warm-water or mineral oil enema can relieve constipation, and a non-digestible sugar (lactulose) or special electrolyte solution is recommended for adults and older children with stubborn symptoms.

If a patient has an impacted bowel, the doctor inserts a gloved finger into the rectum and gently dislodges the hardened feces.

Alternative treatment

Initially, alternative practitioners will suggest that the patient drink an adequate amount of water each day (six to eight glasses), exercise on a regular basis, and eat a diet high in soluble and insoluble fibers. Soluble fibers include pectin, flax, and gums; insoluble fibers include psyllium and brans from grains like wheat and oats. Fresh fruits and vegetables contain both soluble and insoluble fibers. Castor oil, applied topically to the abdomen and covered by a heat source (a heating pad or hot water bottle), can help relieve constipation when used nightly for 20–30 minutes.

Acupressure

This needleless form of acupuncture is said to relax the abdomen, ease discomfort, and stimulate regular bowel movements when diet and exercise fail to do so. After lying down, the patient closes his eyes and takes a deep breath. For two minutes, he applies gentle fingertip pressure to a point about two and one-half inches below the navel.

Accupressure can also be applied to the outer edges of one elbow crease and maintained for 30 seconds before pressing the crease of the other elbow. This should be done three times a day to relieve constipation.

Aromatherapy

Six drops of rosemary (Rosmarinus officinalis) and six drops of thyme (Thymus spp.) diluted by 1 oz of almond oil, olive oil, or another carrier oil can relieve constipation when used to massage the abdomen.

Herbal therapy

A variety of herbal therapies can be useful in the treatment of constipation. Several herbs, including chamomile (Matricaria recutita), dandelion (Taraxacum mongolicum), and burdock (Arctium lappa), act as bitters, stimulating the movement of the digestive and excretory systems. There are also "laxative" herbs that assist with bowel movement. Two of these are senna (Cassia senna) and buckthorn (Rhamnus purshiana). These "laxative" herbs are stronger acting on elimination than bitters and can sometimes cause cramping (mixing them with a calming herb like fennel or caraway can help reduce cramping). Both senna and buckthorn are powerful herbs that are best used with direction from an experienced practitioner, since they can have adverse side effects and the patient may become dependent on them.

Homeopathy

Homeopathy also can offer assistance with constipation. There are acute remedies for constipation that can

Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. (Illustration by Electronic Illustrators Group).

be found in one of the many home remedy books on homeopathic medicine. A constitutional prescription also can help rebalance someone who is struggling with constipation.

Massage

Massaging the leg from knee to hip in the morning, at night, and before trying to move the bowels is said to relieve constipation. There is also a specific Swedish massage technique that can help relieve constipation.

Yoga

The knee-chest position, said to relieve gas and stimulate abdominal organs, involves:

• standing straight with arms at the sides
• lifting the right knee toward the chest
• grasping the right ankle with the left hand
• pulling the leg as close to the chest as possible
• holding the position for about eight seconds
• repeating these steps with the left leg

The cobra position, which can be repeated as many as four time a day, involves:

• lying on the stomach with legs together
• placing the palms just below the shoulders, holding elbows close to the body
• inhaling, then lifting the head (face forward) and chest off the floor
• keeping the navel in contact with the floor
• looking as far upward as possible
• holding this position for three to six seconds
• exhaling and lowering the chest

Prognosis

Changes in diet and exercise usually eliminate the problem.

Prevention

Most Americans consume between 11–18 g of fiber a day. Consumption of 30 grams of fiber and between six and eight glasses of water each day can generally prevent constipation.

Thirty-five grams of fiber a day (an amount equal to five servings of fruits and vegetables, and a large bowl of high-fiber cereal) can relieve constipation.

Daily use of 500 mg vitamin C and 400 mg magnesium can prevent constipation. If symptoms do occur, each dosage can be increased by 100 mg a day, up to a maximum of 5,000 mg vitamin C and 1,000 mg magnesium. Use of preventive doses should be resumed after relief occurs, and vitamin C should be decreased to the pre-diarrhea dosage if the patient develops diarrhea.

Sitting on the toilet for 10 minutes at the same time every day, preferably after a meal, can induce regular bowel movements. This may not become effective for a few months, and it is important to defecate whenever necessary.

Fiber supplements containing psyllium (Plantago psyllium) usually become effective within about 48 hours and can be used every day without causing dependency. Powdered flaxseed (Linium usitatissimum) works the same way. Insoluble fiber, like wheat or oat bran, is as effective as psyllium but may give the patient gas at first.