Problems of Constipation

Constipation is a common problem in clinical practice. Because of the wide range of normal bowel habits, constipation is difficult to define precisely. Constipation refers to persistent, difficult, infrequent, or seemingly incomplete defecation. It is a common problem in clinical practice.

Most persons have at least three bowel movements per week in western countries due to less fiber in the diet. In developing countries the frequency of stool is much more than western countries due to high fiber in their diet. But low stool frequency alone is not the sole criterion for the diagnosis of constipation.

Many constipated patients have a normal frequency of defecation but they complain of hard stools, excessive straining, lower abdominal fullness and a sense of incomplete evacuation of bowel. Every individual patient’s symptoms must be investigated in detail and ascertain what is meant by “constipation” or “difficulty” with defecation.

The consistency and form of stool depends on frequency of bowel habit, the longer the stool stay inside the harder it becomes. Hard, pellety stools occur with longer bowel transit and soft, loose and watery stool occur in shorter transit time. If stool is hard and large in quantity it is difficult to expel. Cultural and psychological factors are also being important. In some cultures great importance is given to daily defecation and will become greatly concerned when he or she misses a daily bowel movement.

Causes of constipation:

Chronic constipation usually results from insufficient fiber or fluid intake or from disordered colonic transit or anorectal function. Certain drugs, advancing age, or in association with a large number of systemic diseases that affect the gastrointestinal tract may cause constipation. Constipation of recent onset may be tumor or stricture. The following are the causes of constipation in adults:

Constipation of recent onset:

Colonic obstruction due to stricture, tumor, or ischemia (death of tissue due to lack of blood supply) can cause constipation.

Anal sphincter spasm as seen in piles or anal fissure can cause constipation.

Many types of drugs (medicines) can cause constipation.

Chronic constipation:

Disorders of rectal evacuation like rectal prolapse, or rectocele can cause chronic constipation.

Irritable bowel syndrome can cause chronic constipation.

Psychiatric disorders like eating disorder, drugs and depression can cause chronic constipation.

Many types of drugs like anti depressants can cause chronic constipation.

Generalized muscle disease like systemic sclerosis can cause chronic constipation.

Finally idiopathic (unknown) cause of constipation, which is by far the commonest type of constipation.

The last type mentioned above that is the idiopathic constipation is the most commonly encountered in clinical practice. The cause is not known, and it has to be managed symptomatically. Psychogenic form of constipation is also very common. This type is to some extent self induced, without knowing that the person is going to have problems. Some people can not evacuate the bowel unless they get to smoke (cigarette) and some people without sitting in toilet with a news paper. These are only few of the examples of psychogenic constipation, there are many more examples.