Common causes of constipation

Constipation means different things to different people. For many people, it simply means passing stool infrequently. For others, constipation means hard stools, difficulty passing stool through the rectum, or a feeling of incomplete emptying after a bowel movement. The causes of each of these types of constipation are different, and the treatment approach must be tailored to each specific type of constipation.

Features of constipation

Constipation may alternate with diarrhea. This pattern of body behavior usually bothers a person as part of irritable bowel syndrome (IBS). The end result is fecal impaction, a condition in which stool hardens in the rectum and does not pass out through the anus.

The number of bowel movements usually decreases with age. Ninety-five percent of adults have between three and 21 bowel movements per week, and this would be considered normal. The most common pattern is one bowel movement per day, but this occurs in less than 50% of people. In addition, most bowel movements are irregular and do not occur every day.

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Defecation and toxins

In medical terms, constipation is generally defined as having fewer than three bowel movements per week. Severe constipation is defined as having fewer than one bowel movement per week. There is no medical reason to have a bowel movement every day. Not being able to have a bowel movement for two or three days does not cause physical discomfort, but only mental anguish for some people.

Contrary to popular belief, there is no evidence that "toxins" that accumulate during bowel movements are a rare occurrence and lead to constipation and cancer.

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Constipation and a visit to the doctor

It is important to differentiate between acute constipation (a consequence of a disease) and chronic constipation (long-term). Acute constipation requires urgent medical examination and may be caused by some serious disease (for example, a colon tumor). Constipation also requires an immediate visit to the doctor if it is accompanied by unpleasant symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and forced weight loss.

Unlike intermittent and acute constipation, chronic constipation may not require urgent medical attention, especially if simple treatment measures (enema, laxative) can bring relief.

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Three Most Common Underlying Causes of Constipation

1. Too much water is absorbed from the stool as it passes through the rectum, resulting in hard, dry stools.
2. There are changes in the ability to coordinate the contractions of the rectal muscles needed to move stool out of the rectum and anus, and then the stool gets stuck in the anus
3. In the intestines, something, such as a tumor, is blocking the passage of stool.

There are various reasons why one of these three things might happen and lead to constipation. Common causes of temporary constipation – something that many people experience from time to time – include:

• There is not enough fiber in the menu
• Not enough drinking water and other fluids
• Lack of exercise
• The patient does not pay attention to the urge to defecate until a more appropriate time
• Frequent use of laxatives and then sudden cessation
• Use of certain medications, particularly some chemotherapy drugs and those used to treat pain (opiates), nausea and depression

Constipation as a Symptom of Cancer

When stool comes out of the colon, it is a thick liquid that may be partially blocked but gets stuck in narrow areas. As stool passes through the rectum and more water is removed, the stool becomes thicker. This limits its ability to go around all the bends of the rectum and especially in narrow areas. A tumor in the middle and lower part of the colon or at the beginning of the rectum can make it difficult to pass stool and lead to constipation.

If you suffer from chronic or recurring constipation, the sooner you see a doctor for diagnosis, the better. Patients with colon cancer should be diagnosed by a doctor first. Research shows that if cancer is diagnosed in the early stages, the survival rate of patients is over 90%. If the cancer is diagnosed late and has spread beyond the colon, the survival rate drops sharply.

If you notice changes in your bowel habits, see your doctor as soon as possible. In many cases, you'll find that you don't have colon cancer and that something less serious is causing your constipation. But it's better to err on the side of less than more.

Constipation occurs when the colon absorbs too much water, or when the muscle contractions in the rectum are too slow and sluggish, causing stool to move too slowly. As a result, stool can become too dry and hard.

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Common causes of chronic constipation include:

• Lack of fiber in the diet; lack of physical activity (especially in old age)
• Taking medications, especially for multiple sclerosis and antidepressants
• Milk in large quantities
• Irritable bowel syndrome
• Life changes such as pregnancy, old age and travel to a country with a different climate
• Abuse of laxatives
• When a person does not pay attention to the need for defecation
• Dehydration
• Specific diseases or conditions, such as stroke (the most common cause of constipation)
• Problems with the colon and rectum
• Problems with bowel function (chronic idiopathic constipation)

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What medications can cause constipation?

Some medications can cause constipation, including

• painkillers (especially narcotics)
• antacids containing aluminum and calcium
• blood pressure medications (calcium channel blockers)
• antidepressants
• iron supplements
• diuretics
• anticonvulsants
• sleeping pills

Let us decipher in more detail the main causes of constipation.

Lifestyle changes that cause constipation

During pregnancy, a woman may experience constipation due to hormonal changes or because the uterus compresses the intestines. Aging can also affect bowel patterns because a slower metabolism results in poorer bowel function and less active muscle tone. Additionally, people often experience constipation when they travel because their normal diet and routine are disrupted.

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Abuse of laxatives

The common belief that people should have a daily bowel movement has led to the abuse of medications with laxative functions. Although people may feel relief when using laxatives, they usually have to increase the amount of time they spend on the toilet. As a result, laxatives may not be needed when the bowels themselves are doing their job.

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Ignoring the urge to have a bowel movement

People who ignore the urge to have a bowel movement may end up making their condition worse, which can lead to constipation. Some people delay having a bowel movement because they don’t want to use the toilet outside the home. Others ignore the urge to expel feces from their bowels because of emotional stress or because they are too busy. Children may delay having a bowel movement because of stressful toilet training or because they don’t want to interrupt play.

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Specific diseases as a cause of constipation

Conditions that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic diseases that affect organs. These disorders can slow the movement of stool through the rectum or anus.

Conditions that can cause constipation are listed below.

Neurological disorders

• multiple sclerosis
• Parkinson's disease
• chronic idiopathic bowel deformation (pseudo-obstruction to feces)
• stroke
• spinal cord injury

Metabolic and endocrine diseases

• diabetes
• uremia
• hypercalcemia
• low glycemic control
• hypothyroidism

Systemic disorders of the body

• amyloidosis
• lupus
• scleroderma

Problems with the colon and rectum

Intestinal obstruction, scar tissue also called adhesions (diverticulosis), tumors, rectal cancer, abnormal contractions of the intestines and rectum can cause constipation.

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Problems with bowel function

Constipation is of two types: idiopathic constipation and functional constipation. Irritable bowel syndrome (IBS), with predominant symptoms of constipation, is singled out separately.

Idiopathic constipation is constipation of unknown origin - it does not respond to standard treatment.

Functional constipation means that the intestines are healthy but do not work properly. Functional constipation is often the result of poor diet and lifestyle. It occurs in both children and adults, and is most common in women.

Problems with the rectum and colon, with delayed transit of feces, dysfunctions of the pelvic floor are related to the type of functional constipation. They lead to weakening of the muscular activity of the rectum. These syndromes can affect the condition of the entire colon, or can relate to the lower, or sigmoid colon, colon.

Pelvic floor dysfunction is caused by weakness of the muscles in the pelvic area around the anus and rectum. However, since this group of muscles is voluntarily controlled to some extent, biofeedback can be successful in retraining the muscles to function normally and improving the ability to have a bowel movement.

Functional constipation is caused by problems in the structure of the anus and rectum and is known as anorectal dysfunction, or anismus. These disorders result in the inability of the rectum and anal muscles to relax, which allows stool to pass normally.

Can constipation lead to complications?

Sometimes constipation can actually lead to complications. These complications include hemorrhoids, caused by straining the rectal muscles to pass stool, or anal fissures. These occur in the skin around the anus when hard stool stretches the anal sphincter muscles. As a result, rectal bleeding can occur, visible as bright red streaks on the surface of the stool.

Treatment for hemorrhoids may include sitting in a warm bath, ice packs on the anal area, and applying a special cream to the affected area. Treatment for anal fissures may include stretching the sphincter muscles or surgically removing tissue in the area where the hemorrhoids are occurring.

Sometimes straining the rectum causes part of it to fall out when stool is pushed out of the anus. This condition, known as rectal prolapse, can lead to mucus secretion from the anus.

Serious treatment is usually needed to eliminate the causes of prolapse, which occurs even when a person coughs. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscles or to stitch the prolapsed rectum back into place.

Constipation can also cause hard stools that clog the intestines and rectum so tightly that the normal pushing action of the colon is not enough to remove the feces. This condition, called fecal impaction, is most common in children and the elderly. The stool can be softened with mineral oil, which the patient takes either orally or through an enema.

Once the fecal impaction has been relieved, the doctor may break up and remove some of the feces by inserting one or two fingers into the patient's anus.

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