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What is constipation?

Chronic or occasional constipation

The constipation is a delay or difficulty in bowel movements. It can be occasional (travel, pregnancy, etc.) or chronic. We talk about chronic constipation when the problem lasts for at least 6 to 12 months, with more or less marked symptoms.

The frequency of stool evacuation varies from person to person, ranging from 3 times a day to 3 times a week. We can talk about constipation when the stools are hard, dry and difficult to evacuate. In general, this occurs if there are less than 3 stools a week .

 

Constipation can be either transit (or progression), that is stool stagnates too long in the colon, or terminal (or evacuation), that is to say they accumulate in the rectum. Both problems can coexist in the same person.

In North America, it is estimated that 12% to 19% of the population, both children and adults, suffer from chronic constipation.

Causes of constipation

The intestines that contract

During digestion, the intestines contract to advance food in the digestive tract. This phenomenon of contractions is called peristalsis. In case of constipation , peristalsis is slowed down and the stool stays too long in the colon. In the vast majority of cases, no organic cause is found and constipation is called “functional”.

Bad eating habits

Most of the time, functional constipation is caused by poor eating habits , physical inactivity, stress, anxiety or the presence of hemorrhoids or anal fissures that cause the person to refrain from having a bowel movement. .

Constipation can result from food allergies or intolerances, such as cow’s milk lactose  , a situation that is less rare than is believed in young chronically constipated children.

Remember to go to the toilet

Delaying bowel movements when the urge is felt is another common cause of constipation. The longer they stay in the colon, the more stools become hard as pebbles and difficult to evacuate. This is because the body, through the colon, reabsorbs a lot of water in the stool. Retaining their evacuation can also cause pain and anal fissures.

Contraction of the sphincter

In some people, at the time of defecation, the muscle of the anus (the anal sphincter) contracts instead of relaxing, which blocks the passage of stool. To explain this poor synchronization reflexes , assumptions often point to psychological factors. In many cases, however, there is no cause or trigger.

A consequence

The constipation may also result from a more complex disease or to accompany (irritable bowel syndrome, in particular). It can also be diverticulitis, an organic lesion of the colon (colorectal cancer, for example), an abnormality of the metabolism (hypercalcemia, hypokalemia), or an endocrine problem (hypothyroidism) or neurological (diabetic neuropathy , Parkinson’s disease, medullary disease).

Bowel obstruction

In rare instances, the constipation is caused by an occlusion (or obstruction) intestinal, corresponding to a total blocking of the intestinal transit. Constipation then occurs suddenly and is accompanied by vomiting . It requires an emergency consultation.

Many medications can also cause constipation , including paradoxically some laxatives when taken for long periods, anxiolytics, antidepressants, morphine, codeine and other opiates, some antispasmodics (anticholinergics), inflammatory drugs, muscle relaxants, some antihypertensives (especially calcium channel blockers such as diltiazem), diuretics, antacids containing aluminum, etc. Some iron supplements can also cause constipation, but they do not all produce this effect.

Finally, in rare cases, in children , constipation may be a sign of Hirschsprung’s disease, a disease present from birth related to the absence of certain nerve cells in the intestine.

When to consult?

The constipation , especially when it occurs suddenly, can be a sign of serious illness, such as colon cancer. We must not neglect this symptom. It is advisable to consult a doctor in the following cases.

  • Constipation recent or accompanied by blood in the stool.
  • Bloating, pain , or constipation alternating with diarrhea.
  • Weightloss.
  • Stools whose caliber decreases steadily, which may be a sign of a more serious bowel problem.
  • Constipation that lasts for more than 3 weeks.
  • Constipation that persists in the newborn or very young child (because it is necessary to eliminate a disease of Hirschsprung).

Possible complications

In general, constipation is benign and disappears of itself in a few days, thanks to an adapted diet . However, if it persists, some complications can sometimes occur:

  • hemorrhoids or anal fissures;
  • bowel obstruction;
  • faecal incontinence;
  • faecal impaction, that is, accumulation and compaction of dry stools in the rectum, which occurs mostly in the elderly or bedridden;
  • laxative abuse.

Symptoms of constipation

  • Constipation of transit  : hard and rare stools (less than 3 per week), but no difficulty of evacuation.
  • Terminal constipation  : an incomplete or difficult feeling of defecation, a sensation of rectal fullness, large or repeated pushing efforts.

Note. In both cases, constipation may be accompanied by bloating, abdominal pain and intestinal discomfort.

People at risk

  • The  women  are 3 times more likely to suffer from constipation than men 3 . This high prevalence is explained in part by hormonal causes. According to a hypothesis, the  progesterone , more abundant during the 2 the  half of the menstrual cycle and during pregnancy, make sluggish bowels.
  • The  children  are frequently constipated, with peak prevalence around the age of 4.
  • From the age of  65 , the risks increase significantly for both men and women.
  • People who have to  keep the bed  or have little physical activity are also prone to constipation (serious, convalescent, accident, elderly).

Risk factors

  • A diet low in  fiber  and  liquids .
  • The  sedentary lifestyle , physical inactivity.
  • Some  drugs .
  •  Systematically ignore your need to have a bowel movement because of emotional stress or a psychological disorder.
  • Hormonal changes   (pregnancy, menopause).
  • The frequency of constipation is two times higher among people with  low incomes , possibly due to poorer nutrition 9 .

 

Why prevent?
  • Simple measures can prevent constipation and avoid the discomfort it causes.
  • These measures also help prevent chronic constipation and can be followed at any time.

 

Basic preventive measures
Adopt a high fiber diet. Plant- based foods  – fruits, vegetables, and legumes, whole grains, nuts and seeds, seaweed – all contain dietary fiber, while those of animal origin do not. There are two types of fiber: insoluble fiber and soluble fiber. Generally, plants contain these two types of fiber, insoluble fibers being the most abundant. Some plants only contain soluble fiber in good quantity.

Cellulose, hemicellulose and lignin are insoluble fibers . They prevent constipation by absorbing a lot of water, which increases stool volume and stimulates bowel contractions.

Pectin, gum and mucilage are soluble fibers . Psyllium is one of the few plants to contain essentially soluble fiber. Oats and barley also contain them. This type of fiber helps prevent constipation by absorbing water and creating a gel. They also help control blood sugar and lower cholesterol levels.

Remember that according to Canada’s Food Guide , we should eat 6-8 servings of grain products per day, preferably whole grain or fortified.

To learn more about the best sources of dietary fiber, see our Nutrient Fiber Factsheet .

Drink enough. It is generally recommended to take 2 to 3 liters of fluid a day, much of which is provided by food. In general, it is suggested to drink 6 to 8 glasses of water daily between meals. Mineral waters rich in magnesium have a mild laxative effect and may be preferred in case of constipation.

Regular exercise. Walking, pedaling, being physically active influences the abdominal muscles and promotes intestinal transit. See our Physical Fitness file.

Answer the need to have a bowel movement as soon as it appears. After eating, the intestines enter a wave of contractions to evacuate the stool. It is a natural reflex that helps the exit of the saddles smoothly. By not listening to the urge to go to the saddle, the evacuation becomes more difficult.
Doctors recommend that constipated persons go to the toilet 2 times a day, about 30 minutes after meals and not push for more than 5 minutes (as this increases the risk of hemorrhoids) . This “ritual” promotes regular bowel movements, especially in children.

Do not ignore important emotional stress.

 

Medical treatments for constipation

Classical medicine does not consider that it is necessary for the health to evacuate the stool on a daily basis. The frequency of stool evacuation depends on each person, but it is usually called constipation if there are less than 3 stools a week and they are hard or difficult to evacuate.

The doctor will first determine if it is a secondary constipation (following another disease) or primary. In the first case, he will treat the cause or he will prescribe complementary examinations, like a colonoscopy . Treat your hemorrhoids if necessary. They are often cause of constipation. If your constipation is recent and you are taking a new medicine , talk to your doctor. Your medication may be the cause of your problem.

Then the doctor will determine if it is transit or terminal constipation.

Transit constipation

The doctor will first recommend changing the diet to increase fiber intake  : raw vegetables, cooked vegetables, legumes, fruits rich in pectin (apple, pear, peach, berries), but especially whole grains.

One can add wheat bran , rich in fiber, or other grains to muffin recipes, etc. To treat constipation , it is recommended to consume about 1/4 cup of wheat bran a day. Whole prunes and prune juice are also very effective in relieving constipation because they contain sorbitol, a natural laxative . A daily dose of 8 ounces is usually sufficient. However, it may take several weeks to feel the benefits of a fiber-enriched diet on transit.

In parallel, the doctor will also recommend drinking enough , while avoiding alcohol and caffeinated drinks, which dehydrate and can irritate the colon. However, if constipation is chronic and accompanied by intestinal irritation, avoid abrupt changes in diet.

If constipation persists, he will recommend a laxative . There are 6 categories:

  • The ballast laxative or weight is generally mucilages or prepared dietary fiber psyllium hydrophilic mucilloid of or methylcellulose. This type of laxative is the mildest for the intestines. By binding to the water, the fibers swell, which helps to form loose, bulky stools. Their volume triggers the peristalsis of the intestines, which advances the stool towards the rectum. It may take a few days before the laxative effect appears. It is recommended to drink the equivalent of 5 to 10 times the volume of the amount of laxative ingested. Metamucil, Prodiem and Kellogs Bran Buds are examples.
    Possible side effects:bloating, flatulence and cramps. Integrating them gradually into the diet limits these inconveniences.
  • The stool softeners , which soften the stool. For example, docusate sodium (Colace, Ex-Lax, Soflax).
    Possible side effects: diarrhea and mild stomach cramps.
  • The osmotic laxatives help retain more water in the intestine, thus softening the stool. They include salts (sodium sulfate, magnesium sulfate or Epsom salt), magnesium hydroxide (milk of magnesia), sugars not assimilated by the intestine (lactulose, mannose, mannitol, sorbitol, etc.). ) or glycerin (as a suppository). Polyethylene glycol laxatives (Miralax, Lax-A-Day) are osmotic laxatives available for adults who complain of occasional constipation.
    Possible side effect: diarrhea, flatulence, cramps, and dehydration in high doses.
  • The laxative lubricants , which lubricate the stool and facilitate their evacuation. It is most often mineral oil (paraffin oil or Vaseline). They can be used orally or rectally.
    Possible side effects: diarrhea and mild stomach cramps. Caution: Inflammation of the lungs can occur if the oil is accidentally sucked into the lungs.
  • The stimulant laxatives act directly on the intestinal mucosa and all peristalsis (bisacodyl, anthracene, emulsified castor oil). They decrease the reabsorption of water and electrolytes in the colon. Stimulant laxatives, which are very irritating to the lining of the colon, are used as a last resort. They are not recommended for chronic constipation . They should not be taken for more than 1 or 2 weeks without medical supervision.
    Possible side effects: abdominal cramps, diarrhea and burning sensation in the rectum.
    Caution.Overdose can cause lazy bowel syndrome by habituation, as well as lead to lower blood sodium and potassium levels, dehydration and possibly more serious disorders.
    Warning. They are contraindicated to pregnant women and those who are breastfeeding.

Some preparations are composed of drugs from 2 or 3 of these laxative groups.

  • Lubiprostone (Amitiza). This drug in a new class is indicated for the treatment of chronic constipation in adults when other treatments have failed. It works by increasing the secretion of water through the intestine.
    Possible side effects: nausea, diarrhea, abdominal pain and flatulence.

Terminal constipation

In case of terminal constipation, the doctor may recommend microlavements or suppositories to restore the evacuation reflex. In addition, biofeedback can be used to rehabilitate anorectal motility after an episode of chronic constipation, if necessary.

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