constipation

Tips to get Constipation Relief


Know what is constipation / Definition of constipation / Causes for constipation / Foods for constipation / Tips for constipation relief / Home remedies for constipation relief / Diagnosis of constipation / Treatment of constipation .

WHAT IS CONSTIPATION ?

Many people wrongly assume that they are constipated because they don’t have a daily bowel movement. In fact, it’s perfectly normal for bowels to move as often as three times a week. Here know what is constipation , definition , symptoms , home remedies , diagnosis and tips for constipation relief and treatment of constipation

CONSTIPATION DEFINITION AND SYMPTOMS :

 The diagnosis should be based upon the presence of the following for at least three months .

1. Must include two or more of the following:

Straining during more than 25 percent of defecations

Lumpy or hard stools in more than 25 percent of defecations

Sensation of incomplete evacuation for more than 25 percent of defecations

Sensation of anorectal obstruction/blockage for more than 25 percent of defecations

Manual maneuvers to facilitate more than 25 percent of defecations (eg, digital evacuation, support of the pelvic floor)

●Fewer than three spontaneous bowel movements per week

(2) Loose stools are rarely present without the use of laxatives

(3) There are insufficient criteria for Irritable bowel syndrome

In other words ,Constipation is a common problem that makes it hard to have bowel movements. Your bowel movements might be:

●Too hard

●Too small

●Hard to get out

●Happening fewer than 3 times a week

CONSTIPATION CAUSES : WHO ARE AFFECTED ?

• people who do not eat enough fiber
• People with diseases such as diabetes, thyroid disease, or Parkinson’s disease
• whoever on medications such as pain relievers (Opiods ), antidepressants etc.
• some people with serious medical conditions such as colorectal cancer or autoimmune diseases

LIST OF CAUSES OF CONSTIPATION:

GENERAL CAUSES :

  • POOR DIET
  • INADEQUATE FLUID INTAKE OR DEHYDRATION
  • IMMOBILITY OR LACK OF EXERCISE
  • IRRITABLE BOWEL SYDNROME
  • OLD AGE
  • POST OPERATIVE PAIN
  • HOSPITAL ENVIRONMENT ( LACK OF PRIVACY , HAVING TO USE BED PAN)
  • DISTANT OR UNSATISFACTORY TOILETS

INTESTINAL OBSTRUCTION :

  • COLORECTAL CARCINOMA
  • STRICTURES ( CROHN’S DISEASE )
  • PELVIC MASS ( FETUS / FIBROIDS )
  • DIVERTICULOSIS ( RECTAL BLEEDING IS COMMON PRESENTATION )
  • CONGENITAL ABNORMALITIES
  • INTESTINAL PSEUDOOBSTRUCTION ( TOXIC MEGACOLON )

ANORECTAL DISEASES :

  • ANAL FISSURE
  • ANAL STRICTURE
  • RECTAL PROLAPSE

METABOLIC / ENDOCRINE :

  • HYPOTHYROIDISM
  • HYPERCALCEMIA ( INCREASED CALCIUM )
  • HYPOKALEMIA ( DECREASED POTASSIUM )
  • PORPHYRIA
  • LEAD POISONING

DRUGS / MEDICATIONS :

Analgesics
Anticholinergics
Antihistamines
Antispasmodics
Antidepressants
Antipsychotics
Cation-containing agents
Iron supplements
Aluminum (antacids, sucralfate)
Barium
Neurally active agents
Opiates
Antihypertensives
Ganglionic blockers
Vinca alkaloids
Calcium channel blockers
5HT3 antagonists
COMMON DRUGS CAUSING CONSTIPATION

NEUROMUSULAR CAUSES :

  • SPINAL OR PELVIC NERVE INJURY
  • AGANGLIONOSIS ( CHAGAS DISEASE , HIRSCHSPRUNG’S DISEASE )
  • SYSTEMIC SCLEROSIS
  • DIABETIC NEUROPATHY

OTHER CAUSES OF CONSTIPATION :

CHRONIC LAXATIVE ABUSE

IDIOPATHIC SLOW TRANSIT

IDIOPATHIC MEGARECTUM / COLON

PSYCHOLOGICAL ( ASSOCIATED WITH DEPRESSION OR CHILD ABUSE )

DIAGNOSTIC TESTS :

Most constipation do not need investigation , especially young ,mildly affected patients

WHEN TESTS ARE NEEDED ? :

  • Age > 40 years
  • recent change of bowel habit
  • associated symptoms like weight loss , rectal bleeding , mucous discharge , tenesmus ( feeling of incomplete bowel evacuation )

Complete blood cell count, serum glucose, creatinine, calcium, and thyroid-stimulating hormone should be performed in patients with hematochezia ( fresh blood in stool ), weight loss of ≥10 pounds, a family history of colon cancer or inflammatory bowel disease, anemia, or positive fecal occult blood tests, as well as a person with short-term history of constipation.

Endoscopy — Flexible sigmoidoscopy and colonoscopy can identify lesions that narrow or occlude the bowel; they also permit biopsy specimens to be obtained and polypectomy to be performed

Radiography — Plain films of the abdomen can detect significant stool retention in the colon and suggest the diagnosis of megacolon. They also are used to monitor bowel cleansing in patients with fecal retention.

Barium radiographs will show the aganglionic distal bowel with proximal dilatation of the colon in classic Hirschsprung disease, and should be obtained when this disorder is suspected because of constipation beginning shortly after birth and persisting, especially in males

Colonic transit studies , anorectal manometry , balloon expulsion tests are rarely necessary.

TIPS FOR CONSTIPATION RELIEF :

Don’t delay trips to the bathroom. Poor bowel movement habits, such as putting off going to the toilet despite an urge to go, can cause constipation.

Exercise :Regular physical activity helps stimulate bowel movements; inactivity can cause constipation.

exercise

Increase intake of dietary fiber :The insoluble type of fiber that absorbs water but otherwise passes through the bowel intact is instrumental in preventing constipation. Doctors recommend a fiber intake of 25 to 38 g daily. Note that any increase in high-fiber food consumption should be gradual and accompanied by more fluids. A high-fiber foods include wheat bran, bran cereals, whole grain products, legumes, fruits and vegetables.

foods for constipation relief with high fiber content
Foods with a lot of fiber include prunes, apples, oranges, bananas, peas, green beans, kidney beans, cooked oatmeal, almonds, peanuts, and whole-wheat bread.

Here is a list of foods with high fiber content https://www.healthline.com/nutrition/22-high-fiber-foods


food for constipation relief with high fiber content
COMMON FOOD SOURCES WITH AMOUNT OF FIBER CONTENT

Drink plenty of water.:Adults should drink at least eight glasses of nonalcoholic fluids every day. When a low-fiber diet coincides with a low-fluid intake, the stool becomes dry and hard, and increasingly difficult to move through the intestines.

water intake

Maintain a proper posture while defecating : When experiencing difficulty in passing stool , place a height of 6 inches under feet while sitting on a toilet seat so that hips are in flexed posture.

posture on  toilet seat for constipation relief


Avoid alcohol : Alcohol causes dehydration and prevents the body from properly absorbing nutrients.

avoid alcohol

Use laxatives sparingly :Excessive laxative use reduces normal colon function. If a laxative is needed, one made of psyllium or another high-fiber stool softener is best

ALSO READ : https://www.thedoctips.com/do-you-feel-heartburn-or-acid-reflux-know-about-gastroesophageal-reflux-disease/

HOME REMEDIES FOR CONSTIPATION RELIEF

SESAME SEEDS :

Sesame seeds make great home remedies for constipation.

The oily composition of sesame seeds works to moisturize the intestines, which can help if dry stools are a problem and provide constipation relief. Add the seeds to cereals or salads for crunch, or pulverize them in a coffee grinder and sprinkle on food like a seasoning.

Asian Spices Natural Sesame Seeds, for constipation relief

 BLACKSTRAP MOLLASES :

A teaspoon before bed should provide constipation relief by morning

Blackstrap molasses is boiled and concentrated three times, so it has significant vitamins and minerals; magnesium, in particular, will help you achieve constipation relief.

Blackstrap Molasses

MINT AND GINGER :

Mint and ginger are both proven home remedies for constipation among other digestive problems. Peppermint contains menthol, which has an antispasmodic effect that relaxes the muscles of the digestive tract.

Ginger is a “warming” herb that causes the inside of the body to generate more heat; according to herbalists , this can help speed up sluggish digestion.

In tea, the hot water will also stimulate digestion and provide constipation relief. Dandelion tea is also a gentle laxative and detoxifier.

GINGER with mint leaves  for constipation relief

OLIVE OIL , NUTS AND AVOCADOS :

Olive oil, nuts, and avocados all contain healthy fats, which can help lubricate your intestines and ease constipation. A salad with fibre-rich leafy greens and a simple olive oil dressing, a small handful of nuts, or a tablespoon of natural nut butter on fruit or toast are good options

How avocados and nuts could boost intelligence and for constipation relief

RAISINS :

 Raisins contain tartaric acid, which has laxative effect. Cherries and apricots are also rich in fibre and can help kick your constipation. Eat these fruits with a bowl of yogurt for the added benefits of gut-soothing probiotics.

Apricot and cherries for constipation relief

PRUNES :

These fibre-rich fruits are a go-to home remedy for getting your digestion back on track. Three prunes have three grams of fibre, and they also contain a phenolic compound that triggers the intestinal contraction that makes you want to go.

Another great dried fruit choice is figs, which may not cause as much bloating as prunes.

figs and prunes for constipation relief

CASTOR OIL :

This home remedy for constipation has been seen for generations. Take one to two teaspoons on an empty stomach and you should see results in about eight hours.

Castor Oil for constipation relief

Drink hot liquids :Hot liquids help stimulate the bowels. Drink a cup of herbal tea or a glass of hot water with lemon, or coffee in the morning.

hot cup of tea with lemon

TREATMENT OF CONSTIPATION / MEDICATIONS :

Often reassurance, drinking more water, and diet/exercise advice is
all that is needed. Treat causes as listed above in causes of constipation.

A high fibre diet is often advised, but may cause bloating without helping constipation.

Only use drugs if these measures fail, and try to use them for short periods only.

Often, a stimulant such as senna ± a bulking agent is more effective and cheaper than agents such as lactulose.

BULKING AGENTS:

Mechanism of action : increases Faecal mass, so stimulating peristalsis.
They must be taken with plenty of fluid and may take a few days to act.

Not to use when : difficulty in swallowing; Gastrointestinal obstruction; colonic atony; faecal impaction.

Bran powder : 3.5g 2–3 times/day with food (may hinder absorption of dietary trace elements if taken with every meal).

Ispaghula / psyllium husk : eg 1 Fybogel® sachet after a meal, mixed in water and swallowed promptly (or else it becomes an unpleasant sludge).

psyllium husk for constipation relief

Methylcellulose :eg Celevac® 3–6 tablets/12h with ≥300mL water.

Sterculia:eg Normacol® granules, 10mL sprinkled on food daily

STIMULANT LAXATIVES

MECHANISM OF ACTION :
Increase intestinal motility, so do not use in intestinal obstruction or acute colitis.
Avoid prolonged use as it may cause colonic atony. Abdominal cramps are an important Side effects.

Pure stimulant laxatives are bisacodyl tablets (5–10mg at night) or
suppositories (10mg in the mornings) and senna (2–4 tablets at night).

Docusate sodium and dantron16 have stimulant and softening actions.

Glycerol suppositories act as a rectal stimulant.

Sodium picosulfate (5–10mg at night) is a potent stimulant.

STOOL SOFTENERS

Particularly useful when managing painful anal conditions,
eg : anal fissure.

Arachis oil enemas lubricate and soften impacted faeces.

Liquid paraffin should not be used for a prolonged period (Side effects: anal seepage, lipoid pneumonia, malabsorption of fat-soluble vitamins).

OSMOTIC LAXATIVES

MECHANISM OF ACTION : Retain fluid in the bowel.

Lactulose, a semisynthetic disaccharide, produces osmotic diarrhoea
of low faecal pH that discourages growth of ammonia-producing organisms.

It is useful in hepatic encephalopathy (initial dose: 30–50mL/12h).

SIDE EFFECTS : bloating, so its role in treating constipation is limited.

Macrogol (eg Movicol®) is another example.

Magnesium salts (eg magnesium hydroxide; magnesium sulfate) are useful when rapid bowel evacuation is required.

Sodium salts (eg Microlette® and Micralax® enemas) should be avoided as they may cause sodium and water retention.

Phosphate enemas are useful for rapid bowel evacuation prior to procedures.

OTHER MEDICATIONS :

If these don’t help Prucalopride is an elective 5HT4 agonist with prokinetic properties
Lubiprostone is a chloride-channel activator that increases intestinal fluid
secretion

Linaclotide is a guanylate cyclase-C agonist that also increases fluid secretion and decreases visceral pain.

BEHAVIOURAL TREATMENTS :

Behavioral therapy including biofeedback therapy (teaching the patient to
normalize pelvic floor function while watching real time feedback about
sphincter function) is an effective treatment for patients with slow transit
constipation or impaired evacuation where traditional treatments have
failed (about 2/3 of patients benefit).

WHAT ARE INCLUDED IN BEHAVIOURAL TREATMENTS ?

Behavioral treatments include exercises focused on the gut, psychological support, lifestyle/dietary factors, and help in stopping laxatives and have been shown to improve symptoms, colonic transit, and psychological well-being and reduce the need for laxatives.

A multidisciplinary approach with behaviour therapy, habit training ± sphincter biofeedback may help.

WHEN SURGERY MAY BE NEEDED :

Agreed indications
Hirschsprung’s disease .
Rectocele : About 50% of patients get improvement after repair.
Rectal intussusception and prolapse. Surgery is not always curative.
intussusception is common in non-constipated people, and its presence
in constipated patients is not proof of causation

CONCLUSION :

Constipation is a common problem that makes it hard to have bowel movements. Your bowel movements might be: Too hard , Too small ,Hard to get out ,Happening fewer than 3 times a week

WHO ARE AFFECTED ?

  • People who do not eat enough fiber
  • People with diseases such as diabetes, thyroid disease, or Parkinson’s disease
  • People on medications such as pain relievers (Opiods ), antidepressants etc.
  • People with serious medical conditions such as colorectal cancer or autoimmune diseases

DIAGNOSIS : Most constipation do not need investigation , especially young ,mildly affected patients

WHEN TESTS ARE NEEDED ? :

  • Age > 40 years
  • recent change of bowel habit
  • associated symptoms like weight loss , rectal bleeding , mucous discharge , tenesmus ( feeling of incomplete bowel evacuation )

TIPS FOR CONSTIPATION RELIEF

  • Dont delay trips to bathroom
  • Exercise
  • Drink hot liquids
  • High fiber diet
  • Increase fluid intake
  • Maintain a proper posture while defecating : hips in flexed position while sitting on a toilet seat by placing 6 inches height under feet.
  • Avoid Alcohol
  • Use laxatives sparingly

TREATMENT OF CONSTIPATION :

Often reassurance, drinking more water, and diet/exercise advice is
all that is needed.

Treat causes as listed above in causes of constipation.

A high fibre diet is often advised, but may cause bloating without helping constipation.

Only use drugs if these measures fail, and try to use them for short periods only.

Often, a stimulant such as senna ± a bulking agent is more effective and cheaper than agents such as lactulose.


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