Constipation is a common disease of the modern age. In fact, it is possible to say that it is not a disease but a condition. It can be seen as a symptom of some diseases or it can be seen alone and without any other disease.
Constipation, medically known as constipation, is a common disease of the modern age. In fact, it is possible to say that it is not a disease but a condition. It can be seen as a symptom of some diseases, or it can be seen alone and without another disease. It is a common problem and people do not consult many physicians just for constipation.
What is Constipation Problem? Causes Constipation?
The definition of constipation is not easy. Since defecation is a topic that is not talked about in daily life, people may not clearly evaluate whether they have constipation.
Number of defecations: Every person has his own order. For example, the interval between defecations every three days and three times a day is considered normal. However, the important condition for being able to say normal is that this order is continuous. For example, if a person who has defecated twice a day for years suddenly starts to defecate once in two days, even though the frequency of defecation is in the normal range, it can be considered as an indicator of an important problem. In order to talk about constipation, the normal defecation frequency of the person should be known and evaluation should be done accordingly.
Stool consistency: Unfortunately, people have very inaccurate information about defecation. Unfortunately, the concept of "dirty stool" placed subconsciously in childhood is seriously abused in the market. In this way, the idea that the stool should be soft and even liquid if possible and that the person should be “cleaned inside” is placed in the heads.
However, the human organism is designed to make solid feces. In addition, it should never be forgotten that the stool described as "dirty" is a food source for our own cells in the inner surface of the large intestine. To sum up, we need to determine whether our patient, who says that he is constipated, is actually constipated.
What are the Symptoms of Constipation?
There are two main reasons for really constipated patients. One of them is that the stool consistency is extremely hard and the other is the difficulty in expelling the stool from the anus.
Most of the constipation due to the first cause are followed up and treated in the Gastroenterology department, while most of the second group require the intervention and treatment of Colorectal Surgery.
- Less than 3 defecations per week
- Hard or large pieces of defecation,
- The feeling that there is a blockage in the rectum that prevents bowel movements,
- Feeling like you have not fully emptied the rectum,
- Hand pressure on the abdomen or finger pouring stool from the rectum to empty the bowel.
What Causes Constipation?
In the absence of an underlying disease, constipation may occur as a dysfunction of the large intestine due to intense stress, excessive coffee and / or tea consumption.
In the patient with constipation;
- Presence of anal fissure (characterized by fine tears around the anus)
- Intestinal obstruction in prolonged (chronic) constipation,
- Colon cancer, especially in elderly patients and those with family history of colon cancer and / or colon polyps,
- Previous intra-abdominal surgeries or intestinal narrowing (stricture) of unknown cause,
- Other intraabdominal cancers that may put pressure on the colon,
- Rectal cancer,
- In a female patient, the insertion of the rectum into the vagina through the posterior vaginal wall (rectocele) should be investigated.
- Constipation can also be caused by diseases involving the nervous system.
- Parkinson's disease,
- Multiple sclerosis,
- Spine cuts due to injuries (partial or complete incisions),
- Disorders in the control of the autonomic nervous system,
- Stroke are some of these situations.
- Constipation can also be caused by problems with the muscles.
- Inability to relax the pelvic muscles that play a role in the harmonious progression of bowel movements (anismus)
- Again, disruption of the relaxation / contraction cycle of the pelvic muscles (dysynergy),
- Weakening of the pelvic muscles may also cause constipation in women who have had a large number of vaginal deliveries.
- Diabetes, underactive thyroid gland (hypothyroidism), overwork of parathyroid gland (hyperparathyroidism) and pregnancy are hormonal conditions that cause constipation.
What Are the Risk Factors for Constipation?
- Elderly people, Female patients,
- Those who have fluid loss,
- Those who are fed a low fiber diet,
- Those who have a sedentary (sedentary) lifestyle,
- People who use some drug groups that negatively affect bowel movements,
- Those with disorders such as an eating disorder or depression are prone to developing constipation.
What Are the Diagnostic Methods in Constipation?
- Diagnostic work begins with a physical examination in order to rule out problems that may cause constipation.
- Examination of the anal area,
- Finger anal examination to check the presence of hemorrhoids,
- Rectosigmoidoscopy to examine the last part of the large intestine before exit from the anus,
- Colonoscopy performed to observe the large intestine completely,
- Anorectal manometer assessment to determine the physiological condition of the anus sphincter in patients with stool incontinence, gas incontinence or defecation difficulties,
- In cases where an organic cause cannot be determined, advanced tests such as balloon expulsion test, transit time through the large intestine can be applied to evaluate the presence of complex pathology.
- Blood tests: It helps to understand whether constipation is due to underactive thyroid gland or overworking of parathyroid gland.
- Direct radiography: It helps to understand whether constipation is due to intestinal obstruction or not.
How to Relieve Constipation? What Is Good For Constipation?
Nutrition and active lifestyle have a great role in both prevention and correction of constipation. Here are some simple dietary suggestions for lifestyle changes.
Nutrition in constipation
- Avoiding constipating foods: Reduce the amount of low-fiber foods in your diet (such as packaged products).
- Avoid a fast-food diet with bananas, pasta, rice, excess milk and coffee, which are known to cause constipation.
- Since white bread causes constipation, whole grain bread should be preferred.
Consume more constipation-relieving foods:
- Eat high-fiber foods such as fresh fruits and vegetables. It is known that fresh fruits such as apples, pears and plums are good for constipation.
- Eating dried apricots, figs or plums on an empty stomach in the morning and drinking warm water will help start your bowel movements.
- Red meat is a source of protein that can cause constipation. It will be more suitable with chicken or fish as a protein source.
- Drinking 1 spoon of olive oil in the morning will support the passage of food through the intestines.
- Constipation does not improve as soon as you start consuming foods that are good for constipation. The incidence of constipation decreases after this type of diet is placed as a habit.
- It is recommended that your daily water consumption be at least 1,5 liters.
- Stay active as much as possible. Plan a regular exercise program.
- Gastrointestinal system is the system that can train most easily. Therefore, shift your defecation time to the most comfortable part of the day, preferably after a meal. For this, sit on the toilet for 10-15 minutes at the appropriate time of the day. In time, your digestive system will learn this time as the time of defecation. Newspaper etc. it is not recommended to stay longer by reading.
- Do not delay when there is a desire to defecate during the day.
- Learn and develop the healthy aspects of coping with daily stress (regular sports, yoga, meditation, outdoor walking, etc.)
Use of constipation medications: Over-the-counter constipation medications (laxatives or laxatives) are susceptible to abuse. People with chronic constipation want to get rid of constipation with a medication instead of natural ways and use laxatives without consulting a doctor. The solution is temporary as the underlying cause has not been determined and the constipation recurs. After a while, the drugs used are not as successful as before and the physician is referred with chronic constipation.
If laxatives are used for a long time and without a doctor's recommendation, the motility of the large intestine decreases. In addition, the balance of electrolytes (calcium, chlorine, magnesium, potassium, sodium) in the blood may be disturbed, causing dehydration, kidney damage, abnormal heart rhythm, weakness, sleepiness (confusion), stroke (paralysis), and even death. . It should be known that laxatives (constipation-relieving drugs) are not innocent drugs that can be used casually.
Constipation exercises: Abdominal muscles support stomach and bowel movements. For this reason, abdominal exercises performed 1 hour before or 1 hour after eating without straining the abdominal muscles help the intestines to work better. Bowel movements can be significantly increased by pulling the knees to the abdomen while standing or lying down, crouching and standing up.
In addition, by placing the inside of both hands on the abdomen in the toilet, moving the fingers with soft movements or rubbing with the palms in circular motions, the abdominal muscles can be worked on the abdominal skin and stimulate the bowel movements.
Laxative (laxative) treatment for constipation
Laxatives are divided into groups according to their mechanism of action. These:
- Laxatives (e.g. methylcellulose) that enrich the stool in fiber and increase the volume of the stool and facilitate its excretion.
- Laxatives that increase the contractile action of the guts,
- Osmotic laxatives that accelerate the passage of stool through the large intestine by increasing fluid secretion in the intestine,
- Lubricants (lubricants) (eg olive oil)
- Laxatives that help soften the stool by drawing fluid from the large intestine into the stool,
- Pressure enema using water
- Suppositories, for example containing glycerin, used to facilitate rectal discharge.
- Stronger drugs to aid defecation can be used in patients with chronic constipation and spastic colon (functional bowel disease-restless bowel syndrome).
- With the biofeedback method, training of the pelvic floor muscles required for more comfortable passage during defecation can be provided.
- Constipation situations without an underlying disease usually occur as stress-related dysfunction and acupuncture is very useful in treatment. Acupuncture; regulates the limbic system and regulates the functioning of the intestines.
- Surgery can be used as a last resort in some cases. For example, hot water sitz baths are used to relieve the sphincter and heal the tear in anal fissure patients who do not respond adequately or to correct the obstruction or stricture in the large intestine.
What Are the Harms of Constipation?
Chronic constipation: Stool that remains in the intestine for a long time expands in diameter. In addition, the constant contraction of the muscles around the anus during defecation and the inability to relax sufficiently may cause cracks around the anus (anal fissure) when attempting to expel the stool. This leads to painful stools. Patients try to delay defecation in order not to experience the same pain over time. This causes the vicious cycle of constipation to continue increasingly (chronic constipation).
Another common condition in chronic constipation is stool hardening, which is popularly known as "stoneification of the stool inside". In chronic constipation, the large intestine loses its movement (peristalsis) that moves the stool forward, causing the stool to stay in its place and lose its fluid volume over time and reach a more solid consistency. Some patients cannot excrete this stool and need medical attention.
Bleeding in constipation: In the veins under the breech mucosa, bulging outward, ie hemorrhoids, may develop due to frequent straining. Bright red bleeding can be seen outside the anus from time to time.
Does constipation make you nauseous? In constipation, intra-abdominal pressure increases and may cause compression of the abdominal organs, discomfort, pain and nausea in the stomach.