This article in the self learn series is for student nurses and members of the public. It is not to be used for medical diagnosis and/or treatment. However, it contains valuable information on how to prevent and manage constipation. The writer is a Lecturer in Health Sciences and a Registered Nurse.
What is constipation? Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.
Some people think they are constipated if they do not have a bowel movement every day. However, normal stool elimination may be three times a day or three times a week, depending on the person.
Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.
Normal Faecal Matter and Pattern!
Normal faecal pattern and consistency is the end result of a series of healthy behaviours and proper eating habits. Individuals who exercise daily are more likely to have normal stools. The reason for this is that movement of the body also moves the contents of the intestines. Many of you who are nurses will have noticed that patients who are confined to the bed are more likely to be constipated. So, if you want to have a regular bowel habit, start doing a certain amount of age appropriate activity. The intestines are from 30 to 40 feet long from the tip of our mouths to the anus. The fecal matter has to be squeezed through this lengthy tube which also has folds of different shapes and sizes. In addition to this there are small folds and fingerlike projections which effectively increase the distance the food has to travel and the resistance it has to overcome.
The high stress of society is also a cause of constipation. Many of you will wonder what I really mean. It would be most useful to be able to refer to one's self for this example. The urge to go to the toilet, is greatest after morning breakfast. However, if after breakfast we are in a hurry, we jump into the car and off we go to work. We deliberately suppress our desire to evacuate our bowels. I am sure you can recall the numerous occasions when you have continued to do what you were doing despite the fact that there was an urge to use the toilet. I have done this, on numerous times. Somehow the importance of getting to work earlier is always the driving force to put off going to toilet. At other times, the taught that is going on in my mind is, “I will go to toilet at work” but when I get there the work pressure takes over and I find that I have not gone to the toilet, all day.
Picture 1: Gross Anatomy of Human Intestinal tract.
(Our intestines are 30 to 40 feet long)
In an ideal situation, if habit is formed to go to the toilet each morning, then it will continue until one unlearns it. So, if you have a habit of going to toilet each morning do your best to maintain it.
I have mentioned that our intestines are 30 to 40 feet. If we drink plenty, then the semi digested food can be pushed along quite easily. The intestines have the ability to continuously squeeze food forward. When we drink large amounts of tea, coffee, and alcohol we are removing fluid from our body. All of these liquids are diuretics – i.e. they reduce the total amount of water available for the intestine to push the semi-digested food forward from the stomach into the duodenum, then to the small intestine, and then to the large intestine and finally to be stored in the rectum until expelled. Chronic dehydration can lead to chronic constipation.
Chronic constipation results in the stretching of the large bowel wall permanently. Once this wall becomes stretched, the muscle fibers within it are also stretched out of shape. This means that this muscle will no longer be able to function normally to squeeze and push the faecal mass along. This lack of muscle power results in further stretching as the bowel becomes even more filled with feces. Chronic constipation is very difficult to treat and often require medical intervention.
One other major cause of constipation is the excessive consumption of refined carbohydrates . In other words, we are not eating enough fruit vegetables and fiber. The fibers in fruit and vegetables distend the intestines. Distended intestines contract more vigorously and are able to move the food forward. One point to remember is the intestines will not work if there is no stimulus for them to work. The roughage (fiber) is actually the stimulus for the intestines to push the food forward. If we consume refined foods, drink plenty of coffee and alcohol then we are not giving our intestines either the stimulus or the physical capacity to push the fecal matter forward. A useful reminder, at this point is that the food has to be pushed forward, downward, upward and through all the narrow passages and bends. It is a tall order even in ideal conditions.
