Definition: Constipation is defined as the passage of small amounts of hard, dry faecal matter fewer than three times per week. Individuals who are constipated often experience pain when having a bowel motion. Other symptoms associated with constipation include feeling bloated, uncomfortable, and sluggish. Stool passed are usually hard, dry and small in size. The elimination process may be uncomfortable and require a lot of straining.
Introduction and background information: The general definition of constipation varies from person to person. Some people think that they are constipated if they do not have a bowel movement every day. Others think they are constipated if they do not have three bowel movements each day, one in the morning, one in the afternoon and one in the evening or in the night. However, most health care authorities agree that normal stool elimination may be three times a day or three times a week, depending on the individual.
Constipation is not a disease but may the symptom of an underlying disease or the consequence of an unhealthy life style. Even though it is not a disease it can cause discomfort and distress. Almost everyone has experienced constipation at some point in their life. It is usually associated with a low fibre diet but there are hundreds of other causes. Many people experience constipation as a temporary phenomenon which is usually not serious. Understanding the causes of constipation will help prevent this symptom, aid its treatment and facilitate its management.
Some people confuse constipation with irregular bowel movement. They assume that they are constipated when, in fact, their bowel movements are irregular. The reasons for the irregularity range from the consumption of an irritant foods or foods which are not well tolerated by their bodies. As stated before some people believe that they are constipated when they do not have a bowel movement every day, biologically this is not constipation. There is "no right number" of daily or weekly bowel movements.
Picture: Glass of Water. The simplest and most effective cure of constipation. Image by Sarjeet S. Gill.
The most frequent causes of constipation are a poor diet and lack of exercise. Constipation is temporary in nature and can, most of the time, be easily treated. It is more of an inconvenience than a disease. Greater comprehension and management of the underlying causes will help most people afflicted by this condition.
Underlying Causes of Constipation
Constipation is one of the most common gastrointestinal complaints in the United States. It results in approximately two million visits to the General Practitioner each year. This figure does not include the large number of individuals who treat themselves with over the counter laxatives without seeking medical intervention. Each year Americans spend more than US $730 million on laxatives.
In 1991 a National Health Survey was conducted about constipation in the US. The survey found that 4.5 million Americans were constipated or perceived themselves to be constipated most of the time. Those reporting most frequent constipation were women, children, and adults above the age of 65 years. Many pregnant women also complained of constipation. Studies confirmed that constipation is a frequent problem following childbirth, surgery and other illnesses.
Pathology of Constipation: In order to understand constipation it is essential to have a basic knowledge of the colon and how it works. The colon or large intestine consists of the Ascending Colon, the Transverse colon, the Descending colon and the Sigmoid colon or the Rectum. As nutrient rich food and fibre move through the large intestine nutrients and water are absorbed. Waste materials which consist of undigested food particles, including fibres, are pushed forward toward the rectum. Muscle contractions called peristalsis in the intestines push stool toward the rectum for storage, more fluid absorption and eventual defecation at the right time. When this sequence is slowed down and the stool dries up constipation is said to occur. Constipation can lead to impaction.
Sometimes stool is not defecated in a timely manner from the rectum. When this happens further drying occurs because the walls of the rectum absorb more of the water and the stool is reduced to a small round pallet. The delayed defecation is thought to be due to the colon's "slow and sluggish" muscle contractions or lack of commitment by the person to defecate. There are many pathological features which cause the "slow and sluggish" contractions. The exact causes of the "slow and sluggish" movements are not clearly understood but are thought to be related to the amount of nerve fibres present in each person's large intestine, the effects of ingested foods, medications and exercise. Most medications are known to cause constipation.
In normal working intestines the peristalsis is caused by the intestines being stretched. When there is more bulk in the intestines there is more peristalsis. When there is less bulk then the peristalsis becomes reduced. Peristalsis is the intrinsic squeezing action of the intestines which push the bulk (fibres and semi digested food) forward until it passes through the large intestine and is finally defecated. Ganglia are present in healthy intestines. Stretching initiates peristalsis. In the absence of ganglia peristalsis is absent.
