It’s no exaggeration to say that the bowel is our most pampered and stubborn organ. The bowel is always happiest at home, close to its own toilet.
Holidays, flights and staying in nice hotels are definitely not on the bowel’s wish list! Long evenings in front of the TV don’t exactly hit the bull’s eye either, whereas nice long walks are something the bowel always enjoys.
When it comes to food, it’s absolutely clear that only healthy food is welcome. Fruit and vegetables are wanted every day, and where bakery goods are concerned, it’s only the high-fibre varieties that keep the bowel happy.
Add to that plenty of fluids, ideally tap water or bottled water.
Constipation is explained simply as passing uncomfortably hard and infrequent stools. It is defined as fewer than three bowel movements a week for a period of more than two weeks.
If there is no discomfort and the stools are not hard, this is regarded as normal bowel function for the person if there are no other complaints.
In other words, bowel function varies significantly from one person to another. Some people have two bowel movements a day and others only one a week. What is considered to be constipation is therefore closely connected with a person’s normal bowel habits.
If you have infrequent bowel movements but do not yourself perceive this as problematic, there is no cause for concern.
The opposite of diarrhoea
Constipation is the opposite of diarrhoea. While the latter condition is caused by accumulation of fluid in the colon, constipation is the result of the contents of the colon having been there so long that all the fluid has been absorbed.
The result is hard stools that are difficult to push out. Constipation can also be caused by something blocking the anal passage or disrupting the bowel’s otherwise rhythmic contractions.
Sluggish system normal
Nearly everyone experiences a sluggish system from time to time, not least elderly people. Stools become hard when the rhythmic contractions of the colon, which normally force the food through the system, are not functioning as they should.
The result is that waste builds up in the colon, and the longer it remains there, the more fluid is drawn out of it and the harder it becomes. However, the weight of the accumulated waste will make the bowels open in the end.
For various reasons, children can often have a tendency to suppress a bowel movement. If this becomes a habit, the child gets into a vicious circle where constipation becomes the rule rather than the exception.
A change in bowel habit in elderly people with alternating diarrhoea and constipation should be investigated, as it may be caused by a tumour in the colon.
Constipation can be a symptom of depression or impaired metabolism. Most of the strong painkillers on the market (including morphine and codeine) can also cause constipation, something that can be a problem for people with chronic pain.
Constipation is also a characteristic of irritable bowel syndrome (IBS) and is a widespread complaint among pregnant women. People who eat a low-fibre diet are also prone to constipation.
In addition, bedridden hospital patients are at risk, as there is little movement to stimulate the bowel.
Constipation causes uncomfortably hard and infrequent stools, which in certain cases may contain blood, together with bloating and pain.
What is considered infrequent depends on the usual frequency of bowel movements. In other words, ‘infrequent’ means less frequent bowel movements than usual.
Hard stools may indicate that not everything is as it should be. Hard stools may lead to a blockage in the bowel, often combined with increased wind and intestinal pain. In some people, the abdominal cavity may become so taut that they throw up.
Increased pressure in the rectum as a result of hard stools can lead to haemorrhoids and anal tears. Elderly people who suffer with constipation and bloody stools must be investigated.
If the constipation is accompanied by pain and bloating in the stomach area, medical assistance should be sought as soon as possible.
Treatment and prevention
A high-fibre diet, physical activity and adequate fluid intake are important to maintain normal bowel function. In more complicated cases, laxatives are required.
For all forms of constipation, it is recommended to increase the level of activity and move around as much as possible. It is also important to drink plenty of fluids, gradually increase the intake of high-fibre food and eat regularly.
Many people experience constipation when travelling, and should therefore always remember to drink plenty of fluids and move around as much as possible. A laxative may be necessary from time to time.
Other medicines, such as Lactulose, help the body to retain fluid and soften the stools. Suppositories can also provide rapid relief. Using an enema causes the bowel to empty completely.
Long-term use of medications such as Lactulose, which softens the stools, can cause the bowel muscles to become weak, making the person concerned more susceptible to constipation in the future. For all forms of constipation, increasing the intake of high-fibre food is recommended.
Physical activity and eating regularly can help to avoid constipation recurring.
If children experience constipation without any obvious reason, it is worth investigating whether there are any emotional reasons for the problem.
- Physical activity
- High-fibre diet
- Plenty of fluids
- Eating regularly
Examination and diagnosis
Extensive investigations are rarely required, and a conversation with the doctor often provides enough insight to make the correct diagnosis. In certain cases, an endoscopy is required to rule out other conditions.
An examination is not always required in connection with constipation. A conversation with the doctor can usually reveal the cause. The doctor will often ask whether the patient feels listless or whether he or she has not been very active recently.
It may also be important to investigate whether depression may be the cause, and in children it is necessary to find out whether the child is holding back from bowel movements. Mapping lifestyle and routines is important to investigate fluid intake, regularity and fibre content of meals, and the patient’s level of activity.
A review of any medication the patient is taking is always important in identifying the cause of the constipation. A systematic review of lifestyle and medication is often sufficient to pinpoint the cause and thereby reduce the need for further investigations.
If there is another underlying disease, there are often grounds for a more detailed investigation with a view to slow metabolism, hormonal imbalance and whether the body has a good balance of salts. In elderly people, it is essential to rule out bowel cancer.
Coloscopy is an important investigation in the case of underlying diseases such as bowel cancer, Crohn’s disease or ulcerative colitis. Constipation often causes haemorrhoids or anal tears, which also produce blood in the stools.
Constipation can be caused by poor eating and drinking habits, a low level of physical activity, and stress. But it can also be one of the first signs of an underlying disease.
Constipation is common and often occurs in the elderly, as waste takes longer to pass through the bowel with age. The commonest cause of constipation is lifestyle factors such as a low-fibre diet, irregular eating patterns (such as when travelling), physical inactivity and stress.
A low fluid intake is a particularly important factor in hard stools. Sometimes, eating large quantities of dairy products can also lead to constipation.
Constipation in children is often caused by drinking too little, resulting in hard, dry stools. Long periods of “putting off” going to the toilet can lead to constipation because stools that remain in the bowel for too long become dry.
This makes the stools hard, and repeatedly putting off going to the toilet means the child loses the urge, resulting in constipation.
Long-term use of laxatives that soften the stools reduces the important rhythmic movement of the bowel over time, leading to increased constipation.
In the case of slow metabolism due to low levels of the hormone thyroxin, the bowel works at a slower tempo than normal, which can cause constipation. Inflammatory bowel disease, which is an umbrella term for Crohn’s disease and ulcerative colitis, can also cause periods of constipation.
These diseases usually involve alternating constipation and diarrhoea with blood and mucous in the stools.
Pregnancy often causes changes in bowel habits, with constipation due to changes in the levels of the hormones progesterone and oestrogen. The enlarged uterus can also make the passage of waste through the bowel difficult.
Bowel cancer can cause constipation, and it is important to rule this out if there is also blood in the stools and recent weight loss. It is known that several mental health complaints can lead to constipation, with depression being one important cause.
Medication often causes constipation, particularly strong painkillers containing morphine or codeine. Other medication that can cause constipation includes antiepileptics, antidepressants, anticholinergics, antacids containing calcium/magnesium, and iron supplements.
These are some of the commonest medications that can lead to constipation.
Constipation is usually temporary and easy to treat with lifestyle changes and laxatives. In some cases, surgery will be necessary to open a blocked passage.
Constipation will usually be temporary and can be treated with lifestyle changes and laxatives. In young, healthy people, simple measures will often solve the problem and stop it recurring.
In elderly people, it may sometimes be difficult to avoid relapses. Long-term use of laxatives may be necessary, and is a good solution even if it predisposes the patient to weaker bowel muscles and makes it more likely that constipation will recur.
In cases of constipation where there is an underlying disease, there are often changes in the structure of the bowel or anus that make it impossible to discharge the stool. In such cases, surgical intervention may be required to open the passage and possibly remove the diseased tissue.
Facts about constipation
- Constipation is defined as fewer than three bowel movements a week for a period of more than two weeks.
- Some people will not perceive such bowel habits as uncomfortable, and the stools will not be hard. In such cases, this is regarded as normal bowel function for the person if there are no other complaints.
- Constipation refers to hard stools passed less frequently than normal.
The stools are hard because there is too little fluid in the bowel. This can happen because the stools have been in the bowel a long time and the fluid they contained has been reabsorbed.
- In some cases, constipation is a sign of a serious disease such as bowel cancer, but usually has other, innocent causes.