WHAT IS CONSTIPATION?
Most commonly, it refers to infrequent bowel movements. However it can also refer to passing small stools, the need to strain and push hard to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories or laxatives in order to go on a regular basis.
A normal bowel habit does vary greatly from person to person. It can vary from three times a day to three times a week. Some people may go a week or more without experiencing discomfort or harmful effects. It is important to stress that such bowel habits are not necessarily abnormal and there is usually no need to strive for a once daily bowel movement.
Changes in bowel habit however are important and may need to be investigated further.
HOW DOES MY DIET AFFECT MY CONSTIPATION?
Normal bowel habits are affected by diet. The average UK diet includes 12 to 15 grams of fibre per day, although 25 to 30 grams of fibre and about 1.5 to 2 litres of fluid daily are recommended for proper bowel function.
Eating foods high in fibre, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fibre per day recommended for proper bowel function.
Many people suffer from constipation at some time during their lives, and brief periods of constipation are normal.
More serious causes of constipation include growths or areas of narrowing in the colon so it is wise to seek the advice of a colorectal surgeon when constipation persists.
Constipation may rarely be a symptom of scleroderma, lupus, or disorders of the nervous or endocrine systems, including thyroid disease, multiple sclerosis, and Parkinsons disease, stroke, and spinal cord injuries.
WHAT CAUSES CONSTIPATION?
There may be several, possibly simultaneous, causes for constipation, including inadequate fibre and fluid intake, a sedentary lifestyle, and environmental changes. Constipation may be aggravated by travel, pregnancy or change in diet. In some people, it may result from repeatedly ignoring the urge to have a bowel movement.
CAN MEDICATION CAUSE CONSTIPATION?
Yes, many medications, including pain killers, antidepressants, tranquilizers, blood pressure medication, diuretics, iron supplements, calcium supplements, and aluminium containing antacids can cause or worsen constipation.
WHEN SHOULD I SEE A DOCTOR ABOUT CONSTIPATION?
Any persistent change in bowel habit increase or decrease in frequency or size of stool or an increased difficulty in evacuating warrants medical advice. Whenever constipation symptoms persist for more than three to four weeks, you should consult your GP. If blood appears in the stool your GP will need to refer you to a colorectal surgeon or gastroenterologist.
HOW CAN IS THE CAUSE OF CONSTIPATION DIAGNOSED?
As has been explained above there are many causes of constipation. If persistent then you may need to see a specialist to ensure there are no serious causes for your symptoms such as tumours or other causes of narrowing in the bowel.
A full history of your medications, diet and lifestyle will be taken. An examination of the bottom with a finger will usually be done as this is a simple test which can provide valuable information.
Additional tests may be required which could include an array of blood tests, and an examination of the colon either by a colonoscopy or a bowel X-Ray called a barium enema may be needed.
Additional special tests to look at the bowel transit times can also be performed.
HOW IS CONSTIPATION TREATED?
The vast majority of patients with constipation can be treated by adding high fibre foods like bran, shredded wheat, whole grain breads and certain fruits and vegetables to the diet, along with increased fluids. Regular exercise can also help.
Fibre supplements such as fybogel or regulan may be helpful. Other types of laxatives, enemas or suppositories may be needed on a long term basis. However this should usually be after serious causes mentioned above have been excluded after consultation with a colorectal surgeon.
Only in rare circumstances are surgical procedures necessary to treat constipation. A colorectal surgeon can discuss these options with you in greater detail to determine the best treatment for you.