Constipation

Constipation is the infrequent and difficult passage of stool. The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden, and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass, however, even after shorter intervals between bowel movements. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.

One of the most common misconception about proper bowel habits is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the life span. These misconceptions have led to a marked overuse and abuse of laxatives, and some can do more harm than good. some people naturally have firmer stools than others.

At one time or another, almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through the colon, it absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed. The hard and dry stools of constipation happen when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly.

Common causes of constipation are:

· not enough fiber in the diet
· not enough liquids
· lack of exercise
· medications
· irritable bowel syndrome
· changes in life or routine such as pregnancy, older age, and travel
· abuse of laxatives
· ignoring the urge to have a bowel movement
· stroke (by far the most common)
· problems with the colon and rectum
· problems with intestinal function (chronic idiopathic constipation)

v Medication
Some medications can cause constipation. They include:

· pain medications (especially narcotics)
· antacids that contain aluminum and calcium
· blood pressure medications (calcium channel blockers)
· antiparkinson drugs
· antispasmodics
· antidepressants
· iron supplements
· diuretics
· anticonvulsants

v Laxative abuse
Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

v Changes in lifestyle
Constipation is one of the most common gastrointestinal complaints among women and adults age 65 and over. Pregnant women may have constipation, and it is a common problem following childbirth or surgery. During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.

v Holding back a Bowel Movement
People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.

v Irritable Bowel Syndrome
People suffering from IBS may alternate from having constipation and diarrhea, often brought on by stress and irregular eating patterns.
v Specific Diseases
Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus. Several kinds of diseases can cause constipation:

Neurological disorders:
· multiple sclerosis
· Parkinson's disease
· chronic idiopathic intestinal pseudo-obstruction
· stroke
· spinal cord injuries

Metabolic and endocrine conditions:
· diabetes
· underactive or overactive thyroid gland
· uremia
· hypercalcemia

Systemic disorders:
· amyloidosis
· lupus
· scleroderma
v Colon and Rectum Problems
Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

v Intestinal Disfunction (Chronic Idiopathic Constipation)
Some people have chronic constipation that does not respond to standard treatment. This rare condition, known as idiopathic (of unknown origin) chronic constipation may be related to problems with intestinal function such as problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women.

Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower or sigmoid colon.

Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.

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