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Constipation

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Constipation is a common ailment among urban dwellers. Besides being influenced by dietary habits, lifestyle, and physiological factors, other disease-related factors can lead to constipation. Once constipation becomes a severe issue, it may give rise to anal problems, bowel obstruction, and an increased risk of colorectal cancer, making it a matter not to be taken lightly.

Symptoms

The severity and presentation of constipation symptoms vary among individuals, and constipation may be a symptom of other potential health issues. Common symptoms include:

Difficulty in bowel movements: Feeling the need to strain during bowel movements, with a noticeable decrease in the urge to defecate.
Reduced bowel frequency: Typically indicating a decrease in the number of bowel movements per week, sometimes as infrequent as one to two times per week.
Changes in stool consistency: Stools become dry, complex, and sometimes require manual extraction.
Abdominal bloating and discomfort: Accompanied by feelings of abdominal bloating, discomfort, or abdominal pain.
Sensation of incomplete evacuation: Even after a bowel movement, feeling that the evacuation is not complete.
Discomfort in the digestive system: May be accompanied by other digestive system symptoms such as abdominal pain, bloating, vomiting, etc.
Delay in bowel movements: Patients may spend longer on bowel movements.
Anal pain during bowel movements: Constipation may sometimes be accompanied by discomfort or pain in the rectal and anal area.
Feeling abdominal pressure: Constipated individuals may sometimes feel a certain level of pressure in the abdominal region.

If persistent or recurrent constipation symptoms occur, it could be a sign of other potential gastrointestinal health issues, and consulting a doctor for evaluation and diagnosis is advisable.

Doctors diagnose patients with constipation through the following methods:

Medical History Inquiry: Doctors inquire about the patient's dietary habits, lifestyle, and bowel habits.
Physical Examination: Doctors can understand potential gastrointestinal issues through a physical examination.
Blood Tests: Used to rule out other diseases that may cause constipation.
Colonoscopy: Further examines the structure of the colon to rule out organic problems.

Constipation can be classified into different types, including:

Relaxation-type Constipation

It is mainly caused by slow intestinal movement or lack of peristalsis. It may be related to pregnancy, hormonal changes, certain medications, neurological issues, or a low-fibre diet.

Spastic-type Constipation

It is caused by excessive tension or spasms in the intestinal muscles. It may be associated with stress, anxiety, improper diet, or abnormalities in the gastrointestinal nervous system.

Rectal-type Constipation

It is related to issues in the rectum or anus. It could be due to the inability of the rectal muscles to coordinate bowel movements, leading to difficulty in defecation. Rectal-type constipation may be associated with conditions like anal fissures, haemorrhoids, or other rectal diseases.

Causes of Constipation

Dietary Factors: A lack of sufficient fibre and water in the diet can lead to constipation. Fibre helps increase the volume in the colon, promoting peristalsis.
Unhealthy Lifestyle Habits: Lack of exercise, ignoring the urge to defecate, and irregular daily routines can weaken intestinal function, leading to constipation.
Medication Side Effects: Certain medications, such as calcium channel blockers, antidepressants, and painkillers, may cause constipation.
Intestinal Nerve or Muscle Issues: Dysfunction in intestinal nerves or muscles can lead to impaired peristalsis, making bowel movements difficult.
Hormonal Changes: Hormonal changes during pregnancy or the menstrual cycle can affect intestinal function.

Risk Factors

Age: As age increases, intestinal activity tends to slow down, increasing the risk of constipation.
Gender: Women are more prone to constipation than men, possibly due to hormonal changes.
Lifestyle: Lack of exercise, irregular diet, and ignoring the urge to defecate contribute to an increased risk of constipation.
Chronic Diseases: Chronic conditions such as diabetes, thyroid issues, and intestinal diseases may affect intestinal function, leading to constipation.
Mental Health Issues: Anxiety, depression, and other mental health problems may be associated with constipation.

Long-term and severe constipation may be linked to some serious diseases and complications. Here are some possible effects:

Constipation can lead to straining during bowel movements, increasing pressure in the anal area and making haemorrhoids more likely to form.

Persistent difficulty and straining during bowel movements can lead to anal fissures, causing pain and bleeding.

Prolonged straining during bowel movements may cause the rectum to protrude outward, a condition known as rectal prolapse.

Severe constipation can lead to the distension of the colon, which may be a serious complication requiring early treatment.

If a significant amount of faeces accumulates and causes an obstruction in the intestine, it can lead to colonic obstruction or bowel obstruction, which is an acute condition requiring prompt intervention.

Long-term difficulty in bowel movements may damage intestinal tissues, necessitating treatment.

Long-term difficulty in bowel movements may lead to damage to intestinal tissues, which may require treatment.

Treatment

Treatment methods for constipation typically involve the following aspects:

General Treatment Methods

Dietary Adjustments	A high-fibre diet can promote bowel movements and increase the frequency of bowel movements. Increasing water intake also helps maintain bowel lubrication.
Lifestyle Changes	Increasing physical activity; moderate exercise helps promote bowel movements and improve constipation symptoms.
Establishing Regular Bowel Habits	Establishing a fixed time for bowel movements and avoiding the suppression of the urge to defecate.
Medication Treatment	Includes lubricants, fibre supplements, and bowel stimulants. These medications help increase bowel lubrication and promote bowel movements.

For severe constipation, doctors may consider the following treatment methods

Bowel Activators	These medications stimulate bowel movements, promoting defecation.
Pelvic Floor Physical Therapy	For constipation related to pelvic floor muscle dysfunction, physical therapy may help improve muscle coordination.
Biofeedback Therapy	By measuring physiological indicators such as muscle activity, biofeedback therapy assists patients in learning and changing physiological responses.

Surgical Treatment:
For most cases of constipation, surgery is generally not the first-line treatment. However, in extreme situations, doctors may consider the following surgical options:

Colon Resection Surgery	In specific cases, removing a portion of the colon may improve motility.
Rectal Prolapse Surgery	For constipation related to rectal functional disorders, rectal prolapse surgery may be an option.
Intestinal Transplant	For sporadic, severe cases of constipation that cannot be alleviated through other treatment means, intestinal transplant may be considered.