Constipation is a common issue that afflicts a lot of healthy people and is more common in women than men. However, the definition of Constipation varies between people. Some people define constipation as the passage of hard stools, even if this occurs daily. For others, constipation is defined as passage of stools once every two to three days if not more.

It is important to note that having ‘constipation’ per se is not an issue, particularly if the person is not having any abdominal symptoms or blood in the stools. A common misconception is that faeces that is not passed out daily is ‘toxic’ and harms the health of the colon. This is incorrect. In addition, regular cleansing of the colon or douching of the colon is not recommended and actually harmful to the colon.

In summary, it is actually all right to have some ‘constipation as long as there is no discomfort associated with it.

Causes of Constipation

Dietary causes

Dietary issues are one of the commonest causes for Constipation. Lack of water intake and lack of fibre intake are the two most common dietary causes for constipation. Lack of water produces hard stools which makes the colonic passage slower and the actual act of passing motion more difficult. Fibre on the other hand is needed to make the stools bulkier but yet fluffier and as such, the lack of fibre produces pellety hard stools. It is important to note that taking fibre alone without adequate water intake can worsen the pre-existing constipation.

Poor toileting habits

Contrary to popular belief, sitting on the toilet bowl to read the newspapers or to scroll through one’s phone is not a contributing factor to constipation. One possible cause for constipation is to ignore the urge to pass motion. For a number of people who have busy jobs or jobs that do not have ready access to the toilet, they will tend to control the urge to pass motion until the urge passes. In the long term, the body will produce weaker and infrequent urges to pass motion and the faeces will then be remaining in the rectum for longer period of time instead of being passed out. The faeces will also become harder and drier and this in turn makes the passing of motion more difficult.

Idiopathic and IBS (Irritable Bowel Syndrome)

A good number of individuals will have constipation despite a good diet and good toileting habits. It is quite common to note that the constipation issue has been with the individual since their 20s and persisted till the current moment. This is usually innate to the individual and is not related to external factors. Some individuals may have slow bowel transit noted on special X-ray studies.

In other individuals, the constipation type of IBS can also be responsible for constipation. This is often accompanied by symptoms of abdominal bloatedness and distension or a sensation of incomplete emptying of stools.

 In such cases, certain pro-motility (improves intestinal movement) medications such as Prucalopride or Lubiprostone may be helpful.

Low Thyroid hormone levels (Hypothyroidism)

Hypothyroidism can cause constipation. This can easily be diagnosed on a thyroid function test. The constipation will improve with correction of thyroid hormone levels

Obstructing Colorectal cancer

Sudden onset of constipation can be a sign of an obstructed colorectal tumour. This is usually accompanied by acute distension of the abdomen with abdominal pain and associated vomiting. In addition, there can be absolute absence of bowel motion and flatus.

These symptoms are a sign of acute intestinal obstruction. Emergency surgery will be needed in such cases

What Should I Do

Consultation with a specialist in the gastrointestinal system will be helpful. A Colonoscopy will be necessary to exclude any obstructive lesions in the colon before any medical treatment can be started. Pro-motility medications can be considered to improve the frequency of bowel movements. Probiotics have also been shown to be advantageous in relieving constipation

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